The Health Information Technology for Economic and Clinical Health HITECH Act, which was passed as part of the American Recovery and Reinvestment Act of 2009, has driven significant progress in the adoption of electronic health records. Health Records (EHR) in various clinical settings, particularly through the Medicare and Medicaid EHR Incentive Programs and emphasis on EHR adoption at Meaningful Use Stage 1 (CITATION gov). For example, thanks to the Medicare and Medicaid EHR incentive programs, the percentage of office-based physicians who have adopted an EHR system has increased dramatically, from 18.2% in 2001 to a staggering 78.4% in 2013 (CITATION physical data). Additionally, as of July 2013, 67% of hospitals had achieved Meaningful Use Stage 1 and an additional 16% had been paid for EHR adoption (CITATION hospital data). However, despite the $24 billion in federal spending allocated for EHR adoption, the benefits of EHR adoption are not yet close to being fully realized (QUOTE 24b). Specifically, duplicate and unnecessary medical testing, which EHRs were designed to solve, still represents a significant financial burden and, more importantly, less efficient and effective patient care due to a lack of care coordination and communication with service providers (CITATION information note). In fact, a recent Boston study found that 20% of patients transferred between hospitals had unnecessary and duplicate medical tests in the past 12 hours (CITATION Boston). These problems manifest themselves in two ways. First, the criteria defined for Meaningful Use in Step 1 overlooked the lack of incentives or requirements for EHR vendors to design their EHR systems so that they can easily transfer patient data to others suppliers. ...... Due to the interoperability of EHRs, several challenges inevitably need to be considered in order to ensure that these solutions are successfully implemented. Medicare and Medicaid Incentive Programs – Step 2 Meaningful Use Although most physicians may be willing to certify to Step 2 Meaningful Use, many of the stakeholders they interact with may not do so, potentially compromising their ability to meet all of the Stage 2 meaningful use criteria and result in Medicare reimbursement penalties due to factors over which they have no control. For example, there is currently no federal incentive for home health agencies or skilled nursing facilities to adopt EHRs, representing a lost opportunity for physicians to complete an electronic summary of care documents when they make care transitions or referrals to these care facilities (CITE narsin' maisonzzz).