The HITECH Act created the Health Information Technology Extension Program, an effort to drive HIT adoption among primary care clinicians. The program creates Regional Extension Centers (RECs) across the country, each working to assist providers learn about health IT, find EHR solutions, procure and implement those solutions, and become meaningful users. HHS defines the REC’s mission as:
The Regional Extension Centers will focus their most intensive technical assistance on clinicians (physicians, physician assistants, and nurse practitioners) furnishing primary-care services, with a particular emphasis on individual and small group practices (fewer than 10 clinicians with prescriptive privileges). Clinicians in such practices deliver the majority of primary care services, but have the lowest rates of adoption of EHR systems, and the least access to resources to help them implement, use and maintain such systems. Regional Extension Centers will also focus intensive technical assistance on clinicians providing primary care in public and critical access hospitals, community health centers, and in other settings that predominantly serve uninsured, underinsured, and medically underserved populations.
During the first two years of the program, the REC receives funds from HHS for each provider that they assist in attaining Meaningful Use. Funds continue in the third and fourth year of the program but at a vastly reduced rate, with a goal of weaning off of federal dollars and ongoing sustainable independence.
The REC concept is a promising one. It brings localized support to providers looking to swim in the EHR pool, with the watchful eye of an “EHR lifeguard” nearby. The model fills a potential gap between the software and services provided by an EHR vendor and the actual amount of work it takes to get a small practice to be a meaningful user.
I believe one of the issues we’ll see play out is how RECs compete with EHR vendors themselves. Providers can buy from a REC or an EHR vendor – the choice is theirs. Frankly, the RECs are in many ways offering the same solution as the vendors: they resell EHR software and services, they provide consulting services, and they push providers to the Meaningful Use level.
Of course most of the providers’ purchase decisions will come down to value per dollar… RECs need to keep costs down and consider value-added services. I offer some ideas of value-adds:
- Stay Local – The hands-on support of local service suppliers who have EHR expertise is critical. This might be a tough to offer across a broad or rural geography, but RECs should look to small boutique partners to fill this role. Large EHR vendors cannot provide this same level of intimate support, and it is essential to truly meaningful use (note lowercase!)
- Bundle HIE – This is a great opportunity to connect EHRs to local resources right from the get-go. RECs can require that EHRs include connectivity to nearby HIEs, local labs, local service providers, and others critical to the patient care continuum in the community. The “local” nature of this service cannot be beat by national vendors, and RECs can bring value with their regional expertise.
- Drive Volume – Probably a no-brainer, but RECs bring the ability for a small provider to benefit from a leveraged, large group purchase. Volume pricing will bring costs down considerably for small physician practices.
- Centralize Operations – Providers can benefit from a centralized hosting and support offering, so they all can expect the same service level, same helpdesk phone number, same folks with local knowledge of the products, services, and healthcare providers within the REC community. A local operations approach also brings economic development within the REC community, a nice side effect. I believe many large EHR vendors would struggle to offer local personalized support like this.
- Offer Portability –
Having been in this industry for a while, we know that relationships between a healthcare provider and an HIT vendor looks more like a high school sweetheart fling than a committed marriage; they last for a while, going through high highs and low lows, but frequently end up with the provider looking for another partner. The REC could be a long term partner, offering a variety of EHR vendor solutions, and giving providers an outlet to switch technology and a “painless” method to move records from one vendor platform to another.
Regional Extension Centers play a key role in covering the difficult “last mile” of provider HIT adoption by targeting their support at primary care practices with ten docs or less. RECs should consider the list above when amassing their teams of suppliers and vendors to go to market (not just EHR vendors, but also consultancies, HIE vendors, hosting facilities, and operational support groups). I hope RECs can sustain their important service by putting together these pieces in a high value, low cost way, and help us all improve healthcare.
I think the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the ‘safe EHR vendor’ challenge as discussed by many critics.
As far as implementation challenges goes, the federal guidelines for certification and usability are pretty much clear. Useful improvisation on these lines can make ones EHR’s friendly to most practices of varying specialties.