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Top 10 Barriers to Electronic Health Records

John Halamka, MD, is Chief Information Officer of Beth Israel Deaconess Medical Center and Chief Information Officer at Harvard Medical School.  He recently asked his students of his healthcare I.T. class at Harvard to read his EHR implementation project and “then develop a list of barriers to EHR implementation in their organizations.”  The result was the following 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)

If you want to read more about the study, take a look at Dr. Halamka’s overview of the BIDMC/BIDPO EHR implementation project.  Dr. Halamka writes for his blog, Life as a Healthcare CIO.


  1. Federal funding may be encouraging a move toward EHR, but there’s more to it than just installing systems. How can healthcare data pooling lead to a better system?

  2. Frederick M Pevow, MD, MBA

    The bottom line is that it’s not cost effective for most practioners.
    Voice recognition after 20 years is still unreliable. Therefore you must pay someone to check for accuracy in your dictated notes, do it yourself or you can hire someone to transcribe dictated notes into an electronic record. Scanning written notes works but again you have to pay someone to scan the written notes and the task is time consuming.
    Electronic transmission of laboratory results and x-ray reports is feasible and desirable and certainly would help to eliminate duplication in testing.
    The meager carrot and stick approach that the federal government is proposing doens’t begin to pay for the costs and will probably result in more doctors refusing to accept medicare and medicaid.
    Also, not mentioned, is the cost of ongoing technical support.
    One certainty is that no one is going to ask a solo or small group practioner for advice.

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