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Computerworld - Editor's note: This is Part 1 of a two-part look at the ongoing efforts to roll out electronic health records in the U.S.

Hospitals and physicians in the U.S. have until 2015 to deploy comprehensive electronic health records (EHR) and the accompanying technology to meet federal guidelines and qualify for billions of dollars in reimbursements. But some health care experts are concerned that the quality of e-health systems might be at risk because of unrealistic deadlines and confusion about what to do first.

"I think we have nontechnology people making decisions about technology," said Gregg Veltri, CIO at Denver Health, a health care group that serves some of Denver's poorest residents. "The issue is the timelines. I wonder if anybody understands the reality of IT systems and how complex they are, especially when they're integrated together. You're going to sacrifice quality if you increase the speed [of the rollout]."

Veltri said he sees a "perfect storm" coming when it comes to EHRs, with security gaps, system integration problems, federal certification issues and clinician education challenges.

To try and smooth the way, federal agencies are working on rules designed to help explain what needs to be done and how EHR efforts will be measured.

Rules, rules, rules

In late December, the federal government released a long-awaited 556-page draft rule that contains specifications and certification criteria for EHRs. Those rules, now available for public comment, set a four-year goal for implementation and spell out best practices in delivering care and sharing patient information between hospitals and clinicians.

More recently, on Feb. 12, the U.S. Centers for Medicare and Medicaid Services issued a finalized version of its Notice of Proposed Rule Making that help define what type of technology should be used and how $36 billion in incentives from the American Recovery and Reinvestment Act of 2009 should be paid. That money would be distributed between 2011 and 2015.

Last year, just 10% of health care facilities in the U.S. used EHRs; by 2014, the government wants more than half of all facilities to use them. To spur the initiative, it's offering money -- a lot of it. Physicians who implement EHR systems can get as much as $44,000 to help defray technology costs; a typical 275-bed hospital would be eligible for approximately $6 million. But clinicians and health care facilities must show they're using EHRs in a meaningful way beginning in the government's 2011 fiscal year to qualify for a full incentive payment. Hospitals that do not meet federal guidelines by 2015 face Medicare reimbursement cuts.

At issue is what constitutes "meaningful use." The rules already proposed by the two agencies -- both of them part of the Department of Health and Human Services (HHS) -- explain that standard and detail the first phase of any EHR rollout. The rules, which are expected to be finalized this spring, focus how to capture patient health data in a coded format, how to use it to track patient condition and coordinate care, and how to roll out clinical decision support tools to facilitate disease and medication management.