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)

Wired Magazine never fails to make me think. The October 2009 issue featured “The Smart List: 12 Shocking Ideas That Could Change the World.” There were six ideas that have specific relevance to our field:

1. Recruit Autistics. "A preternatural capacity for concentration and near-total recall" makes autistic folks ideal software engineers according to Thorkil Sonne, who founded Specialisterne in Denmark, an IT consultancy that hire mostly people with autism-spectrum disorders.
2. Embrace Human Cloning. Human clones walk among us—identical twins—so why not take in vitro fertilization to its logical conclusion?
3. Make Health Risk Management Meaningful. According to Ralph Keeney, 55% of deaths for people aged15 to 64 are now due to their own decisions—compared to 5% a century ago. Provide people with better calculations of risk (for not using seatbelts, not exercising, bad diets, etc.) and then adjust health premiums accordingly.
4. Release All Nonviolent Offenders in Prison. Incarcerating nonviolent criminals costs us $22,000 per year—and has no social gain. Make nonviolent offenders go to counseling, get an education, do public serivce, and repay their victims.
5. Legalize Assisted Suicide. Ludwig Minelli, founder of Dignitas, a right-to-die organization, believes that prohibiting suicide doesn't keep desperate people from trying. Instead, provide dignified options—and counseling for people considering suicide.
6. Forget Medical Privacy. Guest commentator Jamie Heywood of PatientsLikeMe believes "privacy has been used as an excuse by those who have a vested interest in hoarding" health care information. He wants us to share our personal data on-line in social communities.

You may or may not agree with them—but, if implemented, they certainly will change our world.