First, the federal government should accelerate the adoption of EHRs by federally owned health care organizations serving rural areas, such as the Indian Health Service. Building on the excellent accomplishments of the Veterans Health Administration (VHA), which has already adopted EHRs (Duncan et al., 1995), emphasis should be placed on rapid deployment of this technology to Indian Health Service providers (e.g., hospitals, clinics, nursing homes). Greater efforts should also be undertaken to make the VHA’s software (i.e., VISTA) available to and usable by private-sector providers (e.g., small hospitals) in rural areas.

Second, HRSA, which administers the community health center and rural health clinic programs, should provide resources and technical assistance to these ambulatory providers for the acquisition and use of EHRs. HRSA should work collaboratively with private-sector organizations, such as the American Academy of Family Physicians (AAFP), which is sponsoring an initiative to assist small and medium-sized offices of family practitioners with the purchase and implementation of EHRs and the training and technical assistance required to incorporate the technology into their practice (AAFP, 2003). AAFP’s initiative includes both the Open EHR Pilot Project, a small-scale phase 1 project to study and promote the transition to a paperless office and the use of EHRs, and the Doctors Office Quality Information Technology project, designed to assist physicians’ offices in migrating from paper to EHRs, storing health information electronically, and using computer-generated decision support tools (AAFP, 2003).

Third, consistent with the recommendations of other IOM committees (IOM, 2002a), this committee encourages the Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, to consider providing modest financial incentives to providers for investing in EHRs. Other public and private purchasers should do the same. Financial incentives to providers should be conditional upon the acquisition and use of EHRs that possess key capabilities necessary for the provision of high-quality care (IOM, 2003c,d). The bulk of costs and behavior changes is the responsibility of providers, while the bulk of benefits accrues to patients and insurers. As a major insurer, the federal government has every reason to speed the transition to EHRs.

Fourth, all public and private purchasers should reexamine their benefit and payment policies to ensure adequate coverage and payment for telemedicine and other services delivered electronically. Adequate payment for these services will result in a more favorable return on investment in ICT. Lack of reimbursement for telemedicine services has likely been the chief



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