Texas Medical Association (TMA) released the results of its EMR 2009 Report. Reflecting a national trend, the percentage of physicians in the state who report using an EHR has grown from 27 percent in 2005 to 33 percent in 2007 and now 43 percent in 2009. There is a lot of positive data to be mined from TMA's survey, but the most interesting is the data on those physicians who reported that they do not plan on implementing an EHR.

Not surprisingly, the highest percentage - at 31 percent - of physicians who will not be implementing an EHR is the oldest age group - 61 years and older. It makes sense. While significantly less for the next age group down - those who are 50 to 59 years old - 16 percent is somewhat surprising. Many of these physicians still have as many as 15 years left in their careers. Perhaps they're thinking that while physicians' offices are slowly but surely going digital, it's just slow enough for them to make it to retirement without negative impact. It's not so much a gamble.

Ten percent of respondents in the 40 to 49 year age group reported they would not implement an EHR. This is where the question marks go up. You could say that 10 percent is not that much. And that percentage could go down in 2011 if they are fence-sitters. But for now, is it a risk to not implement a year into ARRA, and with the recent announcement of $750 million being released by the Dept. of Health and Human Services? Not implementing now pretty much guarantees being out of the running for disbursement of the 2011 incentive payments. Given that 23 percent of the respondents overall don't think they will try to qualify for the stimulus funds, it's easy to imagine they are sporting the attitude of we wouldn't meet the requirements anyway so why bother.

Perplexing is the six percent of physicians 40 and under who said they would not implement an EHR. This is the Internet, iPhone, Blackberry, notebook-toting generation. They may not have graduated from medical schools whose curricula have fully embraced health IT, but they're steeped in the technology world. Could they also have the attitude that the cost far outweighs the pain and benefits? Could it simply be a cost issue? The survey showed that cost to purchase, train and implement has gone down in the last two years, from $25,000 per physician in 2007 to $18,000 per physician in 2009. Monthly maintenance went down $425 per physician in 2007 to $350 per physician in 2009. These statistics are encouraging in addressing the cost barrier.

The 2011 survey should prove to be very interesting. We are at, if not beyond, the tipping point for EHR adoption. This time we'll likely have qualitative and quantitative data on the benefits of EHRs. When the survey comes out again in two years, the telling percentages will be in the category of who will not be planning to implement.