Ellen Perlman was a GOVERNING staff writer and technology columnist.
E-mail: mailbox@governing.comTwitter: @governing
One thing a lot of people don't think about when discussing the idea of a national health records exchange is that it all begins in individual doctors' offices. The technological skill set in that diverse crowd varies widely. As does the interest in going electronic. Stating the obvious: If your doctor and his or her staff aren't computer savvy, the medical office isn't going to be very good at getting your lab records via the Internet, now is it?
I know that my doctor still takes handwritten notes while we talk. It would be way more efficient if he just typed notes into a health record created specially for me. But who knows? Maybe he doesn't even know how to type. He certainly didn't grow up blogging, texting or emailing.
But there's another major stumbling block. To go electronic, medical offices have to invest thousands of dollars in technology and training. Yet many medical offices contain only a few doctors, and their profits have been shaved thin already by changes in insurance and health care. So, it's a big leap for physicians first to invest in the technology, and then to learn how to use it. Time away from patients is money lost. And they've done just fine up to now with their chicken-scratch records.
Louisiana, home to many small-town providers, understands the issue and is trying to do something about it by helping physicians financially. Other states likely are considering doing the same. It seems that any state that wants to encourage the development of a health-record exchange is going to have to examine the "plight" of its physicians. Though it does seem counter-intuitive at first glance.
Ellen Perlman was a GOVERNING staff writer and technology columnist.
E-mail: mailbox@governing.com 
Written and compiled by staff writers and editors, GOVERNING View is an on-the-ground, and sometimes behind-the-scenes, look at the topics we're covering in print and online. From notes on what's up in statehouses, county courthouses and city halls, to encounters with people, places and things, GOVERNING View is a window into the side of state and local government you don't always see.