As the government aims to induce thousands of physicians to deploy electronic health records (EHR), a collection of some 70 federally backed organizations has been charged with making it happen.
The regional extension centers" RECs as they are called"will play vital roles over the next few years as sources of best practices to providers on EHR selection, retooling workflows in doctors' offices and establishing group purchasing vehicles for software and hardware.
Their overall objective is to help providers, particularly small practices in underserved areas, achieve meaningful use of EHRs.
The RECs have limited time to meet that challenge, however. Providers next year face the first wave of deadlines for meeting meaningful-use criteria. And the centers have not had much of a head start to set up shop. The Department of Health & Human Services commissioned the first batch of RECs in February, awarding grants to 32 organizations. HHS was set to establish a second group of RECs at press time.
Time isn't the only obstacle the centers confront. RECs will need to get the word out about their services to a constituency that is still largely confused on the tenets of meaningful use. They must also staff up or partner with other service providers to meet doctors' technology and business-process needs. Competition for already scant health IT resources could complicate matters.
The RECs job would be difficult in the best of circumstances, given their charter.
"Our charge as RECs is the safety net provider," said Speranza Avram, executive director of the California Health Information Partnership and Services Organization (CHIPSO). CHIPSO will focus on physician practices that work with Medi-Cal (
California
's Medicaid program) patients and the uninsured.
"Those are the organizations that have the least ability to finance this kind of operation and the least ability to withstand the disruption in business practice and billing that happens when you transition from paper to electronic," she said.
"You've got to go after these small medical practices and doctors who work in community health centers," said Bradford Seamon, president and chief executive officer of B.L Seamon Corp., a communications firm that helps agencies promote health IT. "They don't necessarily have the administrative and financial resources to jump up and do this like a hospital could.
The RECs are support to help them do that."
Getting the word out
The initial task for newly fledged RECs is to simply let providers know they exist. Centers plan to tap medical societies, hospital associations and other organizations already well known to physicians.
"Physicians, when part of an association like a medical society, will most likely trust what their peers are telling them," said Jonathan Harner, policy director at the
Colorado
Regional
Extension
Center
. Meanwhile,
Purdue
University
, which has a REC grant to set up the
Indiana
Healthcare
Information
Technology
Extension
Center
(I-HITEC), will partner with the Indiana State Hospital Association, the Indiana Medical Society and the Rural Healthcare Association. "We're relying on our partners to use their e-mail lists," said Mary Anne Sloan, the center's director. "Our partners have been very good about inviting us to speak at conferences."
Peer-to-peer support is another aspect of the trusted-party approach. Vermont Information Technology Leaders, a nonprofit health IT organization that now serves as a REC, has been working with providers over the years on EHR pilots. Those providers can serve as "champions" who can talk to other doctors about their experiences with VITL, according to Dr. David Cochran, president and CEO of VITL.
"Providers are more likely to want to talk to someone who has gone down the same path before them," he said.
VITL, however, will establish a more formal outreach program as well. The organization will pick a marketing communications firm to devise an education and marketing plan. "We are using marketing expertise to make sure we're planning this one well," Cochran said. "We've got to do a lot quickly."
Physician outreach needs to be multifaceted as well as timely. Seamon, citing research conducted in
New York
State
, said it takes an average of 22 contacts with a physician to persuade him or her to get on board with an EHR implementation. To reach that number of contacts, a REC may need to use a combination of Webinars, face-to-face meetings, open houses and the involvement of trusted third-parties.
"I don't think any one approach will fit," he said. "I think it's going to have to be a coordinated effort."
A range of services
ONC calls for RECs to offer a range of services to physicians on the EHR deployment track. Basic education will be an important part of the menu as many doctors still struggle with the concept of meaningful use. "I think there is general confusion," said CHIPSO's Avram.
The RECs early days should prove especially trying. At press time, the final meaningful use criteria and the final EHR certification standards had not yet been promulgated. Avram said the REC leaders she spoke with in March during ONC's national REC kickoff meeting expressed concern over that fact. "We are being asked to move forward very quickly and aggressively and yet the rules of the game are still being finalized," she said.
Added Harner: "We are going out into the field and meaningful use is not defined yet."
And even when the criteria and standards are released it will take some time for software vendors to ensure their software complies and go through the certification process. Vendors, however, have contended that they will quickly adjust their EHR applications to the final regulations.
Helping practices evaluate and purchase those systems will soon emerge as a critical task for RECs. The difficulty here is the sheer number of solutions in the market"more than 200 by some counts. The test for RECs will be cultivating expertise across such a crowded market.
Dan Armijo, director of information and technology strategies with Altarum Institute, acknowledged the expertise scarcity. "How do we field a staff who has extensive knowledge of vendor offerings and [value-added resellers] in a market?" he asked.
Altarum, a health systems research and consulting organization based in
Ann Arbor
,
Mich.
, is taking the lead in setting up the
Michigan
Center
for Effective IT Adoption (M-CEITA), the state's REC.
Armijo
said Altarum has experience with particular EHR vendors as does M-CEITA's partners, which include the Michigan Primary Care Association and the Michigan Public Health Institute. Moreover, an ongoing procurement to establish an EHR group purchasing vehicle will create a short-list of vendors the REC can focus on.
"We will start to build familiarity with a small number of vendors based on the responses to the group purchase effort," he said.
Group purchasing
Armijo
said he anticipates the group purchasing vehicle, which he cited as one of the REC's most important service offerings, will feature 12 to 15 vendors. The multiple-award program will provide M-CEITA the flexibility to "drive demand to the vendors who are the most responsive."
For example, if one vendor fails to meet its service agreement, the REC can divert customers elsewhere, he said.
In
Indiana
, Sloan said her organization plans to develop a vendor short list. Hardware as well as software vendors will be included, as some practices may need to acquire a box
