Many medical practices and community health centers will soon have an opportunity to begin collecting substantial payments for "meaningful use" of electronic health records (EHRs) under the American Recovery and Reinvestment Act of 2009. Billions of dollars in Medicare and Medicaid incentive payments ("the carrot") will be available. There will also be penalties — in the form of reduced government reimbursement — for not participating ("the stick").

To help health care providers who may lack the knowledge and skills they will need to implement EHRs successfully, this report provides the insights of a variety of early adopters. The medical practices and community health organizations that were interviewed have already been recognized for excellence in EHR implementation. Their firsthand accounts address the challenges they encountered and the solutions they devised to achieve improvements in health care efficiency, quality, and safety. The questions that they answered are summarized below:

1. Where are you now? Since being recognized for EHR excellence, what have been the key modifications to your system? What has been the effect on the culture, the practice of medicine, the workflow, and the operational, financial, and clinical outcomes?
2. Describe your journey toward meeting meaningful use. What is your advice for others?
3. Is your organizational strategy well aligned with the expectations of meaningful use?
4. How have the financial incentives and penalties affected your organization's strategic plan?

The complete report is available as a Document Download.