Question 20. What kind of incentives should be available to regional stakeholders (e.g. health care providers, physicians, employers that purchase health insurance, payers) to use a health information exchange architecture based on a NHIN?

There are a variety of examples that merit further exploration:

• Pay for Performance incentives for improved outcomes based on validated measures and achieved as a result of health information access (e.g., avoidance of drug interaction by using the Health Information Environment for data access).
• Fund rapid experimentation with various models of reimbursement.
• Medicare and Medicaid should coordinate their incentive structures, and should make sure they are compatible with incentives available to regional stakeholders.
• Provide access to capital through low cost or government-backed revolving loans for EHR purchase.
• Develop a joint regional or national pool of funds to invest in clinical technology adoption by healthcare providers.
• Establish a matching grant program.
• Consider creative structuring to allow early transition from adoption-based to performance-based incentives, e.g., forgiving payments based on physicians meeting performance targets.
• Allow investment in EHR as a tax credit.
• (See "Financial, Legal and Organizational Approaches to Achieving Electronic Connectivity in Healthcare" at http://www.connectingforhealth.org/assets/reports/flo_sustain_healtcare_rpt.pdf for greater elaboration.)