IVANS, a provider of healthcare connectivity conducted a survey--"Providers Believe Healthcare Reform will Increase Their Costs."  Here follow a few of its responses:

• 61% believe "electronic health records (EHRs) could have a positive impact on their businesses"
• 82% cited their biggest challenge in implementing HlT is cost.
• 17% of providers are or are planning to participate in a Health Information Exchange (HIE) over the next 12 months. 

Conclusion: "More than 50% of healthcare providers believe the billions of dollars from the American Recovery and Reinvestment Act (ARRA) earmarked for healthcare information technology (HIT) will have little to no success in encouraging HIT adoption."

However, without "interoperability"--the ability to exchange/share and otherwise make use of information, especially between practitioners and across settings,  (e.g. via "Health Information Exchanges or similar data exchanges), the value of an EHR is severely restricted," and providers could face reduced fees and other penalties from Medicare and other payers.

The opposing (i.e., more optimistic) view is captured in "Investing in a Nationwide Health Information Interoperability Framework," American Health Information Management Association

Why is it difficult to encourage Health Information Technology?  Inertia?  Cost?  Techno-phobia?  Lack of a hand-held (PDA) Interface?  Security? Less eye contact with patients? Having to type? Paradigm Paralysis?  (Take the HIT Survey)

Clearly, the government, networks and providers "all have different starting points, goals, and resources....We must understand, therefore, that building national scale health IT infrastructure is a problem entirely different from that of simply replicating a clinical system across may different institutions (in the manner, for example, that the Veterans Administration did in the United States). Building national healthcare IT systems involves defining a policy and standards framework that can shape the convergence of public and private, local and central systems into a functional national system. It is also about governments doing those things that only governments can do well, like supporting public sector institutions to join the NHIS, providing incentives for the private sector where the private business case for change is weak but the national interest is strong, supporting the development of public goods such as the skilled health informatics workforce essential to the success of any NHIS, and crucially, developing the legislative instruments needed to protect the privacy and legitimate interests of citizens. And government should avoid doing what it is not good at, like designing, buying, or running IT."

Colera E.* "Building a National IT System from the middle Out." J Am Med Inform Assoc. 2009;16:271-273. DOI 10.1197/jamia.M3183 [pdf (free)].© 2009 American Medical Informatics Association 

* Centre for Health Informatics, Institute for Health Innovation, University of New South Wales, Sydney, Australia; (Email: e.coiera@unsw.edu.au).

Closing Remark: "Never underestimate the complexity of a multi-faceted programme." 

Pagliari C. "Implementing the National Programme for IT: what can we learn from the Scottish experience?" Informatics in Primary Care 2005;13:105-111.  [(pdf; (free full text)]