Hospitals, physicians and the federal government are at an uncomfortable point with their capital investment in electronic health records, though much progress has been made.

They've spent billions of dollars in mostly government funds on EHR systems, yet health care as a whole isn't in a position to reap the full benefit of that investment, and more spending will be needed to get there. Before one can say the country has a successful electronic health record system, more providers are going to have to adopt health IT and then those providers need to connect their systems.

"That is a big problem," says Michael Painter, M.D., a senior program officer at the Robert Wood Johnson Foundation, which, along with the Harvard School of Public Health and Mathematica Policy Research, just published a report on the current state of health information technology affairs.

The report mirrors findings in the H&HN's 2013 Most Wired survey, which was released today. Over the past 15 years of conducting the survey, we've found that hospitals have made big strides in laying the foundation for robust clinical information systems, but there's room for improvement when it comes to harnessing the power of IT to truly making care better.

One of the main reasons for implementing EHRs is to realize the quality and efficiency gains of enabling clinical data to follow patients from provider to provider, and doing that remains a challenge, Painter says.

The report, called "Health Information Technology in the United States: Better Information Systems for Better Care, 2013," shows that only 18 percent of hospital service areas had an operational effort that met the basic criteria for basic health information exchange.

Without better exchange of patient data, the accountable care and population management efforts being introduced will not work as designed. It may be, though, that better data exchange will follow the creation of ACOs and other new deliery models, which will require greater integration of these systems.

There was good news in the report as well, with 42.2 percent of hospitals, as of 2012, reporting implementation of the core elements needed to qualify for Stage 1 of meaningful use, up from 18.4 percent in 2011. Rural hospital implementation of a basic EHR more than tripled over two years to 33.5 percent of hospitals in 2012 from 9.8 percent in 2010.

Physicians also have come a long way, with some of the previously lagging physician types catching up in their EHR adoption rates. "This is really incredibly hard work what doctors and other health professions have been doing," Painter says. "I think it's remarkable that they're making this progress."

In other news yesterday, was a report arguing against a reduction of the 340B Discount Drug Program, as some in the industry are calling for.

Produced by the Safety Net Hospitals for Pharmaceutical Access Coalition, "Setting the Record Straight on 340B: A Response to Critics" makes a case for preserving the program as a vehicle to save taxpayers money, but with some refinements and modernization.

"We believe the program does work and it works well," says Bruce Siegel, M.D., president and CEO of America's Essential Hospitals, formerly the National Association of Public Hospitals and Health Systems.