Doctors also are pushing for legislative measures to remedy what they say is an outdated Medicare geographic formula.

The shift from storing information on paper to electronic form has prompted major changes in court rules for legal discovery. Doctors must be prepared to meet the digital demand.

Treatment innovations and coverage expansions played a large role in the increase.

One bill would charge physicians fees for using a national EMR system; another would offer incentives to join and let doctors participate at no cost.

Texas tries to reclaim lost SCHIP enrollees, while Washington and Oklahoma strive to cover new children. About 210,000 kids are expected to gain coverage.