Long before ARRA, more than five years ago, the University of California San Francisco (UCSF) Medical Center began a $50 million electronic medical record (EMR) initiative. This past summer, UCSF reportedly wrote off a third of that cost and scrapped its contract with the EMR vendor. The EMR system reportedly had technical difficulties that never enabled it to be fully functional. Undeterred, UCSF is forging ahead with its goal of digitizing its patient records, which says a lot about its faith in EMRs.

UCSF Medical Center isn't the first healthcare system to have a costly, disastrous experience, and it won't be the last. Industry stakeholders, however, need to work together to ensure that the number of failures dwindle significantly.

The most important thing that the EHR/EMR market can do for itself is to be transparent. If there is no transparency, how can healthcare systems perform accurate due diligence? There's a business reason for non-disclosure clauses in sales contracts, which prevent purchasers from reporting problems with the health IT vendor or their products, and "hold harmless" clauses, which exempt vendors from any liability. It may guarantee a risk-free business environment for the health IT vendor, but it hurts the EMR market and eventually hurts the health IT vendor's reputation. Clinicians and healthcare organization executives may be obligated to remain silent about the product and/or the vendor's problems, but they will talk informally to their counterparts in other healthcare organizations. You've heard the complaints. You know which health IT companies did what to whom.

Transparency need not be the enemy of health IT companies if they have solid products and customer support. For those that have had problems - and I'm not saying they have bad products or customer support - it's a business imperative to fix those problems. There are less-expensive, more flexible EMR solutions that have come into the market in the last year. There will be other UCSF Medical Centers that cut off their legacy vendor and start anew.

There are some in the industry who say so long as the federal stimulus incentives help subsidize the purchase of legacy systems the problems will continue. University of Pennsylvania sociologist Ross Koppel believes the federal government should have put that money to use by developing "more usable and more responsible software." I think that route would have been successful as a first step, though I still believe in the incentives. There are some who believe the federal government should regulate the EMR industry. If that sounds odious, then perhaps the EMR industry ought to regulate itself.

As for healthcare providers, they need to understand the enormity of the task. What I mean is that they need to not only put up the cash for the initiative but dedicate human resources to the initiative. Dedicate a team, if that is what is required.

I'd be remiss not to mention that for every UCSF there is a UPMC (University of Pittsburgh Medical Center) - large healthcare systems that have successfully implemented big-budget EMRs and are reaping administrative and clinical benefits. The problem is there aren't enough of them. And that's why there is hesitation among healthcare systems. As an industry, let's try to increase those success stories.