The document discusses the challenges of implementing health information technology (HIT) systems. It identifies four key functionalities of HIT systems and the various stakeholders involved. Inpatient systems face the highest degree of economic, structural, organizational and technical challenges to implementation. Barriers for inpatient systems include inadequate capital, physician resistance, and uncertain return on investment. While outpatient systems, regional health information organizations, and physicians also face challenges, patients, payers and policymakers present the least challenges to implementation and would see the highest savings from HIT.

1. The Challenges of
Implementing Health IT
Margaret Hoisington

2. 4 Categories of System
Functionalities
1) Clinical Documentation
2) Test and Imaging Results
3) Computerized Provider Order Entry (CPOE)
4) Decision Support

3. Stakeholders
 Inpatient Systems
 Outpatient Systems
 Regional Health Information Organizations (RHIOs)
 Physicians
 Patients
 Payers
 Policy Makers

4. Interest versus Influence
Influence
Low Medium High
Interest
High Outpatient
Systems
Physicians
Payers
Inpatient Systems
Policy Makers
Medium Patients RHIOs
Low

5. Degree of Challenge to
Implementing Health IT (HIT)
Economic Structural Organizational Technical
Stakeholders:
Inpatient
Systems
High High High High
RHIOs High High High High
Outpatient
Medium Medium Medium High
Systems
Physicians Low Low Medium Low
Policy Makers Medium Low Low Low
Payers Medium Low Low Low
Patients Low Low Low Low

6. Inpatient Systems
 Complex – lots of departments and units
 $20 - $50 million upfront for hardware and software
 Indirect Costs – Lost Personnel Time
 Top Barriers to Implementation:
 74% cite inadequate capital
 36% cite physician resistance
 32% cite uncertain ROI

7. Outpatient Systems
 $20,000 to $50,000 per physician
 Not as complex so costs are lower
 Top Barriers:
 50% uncertain ROI
 54% cite challenges of finding EHR system
 Lack of trained staff
 Real savings accrue to payers not providers

8. RHIOs
 Have relied on local and regional efforts
 Large upfront costs of technical infrastructure
 High rate of failure
 Complexity of technical standard setting
 Issues with privacy, security, data ownership and
liability

9. Physicians
 Face longer hours and/or
decreased efficiency from
implementation
 Redundant tests = profit for
labs and physicians
 As individuals, overall
influence is low but their
importance to hospitals can
make their resistance to
change influential on
adoption of Health IT

10. Patients, Payers and Policy Makers
 Overall, present the least amount of challenge to
implementation
 Would incur least amount of cost and highest savings
 Higher cost efficient and quality healthcare is in their
best interest

11. Conclusion
 Due to the complexity of a Health IT system with all the
desired functionalities, it will be expensive
 The exchange of information between different systems
is an important part of making this system beneficial
and cost-effective but also adds significantly to the
upfront costs
 Incentives and rewards need to be structured to
support the objectives of Health IT
 Standards need to be set and agreed upon for the
system to function properly

12. The End