Quick -- how much federal-government money has been earmarked for electronic health records: $360 million? $3.6 billion? $36 billion? $360 billion? (Anyone for $3.6 trillion?)

We are in a time when incomprehensibly large dollar amounts are being tossed around like coins into a wishing well, and after a while the mind can start to blur a bit -- is there really that much difference between $360 million and $3.6 billion? After all, it's only a matter of one decimal point, right?

So it was quite a shock to hear about the EHR success story of Adena Health System in rural southern Ohio, where CIO Marcus Bost and his team have helped make the two-hospital, 300-bed system one of the most successful EHR implementations in the country.

And they're doing it on a budget that most of us can actually comprehend: the total EHR investment at Adena will be about $16.5 million spread across five years, from mid-2006 to mid-2011, Bost said. So next time someone says you'll need a few million bucks just to draw up a strategic outline for EHR, tell them to lay off the painkillers and look at what Adena's done.

"At our size, we can move a little quicker than some of the bigger places -- we can be a little more nimble," Bost said, noting that he's had the full support of the health system's board to allocate to the EHR project what this year amounts to about 50% of Adena's total capital budget.

Three years into the five-year project, Adena has strung together an impressive list of achievements centered on the eager and fully engaged involvement of nurses, office managers, physicians, and other health care practitioners. It has:

• Assembled a formal cross-discipline EHR team of 11 professionals, including four nurses with IT training, one IT staffer with a master's in IT, and another with a Six Sigma Black Belt
• Assigned that team to focus primarily on winning the acceptance of the clinicians rather than on technology demonstrations and discussions
• Put a chief medical information officer in the department to live the life of the clinicians -- "a communicator, a cheerleader, a champion" -- and to work very closely with the chief medical officer
• Built a patient portal called MyAdena that allows individuals to manage "some basic but time-consuming stuff" like self-scheduling and getting prescription information
• Connected and trained Adena's 130 physicians on the system, now used by all 130
• Changed or is in midst of changing many, many long-established processes within the system

"There's no way of getting around the fact that EHR gets you into the weeds of changing how people run their daily lives and do their daily jobs -- for the physicians, clinicians, officer managers, and nurses, EHR was a real sea change for them because it requires new processes across the board," Bost said.

"And since there's never a process change without a funeral, we've found that we've had to go through some of those, and some people just weren't able to make the adjustments. And none of that would have been possible without senior-level support from executives and the board."