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The federal government is trying to make the decision on whether to automate a no-brainer.

New rules that make exceptions to the Stark Act and anti-kickback statues were created to make it easier for hospitals to subsidize the purchase of EHRs by group practices. The Internal Revenue Service recently ruled not-for-profit hospitals could make donations and not threaten their tax status. And members of Congress are proposing grant programs to spur health I.T. adoption, although introducing bills is a lot easier than passing them. (More information about these developments can be found in our Newsline section, starting on page 12.)

The actions are potential lifelines for practices, but they also dial up the pressure on physicians-and have we reached the point where we can safely say doctors are fools if they don't adopt EHRs?

I don't think so. We recently posed the question, via our online Quick Poll, about whether relaxation of I.T. donation regulations would lead to rapid growth of EHRs in outpatient settings. A total of 624 readers voted, and the comments, many of them published on page 10, indicate that EHR adoption is far from a no-brainer in the minds of many.

Kathleen Saxton, R.N., agrees that the relaxed regulations will lead to outpatient EHR growth, but notes that the government has wedged physicians between a rock and a hard place-for all the talk of lending a hand, it is cutting reimbursements while driving doctors to install EHRs many can hardly afford.

And Elliot Livstone, M.D., is skeptical that all the talk about EHRs is really focused on improving care: "They (EHRs) serve the interests of insurance companies and malpractice companies more than they serve the interests of patients and doctors." And Mel Ostlie, CIO, notes that hospitals aren't exactly rolling in dough and don't necessarily have the money to help automate practices.

This issue won't be laid to rest until success stories roll in about how donations and government and private insurer support have helped practices install EMRs without bankrupting themselves.

Many physicians who have adopted EHRs and related I.T. will wax eloquent about the clinical and financial benefits of information technology. But we've learned time and time again that arm-twisting is not the best strategy to win over clinicians. And it seems that a significant chunk of the medical community is concerned that we're moving into an arm-twisting phase, and the one doing the twisting is the 800-pound gorilla.