Physicians may consider the EHR to simply be a better version of the paper chart--not true.

The Health Information Technology for Economic and Clinical Health Act (HITECH) provides incentives to clinicians and hospitals via Medicare/Medicaid when their EHR is used privately and securely to achieve specified improvements in care delivery.  However, as primary care physicians (PCPs) "strive to meet the formal criteria, they would be well advised to think about the ways in which EHRs can help them care for patients and solve the practical problems confronted every day, while policy makers and insurers would be well advised to pay for something other than visits and the progress notes that document them. Using information technology to manage information supporting better care of patients will be the most meaningful use of all."

If using the EHR to efficiently generate a progress note that serves to justify a payment or reimbursement for an office visit, that simply does not go far enough.  Moreover, that may be the proximate reason for the incomplete adoption of the EHR as documented elsehere, over and over.

Note: A 2008 survey defined "Comprehensive Use" as one that employed 4 domains of electronic capability:

1. Record patient health information and data
2. Order entry
3. Results management
4. Decision support

With that, only 4% of physicians reported using all 4 domains in their practices comprehensively, and 13% reported only "basic use," ie, using portions of 3 domains. [3]  "One study of the financial implications of EHR adoption in small medical practices found that 51% of the financial return came from more aggressive fee-for-service coding and more frequent use of higher-level primary care billing codes, both supported by more comprehensive documentation. [4] If the goal is to justify billing codes to an auditor, word processing is all that is needed. However, primary care practice poses a different problem: managing the massive amount of information received about patients every day and using it quickly, efficiently, and safely to meet patients' needs. Word processing does not help do that.

An analysis of the work in our primary care office revealed that, on average, there were 18.1 office visits per physician per day. In addition to visits, however, 12.1 prescriptions were refilled, 31.5 laboratory panels or imaging reports were reviewed, and 23.7 phone calls were processed. [5] Each of these activities demands ready access to information. When reviewing a cholesterol test result, physicians need to know if the patient has diabetes, when the last cholesterol reading was obtained and what the level was, what medications the patient is currently taking, and perhaps the patient's most recent blood pressure. If physicians understood their work to be responding safely and efficiently to these requests—none of which generate revenue in a primary care office—they would make very different use of health information technology."

Also, unless data are structured (optical character readout, OCR rather than optical mark readout, OMR), they cannot be easily searched, retrieved electronically or used for trend analysis. 

"For instance, in an effort to improve mammography rates, we undertook a project in the fall of 2005 to identify and contact women in our practice who should have had a mammogram but had not. Simply running a report of "women who had mammograms" was misleading: physicians could electronically sign a mammogram report (time and date stamped) with a single mouse click, the electronic equivalent of initialing and dating a paper report in a chart—a best practice in paper charting. However, to enter the report as structured data (which ensured the EHR database would associate that mammogram with a particular patient on a given date and include it in a report that included all women who did or did not undergo mammography) required a total of 13 mouse clicks.[7] Before this project, physicians were inconsistent about whether they simply signed mammogram reports or performed the additional work of entering them as structured data. After this project, the work flow for mammogram review was changed to assign a clerical person in the office to perform the data entry once the physicians had reviewed the reports.

Similar processes have been adopted for managing colonoscopy results, medication changes made by specialty colleagues, selected laboratory results received on paper, data captured about vaccines administered to patients outside our office, and other important clinical information physicians would like to manage electronically."

Baron RJ. "Meaningful Use of Health Information Technology Is Managing Information." JAMA. 2010;304(1):89-90.

See also, David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N., M.H.A. "The 'Meaningful Use' Regulation for Electronic Health Records." NEJM • Posted July 13th, 2010 [with a summary of meanful use objectives.]