As part of the federal government's push to encourage the adoption of health information technology, the Health Information Technology for Economic and Clinical Health (HITECH) Actset aside $677 million to establish regional extension centers, or RECs, which will help small practices select, implement and maintain electronic health record (EHR) technology. By February 2011, the Office of the National Coordinator for Health Information Technology (ONC) had funded 62 regional extension centers in all 50 U.S. states.
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Physicians working in small, remote offices, as well as those who are not affiliated with a hospital or integrated delivery network, tend to lack the expertise, resources and IT infrastructure to adopt EHR technology. The HITECH Act's 2015 deadline for demonstrating the meaningful use of EHR, however, requires all health care providers regardless of size to not only use electronic records but also be able to share them in a secure manner with hospitals, specialists and even patients.
Health care providers that cannot meet the tight HITECH Act deadline face a financial penalty in the form of reduced federal Medicare reimbursements. The regional extension centers -- which the ONC has charged with enrolling 100,000 providers by the end of 2014 -- aim to prevent that from happening.
- What do the regional extension centers do?
- Why should health care providers enroll in an REC?
- Are the RECs working with certain EHR vendors?
- What concerns have been raised about the REC program?
- How will the success of the RECs be measured?
It's best to begin by pointing out what the RECs will not do -- go into a physician's office and implement an EHR system for him or her.
On the other hand, regional extension centers will help providers select an EHR system; determine whether they will need to invest in hardware, such as laptops, servers and routers; provide documentation pertaining to EHR implementation and staff training; and identify outside funding sources if necessary.
In a panel discussion at a recent Massachusetts Health Data Consortium (MHDC) event, Andrew Principe, director of health care for Burlington, Mass.-based Arcadia Solutions Inc., described regional extension centers as a sort of Consumer Reports for the health care industry. "Your REC will help you source the assistance you need, intervene on your behalf, ensure you understand what meaningful use incentives you're eligible for [and] pick up the tab for some of the services," he said.
At that same MHDC event, Carole Rodenstein, program director for the Massachusetts eHealth Institute -- which has received ONC funding to serve as the Bay State's REC and its health information exchange -- listed the 10 goals of regional extension center membership. The list, she admitted, is not original, and has been adopted by several other RECs:
- You are ready to adopt EHR technology.
- You want EHR implementation to be as simple as possible.
- You want a vetted, prequalified independent optimization organization, or IOO, and EHR vendor.
- You want a roadmap to achieve meaningful use to receive maximum incentives.
- You want to streamline administrative clinical workflows.
- You want assurance that EHR implementation will be done properly.
- You want end-to-end project and vendor oversight.
- You want an average 17% discounted pricing on EHR software.
- You want to take advantage of direct assistance support.
Meanwhile, Dr. Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative -- which serves as New Hampshire's REC -- presented the results of three community EHR implementation pilot programs in Brockton, Newburyport and North Adams, all in Massachusetts.
Over the course of the pilot program, which involved 435 physicians in the three locations, the cost of implementing EHRs -- including hardware, software and installation services -- averaged $40,000 per physician. A preliminary analysis showed that over five years, primary care physicians had a small, negative return on investment (ROI) that averaged $1,000, while specialists had saved $10,000, primarily by cutting staffing and dictation costs. These ROI figures do not take into account the $44,000 in incentives that providers are eligible to receive when they demonstrate the meaningful use of EHR technology.
Various estimates place the number of EHR vendors in the United States at close to 400. Because regional extension centers have received finite funding from the ONC, many have opted to produce a selected EHR vendor list. These lists vary: Some organizations name as few as three EHR vendors, and others name 10 or more. In focusing their implementation, training and education efforts on a handful of EHR systems, it will be easier and faster to implement EHR technology for their providers, these RECs say.
Some RECs, on the other hand, have indicated they do not want to place any restrictions on the EHR systems their physicians can choose.
Some commentators have suggested that the regional extension center program is reckless and will ultimately waste taxpayers' money.
For starters, the idea behind the selected EHR vendor list is not without controversy. It has been argued that such lists are limiting the market for EHR systems, perhaps even "warping the free market." Others fear that the process of picking preferred vendors will stifle innovation, because established EHR systems -- some would call them legacy systems -- will be selected over newer products.
In addition, there is concern that with EHR vendors and health care organizations around the country already hiring, the regional extension centers will suffer a severe shortage of manpower, especially given the short time frame in which the RECs must enroll and support physicians.
Funding is another issue. The EHR implementations in the Massachusetts eHealth Collaborative pilot program cost an average of $40,000 per physician. That's several times larger than the amount the RECs have been given. (The figure, though, includes implementation costs, which RECs will not be paying.) That funding gap and the enormity of the task facing the RECs -- as well as the notion that there are enough health IT consultants and research firms out there to do the same job -- has led some to conclude that many RECs will simply fail.
As stated, the ONC has set a goal of enrolling 100,000 providers in regional extension centers by the end of 2014. In turn, each REC must enroll a certain number of physicians within 24 months of its receiving its grant from the federal Health & Human Services (HHS) department. The number of enrollees required is based on the amount of grant funding a REC receives, and cannot be fewer than 1,000 physicians.
At the MHDC event, Tripathi -- one of three authors of the seminal Health Affairs website article, A tale of two large community EHR extension projects -- graded the national REC effort on six criteria. Only on one measure did Tripathi see success so far:
Relevance to users: Good. The regional extension centers appropriately target the right market.
Business alignment: Fair. The connection of RECs to meaningful use requirements remains unclear.
Operational effectiveness: Fair. It's "way too soon to tell," Tripathi said, noting that many RECs have had a rough start and the lack of funding beyond the initial HHS grants could limit what the RECs can do.
Ease of comprehension: Poor. Physicians have had trouble determining whether they are eligible for help from a regional extension center -- not to mention whether they should participate in the Medicare or Medicaid EHR incentive programs.
Ease of process: Poor. States are taking "widely divergent approaches," he noted. Some are charging membership fees, while others are not. In addition, many RECs lack name recognition and as a result, user trust.
Speed to market: Poor, but improving. "It's taken a lot of time to launch," Tripathi said. "That said, we're starting to get some traction."
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