the entire cost. The federal government says, “No, I’m here to stimulate, and in a pragmatic business way, I account for maybe half the care in the country, so I’m covering my half.” You will get some gain out of it, operationally, other healthcare payers will follow suit, because of their pay-for-performance or incentive plans. Massachusetts has this conversation that you may need to be a meaningful user of electronic health records in order to be licensed to practice. So the government never was planning to cover all of it, they were planning to cover enough of it to get you to start thinking about it and actually cover enough of it to create a snowball effect, where other forces would converge on this. So I think there will be a backing down in meaningful use, but I don’t think you can dodge this and say that it will all blow away and I’m not playing ball.
X: You’ve written previously that you think adoption of EHRs under Obama’s plan will be “bumpy.” Please explain what you mean by that.
JG: It’s very hard, maybe it’s impossible, to predict with great certainty how this will work and how it will all come together. The definition of “Meaningful Use” is just a very different definition than we’ve used for EHRs in the past. So they are introducing new definitions, new payment, new regional [support] centers for EHRs, and state grants. The private sector response to all this will be thoughtful and diverse. How that will all come together, and what percentage of doctors will be meaningful users two years from now? Nobody really knows. So it’s hard to imagine that you’re going to change it all and it’s going to be this seamless, bump-free evolution, that all physician EHR implementations will go well, that all states will rise to the challenge and have solid, efficient infrastructures. Some states will screw it up. It’s just inherent. That means there will be some percentage of doctors and hospitals in some states that won’t be able to get their health information exchanges to work. There will be some privacy problems that will come along the way. Some people will say, “Holy smokes, what were we thinking when we did all of this?” I don’t see how you can introduce a set of changes to a $2 trillion-plus component of our economy and expect that it will be executed flawlessly. And that’s what I mean by “bumpy.”
X: If one has high expectations for this program to bring swift adoption of EHRs, will they be disappointed?
JG: We’ll find out. The President has said every American by 2014 will have an EHR. That won’t happen. The national adoption rate now is about 6 percent of doctors that are using a
