On December 31, 2009, the federal Department of Health and Human Services (HHS) released an interim final rule (IFR) with definitions for certified electronic health record (EHR) technology that will meet the Stage 1 “meaningful use” requirements the Medicare and Medicaid EHR Incentive Programs. Eligible professionals and hospitals must use certified EHR technology to qualify for the financial incentives described in the American Recovery and Reinvestment Act of 2009 (ARRA). HHS will adopt the IFR’s initial set of certification criteria on February 12, 2010.

Once the IFR came out, the behavioral health and human services space was abuzz discussing what was missing, what was unclear, how meaningful ‘meaningful use’ could be—you name it. The other day I came across a great feature written by John Halamka, MD, the Chief Information Officer of Beth Israel Deaconess Medical Center and Chief Information Officer at Harvard Medical School. While teaching a health care information technology (HIT) class at Harvard, he asked his class to read his EHR implementation project and then to “develop a list of barriers to EHR implementation.” The result? Ten major barriers to successfully deploying EHRs:

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—it'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)

“Making College ‘Relevant’”, a piece in the December 29, 2009, edition of The New York Times, was a classic example about how new college graduates are ‘missing the boat’ about being hired. As the CEO of a company that hires both college interns and new college graduates, I want to give some free advice:

1. Learn to write (it doesn't matter what your major is—this is the universally necessary skill for most businesses)
2. Computer skills are a must—and I'm not talking about using Twitter; the basic skills you need are word processing, spreadsheets, and web searches (others are a bonus)
3. Be able to do basic math and understand the meaning of charts and graphs
4. Remember that in the information-based economy workplace, attention to detail matters—your mother isn't there to clean up your work for you
5. Keep in mind that most of your personal preferences are not relevant on the job—if you're not happy with what you're doing, save your comments for after work or find a new job.

For college graduates (of whom there are many) who cannot master the first three items, it is really a systemic fault at the college level. No one should graduate from an academic institution without those basic skills.