When David Brailer, M.D. told healthcare professionals, pharmaceutical executives, and government officials gathered in Sacramento, California on June 12 to discuss improvements to California healthcare that “The battle of electronic health records is already fought and won,” he told an important part of the nationwide automation adoption story—but only one part. Granted, according to news reports (I wasn’t there myself), Brailer, the White House’s former (and first-ever) healthcare IT czar, conceded that the transition to full automation will take time. Still, it’s unfortunate that he didn’t have available the advance electronic version of the New England Journal of Medicine July 3 issue article (made available on June 19) that underscored the still-slow pace of ambulatory EMR adoption.

Respected researchers from several prominent medical and public health schools had conducted a national survey of physicians, and found that only four percent currently have a fully functional EMR, while 13 percent have a basic one. As I said on this website last week, that’s a dismally low nationwide level of adoption, particularly if we’re relying on the automation of patient records in both the outpatient and inpatient spheres to help cut costs, improve patient care and safety, and make clinicians more efficient and effective across the entire healthcare system.

That having said, Brailer did give his California audience a meaty number to chew on: $100 billion. That’s the amount of infrastructure cost he believes will be required to universalize EMRs across the U.S. healthcare system. Brailer compared that figure, spread over 10 years, to the rough equivalent of what hospitals pay annually for general office supplies.

Perhaps… but that’s still quite a chunk of change, overall, at a time when physicians are feeling very defensive about investing in EMRs at a time of straitened reimbursement, and hospitals and health systems are struggling to find ways to help them foot the bill. Had I attended that appearance, I would have liked to ask Brailer whether he believes that a sense of a “burning platform” truly exists yet across healthcare for rapid EMR implementation, particularly among doctors themselves. Don’t get me wrong: I fervently wish it did. But my own primary care physician expressed skepticism—nay, cynicism—about the whole prospect, at my most recent physician office visit a few months ago. My PCP essentially told me that unless he were provided (implicitly, for free) an EMR, it would be ridiculous to expect him to buy and implement one. This, coming from a doctor who practices in two locations somewhat far apart from each other on the North Side of Chicago, and whose patients come to him from across an “integrated” healthcare system. If anyone could use an EMR, my family physician could.

When it comes down to it, it’s not so much the exact cost in dollar terms that I think is the biggest barrier to EMR universalization—it’s that “burning platform” issue. Until the vast majority of physicians come to the conclusion that they need to automate patient records, for market-competitive and survival reasons, as well as for more idealistic ones, we’ll remain at an extremely low level of outpatient EMR adoption compared to most advanced industrialized countries.

I appreciate Dr. Brailer’s EMR boostering, more than two years after he stepped down from his IT czar post. But what would really encourage me would be if he could find some magical way to light a fire under our nation’s doctors—and soon.