Blog: The top 10 barriers to EHR implementation

Last week I taught Module II of Leadership Strategies for Information Technology in Healthcare at the Harvard School of Public Health.

My students included administrators, clinicians, CIOs, CMOs, and policymakers.

On the first day, I gave them a homework assignment - read my overview of the BIDMC/BIDPO EHR implementation project and then develop a list of barriers to EHR implementation in their organizations.

Here's the crowd sourcing results of the top 10 barriers to successfully deploying an EHR:

10. Usability - products are hard to use and not well engineered for clinician workflow.

9. Politics/naysayers - every organization has a powerful clinician or administrator who is convinced that EHRs will cause harm, disruption, and budget disasters.

8. Fear of lost productivity - clinicians are concerned they will lose 25% of their productivity for 3 months after implementation. Administrators are worried that the clinicians are right.

7. Computer Illiteracy/training - many clinicians are not comfortable with technology. They are often reluctant to attend training sessions.

6. Interoperability - applications do not seamlessly exchange data for coordination of care, performance reporting, and public health.

5. Privacy - there is significant local variation in privacy policy and consent management strategies/

4. Infrastructure/IT reliability - many IT departments cannot provide reliable computing and storage support, leading to EHR downtime.

3. Vendor product selection/suitability - it's hard to know what product to choose, particularly for specialists who have unique workflow needs

2. Cost - the stimulus money does not flow until meaningful use is achieved. Who will pay in the meantime?

1. People - its's hard to get sponsorship from senior leaders, find clinician champions, and hire the trained workers to get the EHR rollout done. (this was the #1 concern by far)


After we reviewed the real top 10 list, I read a more colorful top 10 list in the Letterman tradition, from a very creative student

10. You need to attend a Harvard Certificate Program to have a clue

9. Meaningful use is only meaningful to academic scholars

8. Docs keep asking - where's my money?