The goals of ARRA EHR meaningful use go beyond those of most IT changes, many of which are geared toward coding for reimbursement or software integration. EMR meaningful use goals include improving quality at the point of care and providing decision support for increasing clinical efficiency. Implementation will involve actual care process changes at the core of care delivery as well as in administrative areas of the hospital. As such, the implementation will impact all persons throughout the hospital, not just the IT department or a single ancillary department such as pharmacy or lab. Electronic workflows require providers to think differently about processes in which they engage every day. Success depends on the ability to understand and map workflows, and then to translate these processes into an electronic tool. Additionally, they may require a rearrangement of current processes. Workflow changes entail both procedural and substantive re-examinations. For example, before a hospital can roll out a clinical decision support tool, clinicians should review current practice and the medical literature and come to agreement about the "standard care" for each type of case so that appropriate prompts may be programmed into the system. These discussions take time, but offer considerable benefit in engaging clinicians and standardizing care processes. Hospitals must consider how EHR systems will affect patient care. Each hospital will need to redesign numerous workflows to achieve a full transition to electronic processes.

Research suggests that EHR systems enhance the patient experience. However, some health professionals fear that increased use of health IT will depersonalize care and create barriers in the traditional relationship between health professional and patient. Time spent navigating the system may reduce the time spent directly on the patient, and having a computer at the point of care may shift the practitioner's attention away from face-to-face engagement. One study found that physicians using EHR systems could not physically orient themselves toward their patients as could physicians using paper records. The same study, however, found that physicians using EHR systems tended to achieve greater patient involvement and participation.

The extent to which meaningful use regulations specify exact data format and name for fields and data elements also goes beyond what is usual. This is for the purpose of supporting the inter-operability of data exchanges. Fortunately, the National Institute of Standards and Technology (NIST) has provided very detailed definitions and format and layout guidance that is available at this address:

http://healthcare.nist.gov/docs/170.306.f_ExchangeClinicalinfoSummaryRecordIP_v1.0.pdf

Finally, The adoption of EHRs overlaps with other large-scale IT changes which hospitals must make, including conversion to ICD-10 and implementation of HIPAA amendments. The work flow for these large projects must be carefully managed in order to take advantage of any overlap in changes to avoid unnecessary rework or disruptions. Managing the deployment of resources for these changes, in the IT department in particular, will be challenging. Working with medical staff, nursing and ancillary departments will be essential and hospital management at the most senior levels need to understand and facilitate the global nature of change involved in EHRs. Redesigning multiple processes at once could prove challenging for hospitals and health professionals.