The $787 billion American Recovery and Reinvestment Act (ARRA) promised a hefty $19 billion for the adoption of electronic medical records (EMRs). Where has the money gone? According to the White House budget office, $288 billion of the stimulus money was set aside for tax cuts, and the Wall Street Journal confirmed last week that just $81 billion of the remaining $499 billion has actually been disbursed.

The government’s own site reports $500 million to the Indian Health Service (IHS), part of which is allocated for equipment to boost EMR capacity. That leaves $18.5 billion on the table for small business owners hoping to streamline operations with improved EMR software and hardware.

Since enhanced record keeping can reduce fraud, EMRs have become an inevitable piece of the contentious reform puzzle. The improved capacity fostered by electronic records would theoretically make it easier for government to keep track of health care businesses.

For health care entities such as Sleep HealthCenters (SHC) LLC of Brighton, Mass, government efforts to reduce expenses in the billing arena would definitely be welcome as a part of any reform package. “With regard to health care reform, I would prefer to see attention given to the cost of insurance verification, billing, and collections,” said Paul S. Valentine, MBA, president and CEO of SHC. “Most health care organizations spend a significant amount of money in this area. The creation of some kind of reimbursement clearinghouse might have a significant impact on these costs, resulting in opportunities to save money.”

Peter J. Polack, MD, FACS, who has spent a great deal of time and energy instituting a sophisticated EMR system, says that clinicians looking to capitalize on federal dollars must also be on the lookout for various strings attached in the form of noncompliance penalties within the ARRA. “EMRs will help reduce medical errors, improve efficiencies, and cut down costs by, at the least, allowing insurers to police physicians,” says Polack, an ophthalmologist at Ocala Eye PA, Ocala, Fla. “We are already getting some ‘carrots’ for following certain quality-of-care guidelines, and I think that is good. But who’s to say that we won’t see ‘sticks’ through the same process? Not just penalties for not following those quality guidelines, but also for not following specific clinical criteria set by some agency.”

Polack points out that the sophistication of any EMR system varies greatly depending on the size and complexity of the medical practice. According to the Florida-based physician, the government’s definition of meaningful EMR use likely includes such features as e-prescribing and encrypted records. So far, details remain sketchy, and clinicians are still waiting patiently for word on how funds will be allocated. Stay tuned.