You'd think that a society such as ours, one steeped in the Internet and awash in cell phones and iPods, would gravitate toward electronic health records. But, in what has been framed as the first nationally representative study of EHR prevalence in hospitals, researchers in Boston and Washington, DC, found that less than 2% of U.S. hospitals have so far implemented comprehensive EHRs. Less than 8% have even basic EHRs in place.

These dismal adoption figures run counter to the kind of common sense widely found in business. What company, especially one with a large staff spread over tens of thousands of square feet and performing complex tasks, would not use a network to communicate or have a central repository to share documents? What businesses today do not have Internet access on their desktops?

Finding the answer to be 92% of the 5000 acute care hospitals in the U.S. is a bit disconcerting, considering the importance of what they do. This may be a vestige of old school medicine, one that will change in the wake of the Obama administration's $19 billion plan to encourage the use of electronic health records. But it's not going to be easy.

When asked to name the barriers to implementing EHRs, respondents who had not acquired them pegged financial issues as three of the top five issues, according to investigators at the Harvard School of Public Health, Massachusetts General Hospital, and George Washington University. Inadequate funds was the number one reason, with 73% of responses, followed by concerns about maintenance costs (44%), resistance from physicians (36%), uncertainty about the return on investment (32%), and lack of staff with adequate IT expertise (30%).

Lack of capital will probably continue to be a problem for quite a while. EHRs can cost between $20 million and $200 million to purchase. The Obama IT initiative will not provide any of the funds needed to buy these systems, as the $19 billion in payments are earmarked for the use of EHRs rather than their purchase.

There are plenty of reasons, however, for hospitals to jump onboard: a commitment to excellence, the desire to reduce medical errors, and the imperative in these economic times to improve efficiency already exist. We must hope that federal dollars that ensure a good return on investment for hospitals choosing to invest in electronic records will be enough to convince many to move forward.