Regional extension centers (RECs) were created to help physicians implement electronic health record (EHR) systems and achieve meaningful use. However, RECs face limitations including short-term funding, endorsement of select EHR vendors, and lack of experience with all systems. The Veterans Health Administration (VHA) offers a successful example of large-scale EHR implementation through a collaborative development process tailored to clinician needs. While RECs aim to support physicians, their assistance may be constrained without long-term, sustainable support.

2. Not knowing proper hardware, networks, interfaces and supplemental material for the software you chose

3. Not Accessing Support (Vendor, RECs, and Consultants)

5. RECs may focus only on practices that already have EHRs, such as the Colorado REC.

6. RECs must become sustainable before federal funding runs out.

7. Future fees may be applied in order for physicians to use RECs.

8. The RECs can not be a resource if they exhaust funding.

9. Many RECs may only endorse certain EHR vendors

10. RECs are not familiar with all the EHR systems

11. REC may not support the EHR that is best fit for the practice

12. REC Marketing

14. EHR product developed specifically for the VHA

15. VistA/CPRS

16. EHR tailored to VHA clinicians needs

17. Developed over time

18. Collaborative process between front-line clinician champions, supportive local management teams and talented programmers

19. Extensive end-user feedback

20. Collaborative approach in its development and updates

21. Brought together clinicians, administrators, and programmers each year to address needed improvements, role out new features, and ensure that there was both input into the development process and acceptance by the users.

22. VHA redesigned a health care system in a cost neutral fashion

23. This is documented by unchanged cost per patient documents

24. Keep in mind, cost is typically a huge barrier to EHR implementation

26. Not enough training for all users

27. Inadequate Communication Plan and Execution

28. Not addressing user concerns with change

30. Inadequate Resources: Time, Money and People

31. Not Developing New Workflow, Back-Up Method and/or Downtime PlanSingle Payor System? ACKNOWLEDGEMENTS A Special Thanks to Penny Crow, for your direction and insight. CONTACT INFO Jessica Thomas: jessica.thomas@utexas.edu ChandyRavikumar: chandana1221@gmail.com