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Financial and Technology issues make Obama's EHR hard to execute. A recent article published in InfoWorld discusses about the issues related to President Obama's stimulus package with diverse segments of the economy, including health care, education, research, and infrastructure.

The initiative in the stimulus plan address the issue of establishing electronic health records to reduce health care costs and improve the care itself by making all medical information for a patient available to anyone who treats her.
The problems arising for implementing the same is listed as below:

Electronic health records reduce profits

The benefits of EMR that have occurred accrue to just about everybody - patients, employers, state and federal governments, and medical insurers, but the actual health care providers. Doctors get the least benefits, especially in small practice groups that make up most medical practices. An ironic consequence of EHRs is that, by helping raise the quality of health care, they penalize doctors and other medical providers for success. Beyond the income factor, the high cost of EHR systems today -not only the systems, but the setup and training -- also dissuades adoption by doctors, especially those in small groups. Physicians have been unwilling to invest anywhere from $20,000 to $50,000 in an EHR system where the economic benefits tend to go to someone else. Recognizing these factors, the stimulus package tackles these financial challenges head on by offering money to health care providers. Hospitals submitting via EHR systems to Medicare and Medicaid will receive up to $6 million a year in additional payments for sending data electronically.

Solving the technology issues

About $17 billion of the $19 billion allocation for EHR goes to incentive payments. Most of the rest goes for IT research in how to address all the technology issues. Industry analysts warn that roughly $2 billion is far from enough. The stimulus does not really address the Rube Goldberg task of making all the IT infrastructure work together. Epic Systems EHR application that Kaiser Permanente uses is so complex that Epic will not work with any medical group with less than a hundred physicians due to the cost of implementing the system. The good news is health care IT is likely to become a magnet that will surely attract IT professionals in other industries who know how to manage and maintain big enterprise systems, whether used by large hospitals and medical groups, provider collectives, or cloud-based EHR providers. The situation requires both simplification at the process and standards level, as well as serious integration work at the IT level.

Sorting out the standards
The Veterans Administration pioneered electronic medical records with its Vista system, and many lawmakers thought the best idea was to mandate the adoption of Vista as the single, national system, making it available at no charge to health care organizations along with subsidies to speed its adoption.The private medical software providers hated the idea, as it put the government in direct competition with them. They suggested that government couldn't do the job as well as private businesses could, and certainly couldn't be as innovative. At the moment, an effort is under way to create the Continuity of Care Document, an XML-based standard intended to become the equivalent of an RDF or ODF file that lets the various EHR vendors write to the same file format. The part-private, part-government CCHIT (Commission for the Certification of Health IT) does the certification, and it creates interoperability and definitional guidelines in three key EHR areas: privacy, format and content.

Information exchange issues

Privacy issues remain, and they are a more difficult challenge. Most states have added their own requirements to HIPAA's privacy standards. Thus, for the most part, if you are a hospital in one state trying to send patient data to a hospital in another state, it can only be done on a one-to-one basis, typically with a phone call and proper identification. However, both nonprofits and for-profit organizations have been trying to meet this challenge through the creation of something called RHIOs (regional health information organizations), consortia composed of small hospitals and health plans that work out how to share data among themselves, and often with nearby RHIOs. It's an ad hoc approach that tries to get some of the key EHR exchange benefits in place without waiting for federal or state standards

There are two major questions around the reliance on health records from these providers, say industry analysts. One is whether users will trust a for-profit organization to care for the most personal kind of information. The second is whether each of us can be trusted to manage and keep such a life-and-death record up to date or if it's safer to leave that responsibility to organizations whose only job it is to keep the health data updated.

Source: InfoWorld