I don't want to get into whether the EHR system or vendor itself contributed to the failure described in the article; both of the vendors mentioned in the article are supported by MAeHC (the practice left NextGen and is now buying eClinicalWorks) . To me, the most important point raised in the article is that lack of money is not the only issue hampering greater EHR penetration -- it's not even clear that it's the most important obstacle.
Factors that contributed to the failure cited in the article are:
- Insufficient upfront attention to workflow or process changes required to maximize the EHR's potential
- Inadequate project management experience and resoures at the practice-level
- Inexperience with contracts -- writing, negotiating, and managing
This confirms for me that EHR investments are probably not worth it (particularly for small practices) unless they're done under the umbrella of an effectively-managed, community-based program (whether driven by a hospital, IPA, PHO, or RHIO/HIE).
Community-based because there's scale in project management, vendor selection, and contract management, and because patients and physicians will get much more value from EHRs that are coordinated with their medical trading partners (other physicians, hospitals, diagnostic centers in their communities).
Effectively-managed because too many of these programs give scant attention to the project and change management piece of the implementation -- they're usually driven by whiz-bang technology plans (with the requisite clouds and lightning bolts) laid out by IT specialists, and assume that templates and worksheets handed to the practice by EHR vendors and others will take care of the rest. In most cases, they can't and they won't.
I wouldn't recommend that the government or anyone else dump money into EHR programs unless they're managed under a community-focused program umbrella, laying out clear goals and timelines, coordinated interoperability with key trading partners, funding keyed to execution and adoption milestones, and implementation approaches that force behavior change, and maximize and monitor success.
Programs that fund EHRs on a "retail" model -- meaning that they just make money available to physician practices through grants or tax breaks or other practice-focused incentives -- are destined for high rates of failure and could very well cause more harm than good.