Most people think of software when they think of electronic health records, but the systems also require hardware, operational and technical support, broadband networks and wireless connectivity, Bell said. A successful EHR deployment also requires staff buy-in. "Believe it or not, there are still a lot of people who are not comfortable with typing," she said.
Dr. Tom Handler, a radiologist who's now a healthcare analyst at research firm Gartner Inc., said one of the greatest challenges in rolling out an EHR system is establishing what's called clinical governance, or guidelines for how physicians in a practice or in different departments in a hospital need to use the electronic data systems.
"How should you get the system up and running in a practice? Or, if it's a multichain hospital, how do you roll it out to all [your] hospitals ... and ensure all the pieces and parts are rolled out in right order," Handler said. "So in some ways it's less about the technology and the hardware and the software and more about the culture and the governance and the management."
The CCHIT offers two EHR certifications. One is the CCHIT 2011 Ambulatory Certification, which goes to EHR systems with state-of-the-art security features, integrated components and the most robust patient care capabilities. The other certification, the ONC-ATCB, only verifies that an EHR system is capable of helping caregivers meet the meaningful use requirements.
Systems with the latter certification will help physicians and hospitals get federal incentive funds, but they may not offer a full set of features for patient interaction. And more than likely those systems' modules -- for billing, patient scheduling, image archiving and other tasks -- won't talk to each other, meaning they would have to be managed through separate interfaces.
Bell recommends choosing an EHR system with dual certification, which guarantees it will be state-of-the-art for patient care, practice management and meaningful use. Of the 66 EHR systems the CCHIT has certified as meeting meaningful use criteria, 30 have dual certification, Bell said.
"A certified product gives you all the functionality, interoperability [and] state-of-art security... for patient care," she said. "But ... you need to teach all your staff in the process. It can't just be a physician decision.
Which EHRs to use
One way to defer the cost an EHR rollout is to choose the software-as-a-service (SaaS) option, where a vendor runs the applications in its own data center while offering caregivers the EHR functionality over secure networks.