Nonetheless, "there will be regional solutions" for how to pay for health IT, Brailer said, with some markets driven by purchasers, others by providers and still others by intermediaries. At the same time, he said, government, as a huge employer, could make sure doctors covered by its health plans use IT. "We dont expect private purchasers to do something were not willing to do," Brailer said. The government also could increase incentives in the way doctors are compensated by Medicare, by far the nations largest health care payer."Our hope is that Medicare will be able to select on a regional basis," Brailer said. "If Medicare doesnt have to act as a monolith, well be able to move the market.""We need a different kind of health care market," he said, one that is more responsive, gives patients more choices, costs less and discourages mistakes, for instance. "All goals are dependent on data delivered by interoperable health records," Brailer said. This would allow a patients information to be moved seamlessly from hospital staff to outpatient clinics and specialists. Brailer said one huge impediment is that in the current system, the early adopters have to pay the most and they get the least benefit. He compared interoperable electronic systems to fax machines. "If youre the first person to put in a fax machine, what are you going to do with it? If youre the last one, youre immediately connected to everyone else." Thus, when there are only a few users, using interoperable EHR can be a bad value. Once nearly everyone is using EHR, getting onboard is very cost-effective. Health providers, particularly small physician offices, have a strong incentive to wait. Brailer and others recently released an analysis concluding that, for most doctors, the business case for interoperable EHRs is inadequate. Click here to read more. Governments role for spurring interoperability is to "find ways to get us out of the trough, where the disincentive kicks in," Brailer said. But, he warned, "If were not there in five years, we will have made the problem potentially worse. Every industry that has used electronic technology has done so to build barriers for easy shifting [of customers]." Check out eWEEK.coms for the latest news, views and analysis of technologys impact on health care.