U.S. hospitals and physicians have four years to deploy comprehensive electronic health records (EHR) systems if they hope to snag some of the billions of dollars the federal government has earmarked to reimburse them for the work.
However, although health care companies must begin such efforts soon if they want to meet the reimbursement deadlines, the federal government has yet to finalize technology and product specifications for e-health systems, causing concern among health care IT officials.
"I think we have nontechnology people making decisions about technology," said Gregg Veltri, CIO at the Denver Health and Hospital Authority.
"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 [rush rollouts]," he added.
Veltri said that rushed implementations could lead to what he called a "perfect storm" of problems with security, system integration, federal certification and clinician education.
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.
The government is offering significant monetary incentives -- a total of $36 billion in reimbursement funds -- to spur EHR initiatives along. A 275-bed hospital would be eligible for about $6 million to defray IT costs, and individual physicians who implement EHR systems can get as much as $44,000.
The money is slated to become available next year to clinicians and health care facilities that prove that they're using certified EHR technology in a "meaningful" way.
The problem is that in order to finish EHR projects by 2011, work must begin now while the U.S. Department of Health and Human Services' 556-page list of specifications and criteria for what constitutes "meaningful" use of EHRs is still in the draft stage. Final rules are slated to begin coming out this spring.
The IT department at Denver Health supports 480 software applications and almost 6,000 desktop computers. "It's all integrated," Veltri said. "We have 130 integration points. All those inter-relationships are what break when you go too fast on this EHR rollout.
"What we're doing is slamming systems in to meet deadlines and to get money," he said. "I think that goes against what physicians are all about. Physicians believe they're sacrificing quality to meet monetary goals that they can't pass up."
Denver Health has already installed a computerized physician order entry (CPOE) system, Veltri said.
Reid Conant, chief medical information officer at Tri-City Emergency Medical Group in Oceanside, Calif., agreed that EHR systems would streamline workflow and improve the quality of care, but he noted that many hospitals lack the IT resources or expertise needed to implement them.
He suggested that hospitals start EHR projects by developing and gradually rolling out CPOE systems. "That's a highly visible microcosm," said Conant.
"It's nice seeing a nurse or physician use [such systems] and change the way we care for a patient," noted Chuck Podesta, CIO at Fletcher Allen Hospital in Burlington, Vt.
This version of this story was originally published in Computerworld 's print edition. It's an edited version of an in-depth, two-part look at EHR rollouts in the U.S. that first appeared on Computerworld.com.
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