“An EMR could mean anything from order entry, to results reports for labs to automation of financial operations,” says Dr. William Bria, chief medical information officer at Shriner’s Hospital for Children, in Tampa, and president of the Association of Medical Directors of Information Systems (MDIS). “The last type of system is pretty close to 100 percent penetration, but the problem is that a lot of people confuse having one component of an EMR with a fully implemented one. In fact, very few healthcare providers have end-to-end EMR functionality installed.”

Interoperability is going to be key to the success of EMRs. It has to do with the ability of different systems to exchange data so that it can be shared throughout different applications.

In the past there was a major disconnect between the acute care and ambulatory EMRs systems. Today, although all the major healthcare application vendors offer both, to exchange records between the systems of different vendors is still quite a challenge. Government mandates for adopting EMRs has resulted in establishment of standards and certification of systems by the Certification Commission for Healthcare Information Technology (CCHIT). This is getting the EMR vendor world closer to a point where data can be seamlessly exchange even between different vendors’ systems.

“For the most part, the vendors are quite proprietary, and they have a lot of vested interest in their existing architectures, and don’t want to consider a complete rewriting of them,” says Peter Zazzara, vice president of client services for Hayes Management Consulting, in Newton Center, Massachusetts. “Most have quite a lot of work ahead of them.”

Still, there is a great deal of pressure on healthcare providers to put EMR technology in place.

“Patients’ expectations are increasing that their medical records will be available from all the clinicians from whom they are seeking care,” says Bria. “Their tolerance of being asked the same thing 200 times is rapidly decreasing.”

Compare the features and functionality of any two vendors, and you’ll find 98 percent of the same functionality. “What should matter when choosing a vendor is the speed at which it can bring new, solid, and well-tested code to market,” says Zazzara.

Ultimately, it all comes down to money: Who is going to fund it?” asks Bria. Although an Office of National Coordination (ONC) was created in 2004, it does not have the budget or the authority to impose deadlines on EMR adoption by healthcare providers.

There is just too much competition for the same dollars in most medical practices, says Zazzara. “It’s the classical substitution dilemma: do you invest in a new CAT scan or MRI or diagnostic equipment, or in a new IT system that might take some labor costs out of your practice,” he asks. Because most places haven’t gone “wall to wall” with EMRs, “the potential benefits are a little ambiguous,” he says.

“Cost is by far the single biggest barrier to implementation, because EMRs require a pretty substantial investment, not just in new hardware and software, but in the training time, and in the disruption of the office that results from implementing a new system” says Mark Phillips, director of product management for Sage Software, in Tampa. Agrees Stelle Smith, manager, of clinical product marketing at Sage, “you’re asking doctors to make a sea change in the way they practice medicine, and that almost always slows them down.”

The most recent complicating factor is the emergence of the personal health record, which is a record that belongs to the patient rather than to the health care provider. “This is a field where Google Health and Microsoft Vault are gaining a foothold with the general public,” says Bria. How these consumer-based healthcare record technologies will interact with the largely proprietary acute care and ambulatory EMRs is yet to be seen.

“At the end of the day, doctors’ offices are small businesses, and the proof points for investing in new systems is whether they measurably improve quality and reimbursements,” says Andy Hurd, chairman and CEO CareFX, a maker of an interoperability platform for EMR systems based in Scottsdale, Arizona.

“It’s easy to get caught up in technology for technology’s sake, but ultimately the best deployments are those address the doctors’ workflow in a logical way,” says Hurd. “Those that help clinicians do what they do best, and streamline all the necessary steps.”