Arthur Davidson, director of Public Health Informatics at the Denver Public Health Department, sits on the Meaningful Use Working Group—a team of health IT experts who are helping the federal Health IT Policy Committee define the goals and uses of electronic health records (EHR), with which health providers will have to comply to receive incentive payments from the Recovery Act.

Here are some of Davidson's thoughts about the challenges to the development of a national, interoperable system of health information exchanges and electronic health records, and what state and local governments can do to drive change.

Some of the challenges that Davidson sees:

• Current EHR systems may not be capturing or reporting all of the meaningful use measures that will be necessary.

• They may not be organized in a systematic way—either in the way they sort the data or in the way they interface with the provider practice.

• Doctors and other providers will have to adjust the work flow within their day-to-day practices in order to incorporate EHR use, and also to use the information gained for continuous improvement of their health care delivery. “It’s not just the technology,” he explains, “but figuring out how to adapt your processes to work.”

• Given the “extremely aggressive” schedule that Congress has set, Davidson anticipates the possibilities of delays or setbacks over the course of time. But he’s optimistic for the long-term, especially because he believes there's "an environment to learn from mistakes and unintended consequences."

States can help most, he says, by “helping to work through issues of how different regions . . . might play together and how the state could collectivize itself to use the health information exchange." That means that the state needs to make sure it has solid guidelines and principles for providers. In addition, states would be well advised to make sure that regulations don’t inadvertently obstruct providers’ ability to construct electronic records systems or join the exchanges.