In fact, by 2014 the government expects the fully interoperable electronic health record system to be the norm for Americans.

Yet, the national average shows that doctors are slow to adopt an electronic health record system. Currently, only 4% of doctors' offices have a fully functional system for electronic health records. Moreover, of those who have adopted electronic health records 13% have just a basic system.

So, what is preventing all practices from adopting the electronic system, two words time and cost.

Primarily it is the time needed to choose a system. Then there is the time spent installing and training on the new system. That would explain why 16% of practices have purchased a system but have yet to install it; they fear the amount of time it will take to have the system fully functional.

Then there is the cost of converting to an electronic system. Sure, you hear about all the benefits down the road, but what about the cost outlay now. Currently, about 26% of practices said, they plan to buy a system in the next two years but that the upfront cost is a huge factor in their decision.

To that end some Independent Practice Associations or Hospital Affiliated Clinics have banded together to make it easier for practices to purchase and install the EHRs.

It is now possible for a hospital to provide certain assistance to physicians to help them purchase healthcare information technology. This was previously impossible under the federal Stark regulations.

While Stark regulations were enacted to prevent doctors from doing self-referrals. The regulations also prevented hospitals from helping offset some of the financial burden for purchasing major software applications. Now the Stark language has been revised to allow hospitals to help doctors with the expense.

Several other groups are also taking advantage of the changes. For example, the Hartford Healthcare corp. will now be able to subsidize an EHR system for 200 physicians in the affiliated medical groups.

Hawaii, which has a huge amount of small practices, will be able to provide assistance through the Hawaii Medical Service Association Initiative for Innovation and Quality. This group will provide physicians with help in obtaining and installing the electronic health record system.

The larger hospitals and associations are able to offer IT assistance so the smaller practices do not have to staff an onsite IT, they groups can also offer collective purchasing power for the systems and also physicians can rest easy knowing they are installing a system that is used by other hospitals and clinics.

Hopefully, this will help increase the electronic health record adoption rate going forward into 2009.