The United States hit a health care milestone Wednesday: Most doctors now use electronic health care records. The new data, released by the Department of Health and Human Services, shows that more than 50 percent of doctors and 80 percent of hospitals have received enhanced federal funding for achieving "meaningful use" of digital records. That means they've gone beyond purchasing the software and now use it to record patients' blood pressure, for example, or send in prescriptions.

Farzad Mostashari is the national coordinator for Health Information Technology and oversees the implementation of the HITECH Act, which provides this new federal funding. We spoke Wednesday about what the increase in electronic health records means, what needs to happen next and how patients' experience will change. What follows is a transcript of our conversation, lightly edited for clarity.

Farzad Mostashari, the National Coordinator for Health Information Technology. (

Sarah Kliff: Tell me a bit more about what this milestone means, of having most hospitals and doctors having received these 'meaningful use' payments. 

Farzad Mostashari: We're making really, really good progress on adoption. And it's not just people buying the systems, but beginning to use them in certain ways we think are necessary in order to achieve the goals of safety, quality and patient-centered, coordinated care.

When we created "meaningful use," we set a number of targets [for how providers should use electronic health records]. If it's something you should do all the time the threshold is 80 percent, like collecting people’s blood pressure. If it's something we're not doing as much, it might be 40 percent. And if it's something we're barely doing, like giving patients access to their records, it's a 10 percent threshold.

When we started, we wondered "Are we going to be able to meet 35 percent or 45 percent?" Now people are coming in at 90 percent. What it shows is that these systems aren’t something you do on the side. These are the new operating system of health care. If you’re going to use it, you’re going to use it as part of how you do your work.

SK: One other way to look at this is that nearly half of doctors aren't using electronic records, which would be really startling in other industries. How long do you think it will take all these other doctors to get on board.

FM: The numbers keep going up. We keep monitoring the number of registrations, the number on surveys who say they intend to do this and the growth in e-prescribing. It continues strong. Last month we had a very good month.

We are certainly ahead of projections, in terms of where we thought we’d be. And my hope is that nobody gets the payment adjustments. The incentive programs does have carrots and sticks.

SK: And when do the penalties kick in for not adopting electronic records?

FM: That's in 2015, so you have to be a meaningful user by the last three months of 2014. Right now we have 72 percent of doctors registered, saying they want to participate in the program, and we think that will keep going up. With anything like this, you have your early adopters. That's where we were three years ago. Now we have the majority. Pretty soon, you'll only have the absolute holdouts, maybe 10 to 15 percent. And we're not giving up on them either.

One thing I think that has really changed the discussion about electronic records is this move to value-based payments. Doctors increasingly have to manage their patient populations and know, for example, which patients with diabetes have their blood pressure under control. When you file a paper chart, you can't answer that question. But that's something you can do with electronic records.

SK: One of the biggest gripes I hear from doctors is about a lack of interoperability between different electronic systems, where they might not be able to connect to another doctor down the street. How much of a challenge is that?

FM: It’s one of the biggest gripes that I have! Part of it, you can’t blame the vendors for. When they started, there weren't any national standards for interoperability. We've worked very hard to really encourage them to come together. We didn't care what exactly the standard was but just, let's get to yes and figure out a standard.

We were able to accomplish that. Now they all have the same vocabulary for medications and allergies. Until these 2014 standards, there was no one way for lab results to go into an EHR. So we worked with the labs and the vendors to see if we could agree on how lab results should be packed. It's going to take a lot of work for us to get the industry to step up to the new standards over the next seven to nine months. But providers should see a palpable difference in their ability to talk to each other.

SK: I wanted to ask you about the patient perspective. What should patients expect to see change over the next few years as doctors become increasingly digital?

FM: I hear about a lot of small things like, for the first time, they handed me a print out of my visit or gave me online access to my kids immunization records. Someone else noticed in the past three years all their prescriptions get sent to the drug store electronically.

Those are going to be some of the more obvious things. In the near term, people might be noticing the growing pains in practices that are making this transition. It's a really profound change that they're going through.