But in the implementation of EMR/EHRs, meaningful use is an amorphous and moving target (and likely will be through 2Q10), which makes the selection of a software program problematic. CCHIT has already certified more than 200 products, but what happens if the ONC creates the definition of meaningful use and suddenly some or all of those EMR/EHRs can’t meet MU requirements? Now, you have two moving targets.

Let’s also say that I want to implement end-to-end encryption to be sure that all my data-at- rest and data-in-motion is secure. How do I know what compatibility problems that might create?

Studies have shown that these multiple uncertainties are among the major causes of the slow EMR/EHR implementation rates we are seeing.

Absolutely, implementation can be an iterative process, and it is possible to slice most of the mechanics of implementation down to manageable pieces and create an action plan to address them. But providers facing a months-long process that will alter the day-to-day operations of their practice seem to be a little skittish about making a commitment until they know more.

I think there may be an explosion of activity when the ONC finally definites meaningful use and vendors start saying – “Yes, our software will do that”.

Rich Silverman

As with all technology implementations, across all industries, requirements should drive the implementation. In a practice, for example, these requirements take the form of an “As-Is” picture that describes the existing people, processes, workflow, and technologies used.

The target, or the “To-Be” position is the goal. If there is desire (and I expect there will be) to receive federal stimulus financial incentives, then the goal must meet the. as of yet, unfinalized meaningful use criteria. (Expectations are that these criteria will be finalized in 1Q10.)

That said, the current matrix describes many of the “new” reporting requirements to assess meaningful use with electronic health records. Regardless of the criteria’s current status, health professionals should become familiar with them in order to assess how their existing processes may be impacted via compliance. A huge area with significant impact, and one that is already in effect, are the “improved” HITECH / HIPAA Privacy & Security Rules.

Finally, when the starting and ending points are known, the “roadmap” can be developed and it will include many of the phases identified in your article. That said, EHR implementations are not a step-by-step process, but rather, they are an iterative process. This means that providers and/or facilities must recognize problems along the way, prioritize, iterate, fix or postpone the solution, educate clinicians, and assess results throughout the implementation. Once the system is successfully operational, then of course, maintenance and support follows.

For more information on EHR implementations you may be interested in a presentation I gave at the World Healthcare Technology and Innovation Congress on this topic at http://tinyurl.com/y87sjzr