Naturally, when it comes to the number of providers signing up for the HITECH incentive program, HIT policymakers would like to be able to report a banner first year.

But these doctors suggest policymakers will be disappointed, and they say that’s not really a bad thing.

Their argument is a practical one, as they make their case by examining the efforts of two practices that are in very different places along the EHR continuum.

First up is a seven-physician family medicine practice they know “that has used an EHR since 2005.” They point out that while “their current system includes many features and functions that are outside the scope of the meaningful use objectives and measures, it also is missing some key attributes. These include the ability to collect, analyze and report clinical quality measures; as well as engage patients and facilitate interoperable data exchange. Also, because the product is hosted in the practice’s own data center, it is staffed by a full time IT professional, which makes it expensive to maintain.”

Not surprisingly, they claim money is the main obstacle to this practice making a quick upgrade. “The cost of updating the software licenses to meet the first round of meaningful use objectives will knock the practice back $104,000. This price tag doesn’t include the expense of the related hardware upgrades that will be necessary for the updated system nor training costs. In addition, the practice may need to add the vendor’s “patient site” for another $25,000 per year. Taken together, these upgrade costs wipe out the entire $18,000-per-physician EHR incentive bonus possible should all seven of the physicians achieve meaningful use certification by the end of 2011.”

From there they turn to the efforts of another small practice “that plans to adopt a Web-based, already certified EHR that works with tablets.” That system, they say, will be more smoothly implemented, and “the practice calculates that the total cost of the new EHR technology per physician will be approximately $6,000, which will leave them a “profit” of $12,000 per doctor should they qualify for meaningful use in 2012, and a net boost of approximately $25,000 per physician during the five years of the Medicare EHR incentive program.”

In short, the difference between early and late EHR adopters centers on “the time the process will take and the costs that will result.”

In practical terms, that means that for many providers the transition is likely to take longer than policymakers would like. But assuming they successfully make the transition, in the long run, the speed with which they did so won’t matter much at all.