Why is implementing an EHR so hard?

This very topical and provocative question was asked on LinkedIn Health 2.0 group by Paul Roemer. I am editing and summarizing the discussion go here if you want to see it in the entire glory: (http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&gid=80236&discussionID=4467471&commentID=4576469&trk=NUS_DIG_DISC_Q_ucg_mr&goback=.hom#commentID_4576469)

As EHRs are entering the national health care agenda here are some difficult "factoids" that Paul quotes:
Studies suggest that 200,000 healthcare IT professionals are needed for EHR. The total number it healthcare IT professionals today is 100,000
• It’s not known which EHRs qualify for incentives under ARRA
• Less than 8% of non-VA hospitals have EHR in even a single department (this does not mean these pass meaningful use test)
• Only 1.5% have them in all departments
• Studies state that 1/3 to 2/3’s of implementations fail
• Implementation by small practices has been almost non-existent
• Small and individual practices will need a full service “wrap around” solution encompassing the following services:
o Project management
o Selection
o Implementation
o Adapting work flows
o Training
o Support
• Major reasons for not doing EHR are
o Up-front costs
o Lack of IT skills
o Ongoing support costs
• Hospitals and large providers usually use their own IT departments for EHR, none of which has ever implemented EHR. Hence for the most important project undertaken by a provider, they elect to do it with people with no experience, relying on the vendor
• Where will the EHR vendors find the IT expertise and project management resources to staff a national roll out?

All important questions... here is the key feedback from other respondents

• Mark Tumblin mentioned the adoption is slow and problematic because there is no positive incentive and lots of negative incentive to adoption.
• Kim Ewer noted that when she implemented an EMR in 2006 in a geographically distributed practice they experienced system stability and support issues. Raising the question around the maturity of this technology and the support processes.
• Lauren Blumenthal mentioned an implementation requires more than IT professionals, it requires clinicians and folks with strong domain expertise.
• Cameron Lewis suggested an EHR implementation is no different than a large scale SAP implementation. Change is hard.
• Ernie Chang raised the question of cost vs. benefits of an EHR/EMR. The physicians bear the costs and the benefits are targeted towards others.
• A number of folks raised the issue of older doctors being averse to change (expanding on Ernie's earliest comment).
• Satish Nagarajan pointed out that effective Change Management could easily overcome the change resistance of clinicians. Lauren and Larry Ozeran concurred with additional insights.

Overall this group of interested knowledgeable people agree this is going to be a BHAG (Big Hairy Audacious Goal) to get a nationwide adoption and rollout of EHRs. However this discussion has sourced some excellent ideas and I am optimistic we can get it done.