Are We Chasing the Carrot or Afraid of the Stick?

The other day SGC asked in my hospital EHR adoption chart post: “If there were no penalties for non-EHR adoption, what would that chart look like?”

For those that are too lazy to click over to that post to see the chart, it basically shows hospital EHR adoption being massively accelerated thanks to the government EHR incentive program. In fact, we’re approaching full adoption of EHR in the hospital space (worth noting is that the ambulatory provider space is lagging far behind that adoption). SGC asks the question about whether that adoption would have occurred without the penalties.

My personal experience is that most organizations appreciate the EHR incentive money and plan that in as part of their budgeting for an EHR, but that they were really much more motivated by the EHR penalties that would accrue if they didn’t adopt an EHR. So, I’d say that people are more afraid of the stick than they are motivated by the carrot.

This is probably more so the case because the penalties are going to exist in perpetuity. I think most hospital organizations believe (and I think rightly so) that the EHR penalties for not using an EHR are not going to stop. In fact, they could get much worse. Not to mention, other payers might start implementing similar penalties for non-EHR use as well.

What’s been your experience? Are the carrot or the stick more motivating to healthcare organizations?

Another related question would be, “If there had been no EHR incentive or penalties, what would the EHR adoption chart look like today?” That’s a topic for another blog post.

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John Lynn

John Lynn

John Lynn is the Founder of the, 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.


  • Interesting. I have seen hospitals calculating the penalties for the first few years and realizing that they would spend far more money than they would owe in penalties to implement every check box they need for MU. And at the end of the day, they didn’t believe those check boxes were aiding in caring for patients, they were actually hindering.

    But by far the majority has been hearing the cha-ching and MU incentives are just a way of life.

  • Afraid of MU more than carrot or stick. The objectives/measures and costs are way higher than any carrot or stick. More afraid that ONC and CMS are strikingly tone deaf to how overburdening the current state of EHR/MU and other programs are to the front line providers. Carrot/stick, we are so numb, nothing is affecting us.

  • Sarah,
    Are those hospitals you mention planning to just take the penalties? I’ve seen many make that argument, but then they proceed to implement an EHR and try and avoid the penalties anyway. A few smaller, rural hospitals are the exception from my experience.

    I’ve been amazed at how irrational people have become thanks to meaningful use.

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