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Data / Empowering High Performance
Regional Extension Centers: Moving Physicians Forward with Meaningful Use
Whitney L.J. HowellJanuary 24, 2012
When talk first started about moving healthcare providers away from paper files to electronic health records (EHRs), not everyone was convinced it was a good idea. Jane Jenning's boss at Primary Medical Specialists in Portsmouth, Ohio, was one of them.
"Making the move to a new system seemed too complicated for a doctor nearing the end of her career," said Jennings, Primary Medical's office manager. "She didn't know if she wanted to invest the time and money into learning something new."
But that was before the office knew about the $44,000 incentive payment they could receive from the Centers for Medicare & Medicaid Services (CMS) for proving the office had fully implemented an accredited EHR and was using it efficiently. The problem, however, was finding the right one.
That's when Ohio Health Information Partnership (OHIP), Ohio's regional extension center (REC), took the lead. Not only did it help Primary Medical identify the best system, Jennings said, but it will also provide step-by-step guidance when the office goes live with its software of choice next month.
"From the provider's perspective, we want to meet meaningful use criteria," Jennings said. "So rather than the piecemeal approach to an EHR system, it's been very beneficial for us to take advantage of the work OHIP's already done and the information it has."
OHIP, also known as "The Partnership," isn't a one-of-a-kind group. Since 2010, the U.S. Department of Health & Human Services' Office of the National Coordinator (ONC) has invested $677 million in 62 RECs nationwide. Their goal is to guide more than 100,000 primary care providers to EHR meaningful use. The on-the-ground assistance they provide is particularly valuable now - it's crunch time for Stage 1 of meaningful use, which requires that eligible professionals meet 20 objectives related to their use of an EHR, as set forth by the CMS. As of last fall, only a small percentage of hospitals had achieved this first stage, and healthcare providers have only until Feb. 29, 2012, to prove they've reached this goal in order to qualify for incentive payments.
Where RECs Are Today
While substantial, REC funding is a drop in the bucket compared to projections in federal health information technology (HIT) growth. By 2016, software company Deltek Inc. predicts federal HIT expenditures will grow to $6.5 billion. But the millions flowing to RECs has been money well spent - many are already achieving their initial enrollment goals.
For example, OHIP recently hit its 6,000-physician goal. The Chicago Health Information Technology REC enrolled nearly 1,500 doctors by the end of December 2011, and the New York eHealth Collaborative REC passed its 5,100-physician goal around the same time. Last week, the Kentucky REC also announced it had reached its initial 1,000-doctor enrollment goal.
Currently, there isn't one model for how RECs should be organized or work. Each is designed differently, and ONC is watching to see which are successful.
"A lot of these models will fail, but the ONC is looking for the ones that work," said Gregg Alexander, M.D., a pediatrician at Madison Pediatrics in London, Ohio. "They're looking for the homerun hitters so they can replicate that model nationwide."
Alexander has been involved with OHIP since its inception and is currently a member of the Board of Directors. Early on, he said, OHIP decided to help providers identify the best EHR solution for their offices by offering an EHR selection tool. Originally priced at $1,800, OHIP makes the tool, produced by medical-device manufacturer Welch Allyn, available for $50.
In a further attempt to guide providers, OHIP staff analyzed the available vendors, starred five as preferred, and negotiated 15- to -20-percent discounts off the system's usual fees.
Early skeptics wondered whether RECs would be effective, but many on-the-ground leaders have been pleased with the progress. In fact, many say providers see RECs as a trusted advisor.
"The effectiveness of the RECs, in my opinion, is surprisingly high. I think the challenge in terms of the numbers in showing people meaningful use is not so much an efficacy of the RECs, but rather the complexity of getting people to meaningful use," said Sean McPhillips, Kentucky's REC project manager. "For example, some vendors may not have the immunization interface enabled to help information exchange, and that creates a huge obstacle. Or we had one vendor whose quality reporting module is not working properly for some reason, so all of their quality reports are coming up zero. That means the provider who wants to test for meaningful use right now can't."
Challenges RECs Face
Although the relationship between RECs and vendors has benefitted facilities and physician practices nationwide, that coordination has also been one of the biggest criticisms lobbed at the groups. Some industry leaders worry that rather than giving providers impartial advice, RECs will be little more than promotion mechanisms for certain vendors.
It's a delicate dance for RECs and vendors to avoid this perception, said Tom S. Lee, Ph.D., CEO and founder of cloud-based EHR software provider SA Ignite. By offering support services as a third-party, vendors can add value to a REC without solely pushing its own product offerings.
"Vendors play an important role," Lee said. "RECs can't drive the value of EHRs to 100,000 providers alone, and vendors can provide the information technology support that the physicians will need."
Another significant challenge is funding. Each REC currently has financial support from the ONC; however, that money will eventually evaporate. To supplement these monies, some RECs charge for their services, said McPhillips. For example, Kentucky providers who do not fall under Medicare can purchase the REC's tool kit and six hours of consultation for $500. Additional services are available at an hourly rate.
In some ways, though, the most significant roadblock RECs face is the physicians they're designed to help. As with Jennings' boss, many older physicians closer to retirement resist becoming EHR savvy. However, as they leave practice, Alexander said, EHRs will organically grow to be the dominant patient record system.
Primary Medical Specialist's Experience
From the moment Jennings contacted the closest REC to her office, located in Athens, the practice had a knowledgeable partner who could answer any EHR-related question, provide detailed information about preferred vendors, and secure a discounted price.
"After connecting with the REC, we stopped looking for a vendor independently," Jennings said. "We had an additional layer of confidence knowing the vendor we selected had received a stamp of approval from our REC."
Primary Medical used the Welch Allyn tool to weed through OHIP's preferred vendors, eventually pinpointing the electronic system that best fit their needs. Throughout the selection process, whenever she or a provider had a question ranging from software to vendor contracts, their REC representative provided timely, unbiased feedback either by phone or email.
The one drawback to working with OHIP, Jennings said, has been how long it took her to find out about the organization. Knowledge of the group isn't widespread.
"I don't know how many doctors know that there's help from the government for this," she said. "But healthcare providers in general need as much help as we can get to select an electronic records vendor that is right for us."
Primary Medical has no plans to sever its relationship with its REC after it reaches EHR proficiency. Instead, the office intends to stay connected to the REC as it faces healthcare's next information technology challenge, the health information exchange (HIE).
What's Next For RECs?
Guiding providers to meaningful use proficiency is a time-limited responsibility. In order to maintain relevancy, RECs leaders are already considering what the groups' next steps might be.
For the Kentucky REC, the next big challenge will be integrating providers into the state's HIE. But there are other opportunities available, such as coding or patient privacy, to help providers and patients span the existing knowledge gap, McPhillips said. The goal, he said, will be to foster a better-educated and empowered patient population that can more actively participate in their own healthcare.
"There's a lot of transformation going on in healthcare today, whether it be health information technology, healthcare reform, patient-centered medical homes ..." he said. "It's a sophisticated industry in which the principle consumer, the patient, is really at a knowledge loss - so the challenge to empower the patient is health literacy. So we recognize that as a huge opportunity that is untapped."
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