No EMR Mandate in HITECH or ACA – Meaningful Use Monday

I’m going to veer off a little bit from the regular Meaningful Use Monday topics to cover something that I think needs to get more coverage and is related to the EHR incentive money and meaningful use. Let me start by making something extremely clear:

There is NO EMR mandate. There is NO EHR mandate.

For those of you who want a broader post on the subject, you should read my post from a little over a year ago about the 2014 EHR Mandate. The key is that there’s no EHR mandate and no one is going to put an EHR mandate in place. Certainly there are incentives to use EHR and penalties if you don’t use EHR, but that’s not a mandate.

For those that don’t want to click to the full post above, in it I give five other reasons to implement EHR and an explanation of each. These reasons together could feel like a mandate. Here they are:
* Ability to Sale Practice
* Government Mandated Reporting
* Reimbursement Requirements
* Patients
* ROI for Your Practice

I’m sure that people are still confused on this subject. In just the past 7 days, this website has gotten 250+ people searching terms related to EHR mandate. A lot of people are starting to get concerned about what they’re hearing on the street about EHR. Will this fear of an “EHR Mandate” push many into EHR adoption?

HITECH and Obamacare (ACA)
Related to this mandate for EHR, many people are also confused by the EHR incentive money and the supreme court case for Obamacare. Many people confuse Obamacare, otherwise known as ACA, with the HITECH act (which was part of the ARRA legislation).

What you need to know is that when 99% of people talk about EHR incentive money, meaningful use, EHR mandates, EHR penalties, etc, they are talking about ARRA and more specifically the HITECH act. ARRA and the HITECH act aren’t going before the supreme court and so they’re not at risk. ARRA and HITECH could be affected if the republicans win the Presidency, Congress and the House, but most people argue that HITECH is pretty bipartisan. Although, that’s a topic for another post.

ACA is what’s gone before the supreme court and we’re awaiting a ruling. If ACA is declared unconstitutional, then there will be some affect on healthcare IT programs in general but most EMR programs won’t be affected.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Of course there is no specific mandate to purchase an EHR…yet.

    Right now it is more of a backhanded mandate.
    A carrot and stick.
    Psst: see this check…want it? All you have to do us buy an EHR…well and a few other things too, but don’t worry about that, look at this check!

    You even mentioned the “Government Mandated Reporting.”

    Let me be clear, again, I’m a tech guy and I think an EHR makes sense. I’m pretty sure if I was a doc and had a practice, I’d have been on an EHR years ago. I used to have a Commodore 64 that used a tape cassette for storage, far from practical.


    Whatever you want to call it, the government is pushing very hard to get docs to use EHRs…why?

    * Ability to sell a practice? Nope, the government doesn’t give a hoot about this. Also, I’m no expert on the selling of a practice, but I used to think an EHR would make a practice more sell-able also, but as I talk to docs, that doesn’t seem to be the case.

    * Government Mandated Reporting Yes.

    * Reimbursement Requirements I sure can see insurance companies requiring EHRs, but really, a PM system seems to have kept the insurance folks happy.

    * Patients Not sure what is meant here – better patient care or patients demanding an EHR. Better patient care is a small side effect. I scoff at the idea that patients want their doc to have an EHR. I agree ePrescribe & online scheduling are nice, but those are also typically add-ons to an EHR or functions of a PM.

    * ROI for your practice Fortunately my coffee is no longer scalding hot, because when I read this point I laughed and shot some coffee through my nose. ROI for an EHR is mythical. First, if you get fully reimbursed for your EHR by the government (some actually do), then your ROI will always be over 100%…but how do you calculate this? I have yet to see a practice that now sees more patients based on the fact that their EHR makes their practice more efficient…in fact it is quite the opposite.

    If you want to talk ROI, you need to talk PM. Implementing a PM (and most have) shows quick ROI. IT deals with money!

    An EHR does not generate nor save (arguable?) money.

    Let’s be clear here, an EHR may contain a PM, but a PM does not contain an EHR. Most practices, even before going “electronic” have been using a PM for years…because it made sense.

    Has anyone noticed how dentists/orthodontists have been using EHRs for quite some time…without a government stick and carrot? Could this be because the vendors actually give them what they want?

  • I’m not sure what John’s point is. He agrees that there is no government mandate, but then talks about how there are other pressures to adopt one. And?

    My question is simply this, if the only alternative is to keep paper charts, why would anyone want to take the risk of keeping records in something that is so easily lost, damaged or destroyed?

  • John Brewer,
    Those points were other forces encouraging a doctor to implement an EHR.

