Help is on its way for many primary care physicians (PCPs), public and critical-access hospitals, and community clinics moving from a paper system to electronic health records (EHRs).
This technical help is coming in the form of as many as 70 Regional Extension Center (REC) offices, which were established by the HITECH Act of February 2009.
RECs will provide outreach, education and technical assistance ticketed for PCPs. Also eligible are clinics and small hospitals in rural areas. The idea is to get them up to speed with implementing EHR systems that in turn will qualify them for federal EHR incentives.
The U.S. Department of Health & Human Services’ Office of the National Coordinator for Health Information Technology (ONC) is reviewing proposals for the formation of RECs, which will fall under the federal Health Information Technology Extension Program.
Carmela Castellano-Garcia, CEO of the California Primary Care Association (CPCA), said she believes the first round of REC funding will be announced in February, based on what she’s heard from the ONC and other REC grant applicants.
Cal-REC -- a California REC formed by the CPCA, California Medical Association and the California Association of Public Hospitals -- received an intent-of-funding notice from the ONC this month, which means it will get funded pending a detailed ONC review. The organization covers the entire state of California, excluding Los Angeles and Orange County, both of which are subject to pending REC proposals from other groups. It proposes the formation of two RECs in California that would cover the northern and southern halves of the state, respectively.
Similar REC proposals, covering such territories as Ohio, North Carolina and Colorado, also are pending.
“We’re in a due diligence, more in-depth review process,” Castellano-Garcia said. “Basically it means [that], barring any unforeseen critical issue that would disqualify us, we’re on the road to being funded, and the next step would be the Notice of Grant Award. It’s not a formal commitment, but they intend to fund us.”
The dollars for Cal-REC are very specifically for the technical-assistance side. . . . Hardware and software are ultimately going to be paid for by the [Medicare EHR] incentive payments.
Carmela Castellano-Garcia, CEO, California Primary Care Association
RECs will be granted as much as $30 million each in American Recovery and Reinvestment Act grants over four years; they must serve nonoverlapping territories. The ONC provides each REC with a customer relationship management tool to keep track of the health care providers it serves.
Each territory must include at least 1,000 health care providers. In the Cal-REC model, local offices will connect providers with consultants and vendors to achieve meaningful use and receive EHR incentives. Vendors will be encouraged to vet their products through Cal-REC, which plans to assemble a list of recommended standard configurations to meet the needs of its different-sized providers. These lists probably will include no more than three vendors, Castellano-Garcia said.
What RECs won’t do is provide funding for purchasing electronic medical-record software and the hardware to support it.
“The dollars for Cal-REC are very specifically for the technical-assistance side,” said Castellano-Garcia, who added that RECs will be required to provide at least 10% of their funding outside of ONC grants, and may end up charging fees for some of their services. “Hardware and software are ultimately going to be paid for by the [Medicare EHR] incentive payments,” she said.
Cal-REC’s business model, Castellano-Garcia added, calls for the eventual expansion of its constituency to other health care providers, such as specialists, outside the grant’s required target area; these providers could bring in additional fees and help satisfy grant funding requirements. She said she hopes that anything Cal-REC charges could be offset by vendor group-purchasing arrangements that the REC may strike.
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