I work in a mid-sized community hospital that is currently implementing an EHR. Some of the challenges have been clearly communicating with all parties involved (medical staff, nursing units, ER, clinical support areas), getting buy-in from all parties (some physicians are resisting to use the EHR), and staying on-time with implementation. As each phase is rolled out, bugs are undoubtedly discovered and delay remaining phases. In the end, the challenges will be overcome and the hospital will be a better organization with an EHR in place.

I think the idea of EHR is a good one, but it does seem that the healthcare community could get together and develop a common format. Just think if we all had similar systems and any MD, nurse or healthcare professional could walk into another facility and use that system without the additional expense of training. We currently have to train all of our healthcare professionals multiple hours to use our system. This additional training is a huge expense that gets bundled into the cost of healthcare. It is then passed along to the insured patient and their employer if they have an employer based insurance plan. If you were a patient, wouldn’t it be nice if you had your health records transferred from one facility to another and it could simply be imported? Then all of your recent labs or radiology reports could be compared and trended for you and your physician. This type of system could reduce some of the over utilization of our ancillary services and possibly prevent redundant test/procedures from being ordered for the sole purpose of profit.

There are myriad challenges invloved in transitioning to the electronic health record (EHR) environment. The challenges are as complex as the health care environment itself - from different inpatient and outpatient settings, to different organized professional arrangements, to accelerating technological advances, to different health insurance and reimbursement patterns, to different levels of acceptance of the computerized concept itself. The financial aspect is another challenge, including the possible strategies for acquiring, hosting, and maintaining the EHR system. Trainig and maintaining competence of users is another factor. All these challenges, and possibly more, should be dealt with up front in order to position the organization for a successful EHR acquisition.

It seems that each provider may have a different computer system that does not interface to other systems. The patient information is then incomplete for any other provider that has access to a different data base. Physicians that are in a small practice (rural) cannot afford the ehr and its associated upkeep and will fall behind through no fault of their own. The patient will need to become more active in the management and completeness of their records in order to realize ehr benefits.

I work for a large integrated delivery system and our buggest challenge boils down to IT governance. Any size health care organization needs to have a strong IT governance structure in order to realize benefits from EHR implementation. The IT governance structure should have strong representation from management and from the medical staff. It's primary function is to make operational decisions about the system, including: downtime policies and procedures, timing and procedures of system enhancements, documentation standards, and policies, general policies and procedures.

Perhaps the most important element of the IT governance structure is to make decisions about enhancements or modifications to the system. By this, I mean that when you make a change to a field or order in the system, it will be changed for all users and sites. In a large system, this can mean that if one hospital wants to change the standard dose for a particular medication, the change cannot be made unilaterally. The change must be vetted and evaluated in a transparent process where all concerned parties have an opportunity to make a case for or against. This can be done in a represenative manner and if the IT governance structure is set up as a high-performing group they will have good working relationships and be able to make these decisions in a timely manner and have the credibility to speak for their stakeholders and communicate decisions back to those groups. It can be timely, but without a tight change control process, an implementation can devolve into chaos rapidly.

This structure should ideally be in place prior to implementation and continue forward into optimization. Going through implementation can really bring a team together. Plus, they know the history of decisions that were made during implementation and why they may or may not be valid during optimation.

The other major challenges that I think organizations face are technology challenges. I think that EHRs have a lot of potential but in their current state, they are a long way from radically changing the face of health care. Some of the reasons have already been mentioned (interoperability being primary). Beyond the EHR software, there are always going to be hardware challenges, network infrastructure, and the general bumps of doing a massive implementation.

This is probably more of a discussion starter. Challenges come from a variety of places. I agree that the topic was only briefly discussed and that's probably why!

At a conference this week on retail clinics (those appearing in Walgreens, Wal-marts, Krogers, etc, in partnership with a growing number of health systems), it was pointed out, by at least one health system, that the EMR selected by Wal-mart, yes Wal-mart, had influenced their EMR system choice.

Also at this conference, Geisinger and Lehigh Valley health systems described their cooperation in the use of clinics in supermarkets to reduce cost and improve patient satisfaction. One problem for them is that the clinics use Geisinger's EMR which is incompatible with Lehigh's. Apparently, the remedy will cost Lehigh $160,000, which they are not yet ready to invest.