As part of Barack Obama's health reform agenda in 2008, he promised to expand the use of electronic health information technology. His campaign pledge had two components: invest federal money and create new rules that encourage growth.

We already assessed his promise about using federal money to jump-start electronic record systems, giving it a Compromise. Now we are looking at rules the U.S. Department of Health and Human Services used to push electronic medical systems.

Even though we are evaluating these as separate promises, they are connected. The American Recovery and Reinvestment Act, better known as the economic stimulus, included at least $32 billion for electronic health records. As of January 2012, $25.9 billion had been spent. A matching incentive program linked to the stimulus package means even more will be assigned to medical professionals and hospitals in the next four years.

This flurry of federal spending on electronic health records comes with strings attached. Eligible recipients must show that their electronic systems are functional, keep patient information secure and can exchange information with other electronic systems.

Medicaid and Medicare maintain similar -- but not identical -- incentive programs that have more than 20 required metrics. For instance, medical professionals have to show that at least 40 percent of prescriptions happen digitally -- not by phone or by fax machine. Under Medicaid, medical professionals could receive up to $44,000 across five years; under Medicare, they could receive up to $63,750 across six years.

Down the road, the federal government will take a harder line to force the adoption. Health care professionals who don't adopt electronic health records by 2015 could see a reduction in their Medicare reimbursements up to 5 percent in a given year. That's the most significant penalty we found for failing to adopt electronic records.

At the time that Obama campaigned for electronic records, they were widely believed to be a way of reducing medical errors, administrative costs and unnecessary paperwork. Recent surveys suggest that electronic health records are increasingly common among both office-based physicians and hospitals. An April article in the peer-reviewed journal Health Affairs concluded that 26.6 percent of hospitals had some kind of electronic health record system in 2011, up from 15.1 percent in 2010. (Health and Human Services touts a slightly different statistic, but the same trend -- 35 percent in 2011, up from 16 percent in 2009.)

The expanded use of electronic health records has drawn criticism lately. For example, the Health Affairs article noted a growing disparity in the effort to modernize: large teaching hospitals in urban areas have the infrastructure and financial capital to convert to electronic records, while small non-teaching hospitals in rural areas do not.

Electronic record-keeping also seems to be exacerbating a long-standing problem for public health care in the United States: fraud. Medical professionals with electronic systems seem to be using the convenience and immediacy of electronic systems to charge Medicare more for fake services, according to a November government oversight report. The report suggests that Health and Human Services has inadequate auditing procedures, allowing recipients of these stimulus-funded bonuses to self-report inaccurate information.

Policy makers may need to address these criticisms if electronic health records are to become ubiquitous. Nonetheless, Obama promised to phase in requirements for the full implementation of electronic health records and rules tied to his economic stimulus seem to be doing just that. We rate this a Promise Kept.

New federal committees are at work creating standards for health information technology, or HIT.

The economic stimulus bill, also known as the American Recovery and Reinvestment Act, authorized the Centers for Medicare and Medicaid Services to provide incentives for physicians and hospital providers who become "meaningful users" of electronic health records. Incentive payments begin in 2011 and gradually phase down. Starting in 2015, providers are expected to have adopted electronic health records or will be subject to financial penalties under Medicare.

The bill also authorized the creation of the Health IT Policy Committee and the Health IT Standards Committee. The committees work together on creating policy and standards, including creating definitions for "meaningful use."

Both committees have ongoing meetings scheduled and are accepting public comments on implementing HIT standards. So we rate this promise In the Works.