    The point is to help doctors understand reasons they may or may not want to implement EHR. There is no mandate, but that doesn’t mean there aren’t reasons why a doctor should choose to go that direction despite the mandate.

    I’d say the simple answer to your question: paper is comfortable to many docs.

  • John’s article is a good reminder. Its easy for us to unconsciously see the MU incentive program, looming penalties (for not implementing), and recent EHR regulations like a mandate. The recent health legislative environment has certainly spurred anxiety, and probably caused many physicians to make rash decisions about adoptiong an EMR.
    Indeed, it seems like there will be an EMR requirement in the future. BUT THERE ISNT YET….John reminds us that we still have the luxury of making an informed decision at our convenience.

  • With the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH Act), (enacted under the American Recovery and Reinvestment Act of 2009 (Recovery Act)), new Federal mandates were indeed created with respect to Health Information Technology (HIT) and the adoption of Electronic Health Records (EHR). (The HITECH Act is codified in part at 42 U.S.C. §300jj et seq.) Under §300jj(3) the term “Health care provider” expressly “includes a hospital, skilled nursing facility, nursing facility, home health entity or other long term care facility”, among many others. The new mandates seeks nothing short of a complete integration of the health care system through the adoption of HIT and EHR systems. In this regard, the mandate creates the obligation of integrating this system as an “enterprise”, defining the concept as follows:

    “The term “enterprise integration” means the electronic linkage of health care providers, health plans, the government, and other interested parties, to enable the electronic exchange and use of health information among all the components in the health care infrastructure in accordance with applicable law, and such term includes related application protocols and other related standards.” (Id. at §300jj(2).)

    The actual Federal mandate is found within 42 U.S.C. §§300jj-11 and 300jj-12 which specify the “milestones” to be achieved by the Office of the National Coordinator for Health Information Technology. As noted in §300jj-11(c)(3)(A):

    The National Coordinator shall, in consultation with other appropriate Federal agencies (including the National Institute of Standards and Technology), update the Federal Health IT Strategic Plan (developed as of June 3, 2008) to include specific objectives, milestones, and metrics with respect to the following:

    (i) The electronic exchange and use of health information and the enterprise integration of such information.

    (ii) The utilization of an electronic health record for each person in the United States by 2014.

    Ok, so the mandate is on the ONC and it is only to update the plan as such, nevertheless, someone has been mandated to ensure that we have a nationwide EHR system by 2014… Hopefully for the ONC, this is December 31, 2004. Moreover, we have yet to see regulations on the creation of this enterprise.

  • I’ve just taken a quiz in a ONC based HealthIT class, and on it was a question to choose by what date you MUST adopt an EHR. This comes straight from ONC, who really ought to know better.

  • Yes, so there are penalties to not adopting EMR, but there’s no mandate to do so. Plus, if you don’t take Medicare, then there’s no penalty for you either.

  • Well when I take the ONC test I’ll try hard to remember the official answer, wrong that it may be! 🙂

  • I am enrolled in an RN to BSN course and needed to know the “mandate” for my paper. If what you say is true, “there is no mandate”, it kinda makes me angry.

  • I think the point that John L is making is that there is no legal requirement to adopt an EHR, however, if you want to participate in Medicare, etc., you have to do it under certain terms. If you do not want to participate, you can stay on paper or soda crackers for that matter.

  • You have to understand that there is a ‘mandate’ – it’s just not what one would expect it to be. Test wise, the answer is that there is a mandate. Real world, is that a lot of clinicians don’t absolutely have that mandate, only ones that want full payment, etc. from CMS and perhaps someday insurance companies. FYI, one doctor I know would rather not get paid by Medicaid patients then have to deal with these mandates; she says the paperwork costs more then the reimbursement. For her, from her view, there is no mandate. According to anyone giving the ONC test, there absolutely is a mandate.

  • Let’s not forget the reason given for pushing docs to an EHR…
    safer medicine and lots of money saved because of________________

    Who needs a better mandate than safety and cost savings??

  • Kate,
    You should be angry. It’s silly that they have a question like that. They could at least ask it in the right way. Something like, “When did Obama (and Bush for that matter) say that he wanted full EHR adoption?” Then, they could answer 2014 and they’d still illustrate the idea of a Presidential “mandate”.

    Listen to R Troy for your test though;-)

  • When I was taking one of the tests for the ONC HealthIT training for Implementation Manager, there was a question along these lines. The official answer was that YES, there was a mandate, even though the official ONC text made it clear that the correct answer was no. What there was, and is, are incentives and disincentives that only affect providers with Medicaid and Medicare reimbursements. We all know that, of course, but it would be nice if the clowns who wrote that exam and picked the answer knew what they were doing.

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