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One of the obstacles to the adoption of new systems is the absence of
common technical standards for electronic medical records. Each health practice has to choose its own software and hardware configuration
from many different sources, and it is difficult to know which is the
best. No one wants to invest money in a system if it cannot communicate
with those of other providers. Interoperability, or the ability of technology
systems to communicate with one another, is a major problem.
When health care providers use different hardware and software systems,
communicating across different platforms is a challenge. It slows
the pace of innovation, and it is costly and frustrating for all involved.

Some states have solved the problem of lack of uniform standards by
letting a dominant local player dictate the market. In Tennessee, for
example, Governor Phil Breeden approved comprehensive health care
reform to control pharmacy spending, limit personal health benefits, and
provide for health insurance cost sharing with employees. Vanderbilt
University developed a quality information system that integrated existing
office systems of local medical professionals on an incremental basis,
giving them excellent interoperability with regional systems. That simplified
the choice for local medical professionals because many of them
were able to adopt the same recordkeeping system.

Some writers have called for improved federal support for health
information systems. In recent years, the national government has provided
subsidies for new systems, but primarily in the area of billing, not
medical records. That has limited the ability of the industry to move
ahead while highlighting the importance of the federal role in technological
innovation. In effect, a two-tiered system has emerged in which
larger practices have the resources to invest in technology while smaller
practices do not. Federal officials could have a very positive effect by
writing uniform standards, providing financial support, and promoting
interoperability of technical systems.

The federal government has provided new incentives for doctors to
adopt electronic medical records. In 2008, the Medicare program
announced a trial program in which providers who move from paper to
electronic recordkeeping will receive higher Medicare payments to compensate
for the extra time that they take to complete online prescriptions
or enter test results.40 Individual physicians will receive up to $58,000
over five years to participate in the program. Those who have joined the
program feel it has improved the quality of health care and helped them
avoid treatment or prescription errors.