Maryland Governor Martin O'Malley signed a bill on May 19 intended to coax doctors into using EMRs by requiring private insurance companies to offer financial incentives for adopting the technology.

Doctors who do not bring an EMR system online by 2015 could face penalties, according to the new state legislation.

"This is where government and private healthcare providers can come together to really improve not only the quality of care but also, hopefully, create some costs savings as well," O'Malley said. "Health IT is the future of healthcare in our country, and we want Maryland to lead the way."

The bill requires the state to develop a health information exchange for all of Maryland's physicians, hospitals, medical laboratories and pharmacies. The Baltimore Sun reported that it could be linked in turn with those of other states to create the national network envisioned by President George W. Bush and affirmed by President Barack Obama. O'Malley called it "creating one common gauge of railroad track."

The legistlation also allows insurers to choose among several forms of inducement-increased reimbursements, lump-sum payments or in-kind services--as long as it has monetary value.

"The goal here in Maryland was to assure that all of the payors pull their oars in the same direction," Maryland Health Secretary John Colmers said. "There is a great promise in EHRs, but the greatest promise comes when it's done in a coordinated fashion, across all of the payors."