Teater said that Ohio State has been fortunate to be underway with electronic medical records for over 20 years; but it was still unable to achieve meaningful use at its hospitals until the second year, even while having worked at implementing health IT for a very long time, and having published in the last ten years many of the benefits of that work. But Teater is also concerned that even lowering the bar for meaningful use--as discussed during the hearing--will still not be low enough for rural and small providers, "who are the ones who really need the help."

That problem could be addressed in the future, Teater said. But today, the issue of incentives for one provider number rather than per campus makes the situation difficult. All campuses have to meet criteria to receive any incentive payments. For Ohio State, one of the campuses is on the east side of town caring for an underserved population. If that hospital can't be brought up to achieve meaningful use, it jeopardizes all the incentives for Ohio State. "That puts us at a disadvantage to really bring a full continuum of functionality. If we are unsuccessful at one hospital to achieve meaningful use because it is underfunded, we then jeopardize the rest of the campuses.... We only have one shot at it, even though some of the separate campuses may be in difficult areas or underfunded in many ways."


Incentives are very important in addressing those hidden costs for physicians and productivity, Teater went on to explain. That is because health IT is a total change for physicians. "Think about it as if you were an executive and you had an assistant that executes everything for you at a simple command. And you were then asked to replace that assistant with a computer you operated yourself. How productive would you be?" Ohio State is working with its physicians to achieve that change. "Many of the meaningful use requirements are for physicians to do some of the work themselves, and much of it electronically. This is pretty stark when you realize what we are asking our physicians to do. I think we need to do it but they need help with getting over learning curves, and move forward and adopt electronic medical records to bring medical benefits to their patients."

How important is health IT to teach the next generation of health care professionals and improve research? "Part of my job is to understand how health IT can be leveraged to train our future physicians. I think we need to transform our medical teaching for all physicians, nursing and allied health professionals so they are learning to care for patients in a world of electronic systems. It would not benefit our health system to teach our clinicians in a paper world when they in fact will be required to receive full reimbursement and care for patients in an electronic world."

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