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How well can regional extension centers serve physicians?

The regional extension center (REC) is positioned as a cornerstone of the federal effort to help physicians, especially those with small practices, adopt electronic health record (EHR) technology. There has been some debate over the last month, however, about whether the country’s 62 regional extension centers ultimately will be able to serve their constituents effectively and get 100,000 physicians using EHRs, as the federal government has set as an overall goal.

Chilmark Research doesn’t think so, nor does Software Advice Inc.: There isn’t enough time or money to hire the appropriate talent, they argue. If the private sector can’t fill vacancies, then how will public agencies?

Nor is there enough time to research the software adequately, which leads RECs to pick preferred EHR vendors. This is sensible, given that there are literally hundreds of EHR systems on the market, but it dramatically limits a physician’s options. Moreover, the selection process is likely to favor market mainstays over more innovative but less “politically savvy” products, as Chilmark phrased it. Finally, PracticeFusion Inc., which makes a free, Web-based EHR, has expressed concern about survey data suggesting that RECs turn to EHR certification bodies and vendors — not to federal agencies or other more neutral organizations — when they research EHR software.

There’s another problem. In their recent guest post on the Government Health IT website, Steven J. Fox and Vadim Schick of the Post & Schell PC law firm speculated that RECs are ill-equipped to help physicians hone their EHR contract negotiation skills. This will be especially critical when it comes to issues of data ownership, software glitches and indemnification obligations, they noted. It can be even more problematic for Software as a Service EHR systems, which, for all their advantages, tend to offer little, if any leeway in their contracts.

Are regional extension centers doomed to fail? Not so fast, blogger Margalit Gur-Arie argued. Timing shouldn’t really be an issue, because the RECs are charged with helping very small practices — no more than a handful of doctors in a single office. Nor should resources be a problem, because most RECs either are university-based or are preexisting quality improvement organizations. Finally, with 40 EHR vendors submitting applications to be the preferred vendors for Ohio’s regional extension center, the free market seems to be alive and well, she said.

Ultimately, regional extension centers cannot do everything. Their federal grants must be used to help small practices choose an EHR system and understand what an EHR implementation entails. They can educate — as well they should with vendor contracts, because many physicians will be buying an EHR system for the first time — but RECs cannot do the work for physicians.

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