Check out this article. Some fairly common observations for an IT veteran, but good advice for EHR buyers.

Some mitigation tips for each point (read the article for the 4 hurdles)…

1. Build in resiliency. Evaluate options to operate using locally cached data , if supported.
   
2. Learn ITIL, and follow the prescribed best practices. If you do, you won’t be putting in upgrades without putting it through a test plan on a test system before moving to production.
3. If the EMR allows customization of “templates” (or forms), they need to be validated with the representative user communities before imposing them. Some structure, and form element input validation, is needed to ensure completeness and quality of records.
4. The application and system performance needs to be considered in the overall plan. Inventorying and analyzing transaction and interaction types and volumes, and working with the vendor to spec a system that meets the need, if an important but often overlooked step. Also, assessing the EMR for ease of scalability prior to purchase is recommended.

In regards to the comments on the trade off of lost productivity vs. potential new revenue, check out this post from a month ago.