The eHealth Initiative has released its second survey of the nation's regional extension centers (RECs), each of which received a four-year grant through a $643 million program under the HITECH Act to help individual and small-group practices adopt electronic health record (EHR) technology.
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The independent, nonprofit eHealth Initiative released its first survey of the regional extension centers in September 2010. Back then, most remained in the planning stage. The more recent survey, available as free download, suggests that most RECs have transitioned to physician outreach as well as collaboration with other federal agencies. Many have also turned an eye to developing plans for long-term sustainability.
In all, 39 of the 62 regional extension centers completed the survey. Their answers provide insight into the following questions.
Which federal programs are the RECs working with? All but four of the 39 respondents are working with other initiatives funded by the HITECH Act, such as university- and community-college based training programs and state health information exchanges, or HIEs, and all but two are collaborating with other federal health programs such as the Veterans Health Administration and the Federally Qualified Health Centers.
What types of doctors are the RECs working with? So far, it's mostly primary care physicians (PCPs). Most of the regional extension centers have enrolled at least 70% of their targeted PCPs (those in individual and small-group practices), with 10 of the RECs having enrolled at least 90%. On the other hand, enrollment of specialists and providers working in community health centers has been lagging -- most RECs have enrolled fewer than 10% of specialists in their geographic area, and only a handful have enrolled more than half of community health care providers.
The majority of regional extension centers plan to offer in-person, on-site support, though the extent of that support will vary.
Each REC grantee has a mandated goal of enrolling a specific number of primary care providers, with a national goal of enrolling 100,000 providers. To date, several regional extension centers, including those in Massachusetts, Maryland, Mississippi, have met their goal.
How are RECs selecting EHR vendors? About two-third of the RECs that responded have identified, or will identify, selected EHR vendors, meaning that those are the only vendors they will support. This will be done through the request for proposal (RFP) process. Those RECs going through the RFP process said that "willingness to guarantee meaningful use functionality" was the most important criterion for naming a selected EHR vendor. Other key considerations include a local presence, low maintenance fees and support for a Web-based model. Among the RECs that do not intend to name preferred EHR vendors, the majority plan to limit their services to providers who have purchased a certified EHR system.
How will the RECs serve their members? For the most part, providers joining an REC can expect a broad range of support throughout the selection and implementation process. The majority of regional extension centers plan to offer in-person, on-site support, though the extent of that support will vary. Some RECs will limit on-site support and supplement it with remote support, while others will set a standard "flat amount" of customer support, with additional support available for a fee. Only one of the RECs that responded to the survey plans to offer only remote support.
Will the RECs charge fees? There's no easy answer. For starters, there are three types of REC service models -- flat subscription, tiered subscription and service per hour. Of these three models, the flat fee is most prominent, with two-thirds of survey respondents using it. However, when RECs were asked what they expected their members to pay them each year, half said $0. The other half fell in a broad range, with some expecting to see less than $200 per full-time equivalent physician at a practice and others expecting up to $1,000.
How will the RECs sustain themselves? The HITECH Act funding that regional extension centers received only lasts four years. Even with the grants, some regional extension centers are struggling to boost EHR adoption. Once the four years are up, the organizations are on their own. To remain relevant -- and operational -- the RECs said they plan to collaborate with private and state HIEs, expand outreach to health care providers not eligible for the federal EHR Incentive Programs, emphasize the need for data analytics and quality reporting tools as a means of improving patient care, and, for a fee, provide ongoing EHR implementation support.
The eHealth Initiative concluded that, as the REC service model and sustainability plans indicate, there is no single road to success for the regional extension centers. This is not surprising, given the vast disparities in geography and demography that the 62 organizations serve. Ultimately, the eHealth Initiative said, sharing best practices and continuing to collaborate will be the RECs’ best path.
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