Regional Extension Centers Are Enabling Meaningful Use for All
A common concern about health information technology (health IT) adoption is that it may not be feasible for small practices and those serving safety-net populations. Due to economies of scale, implementation and meaningful use of health IT is far less daunting for larger, commercial health care organizations. Even so, some small practices and community health centers around the country are actively defying that statement.
It is precisely this reason that, in developing the HITECH legislation, Congress made sure to incentivize providers and deliver support to those who most need it. Last Friday, Feb. 12, the Office of the National Coordinator for Health Information Technology (ONC) announced the first cycle of grant awards for 32 Regional Extension Centers (RECs), totaling $375 million. Additional REC cooperative agreements will be announced in the near future. The combined REC program will provide support to priority primary care providers in virtually every nook and cranny of the country.
When we at ONC talk about “priority primary care providers,” we’re focusing on solo and small group practices, community and rural health centers, public and critical-access hospitals, and other settings that predominately serve uninsured, underinsured, or medically underserved patients. Through cooperative agreements, we will work closely with RECs to ensure that primary care providers who need help are provided with an array of on-the-ground support to meaningfully use electronic health records (EHRs).
This help includes, but is not limited to:
- Unbiased guidance on vendor selection and group purchasing
- Practice and workflow redesign
- Functional interoperability and health information exchange (HIE)
- Project management and implementation
- Privacy and security best practices
- Local workforce support
- Everything involved in ensuring meaningful use of EHRs
With regard to this last point, the RECs will be committed to ensuring that EHRs aren’t just about automation. We know that simply doing the wrong thing faster won’t improve the care delivery system. Meaningful use of EHRs requires important changes that will result in a better, more convenient and efficient care delivery system for clinicians and patients.
In the coming weeks, ONC will be rolling out more components of our HIT Extension Program. In particular, we’ll keep you apprised of our plans for the HIT Research Center (HITRC) that will help provide support and continuity to the RECs and create a virtual community of shared learning. We also will discuss how the Extension Program will be supported by our workforce development efforts, benefit from the leadership of our Beacon Communities, coordinate with our state-based HIE efforts, and build on the innovation work from our Office of the Chief Scientist.
Will ONC roll out some more health initiatives to the public? I might see the possibility in near future.
Federal funding may be encouraging a move toward EHR, but there’s more to it than just installing systems. How can healthcare data pooling lead to a better system? More at http://www.healthcaretownhall.com/?p=2144
I followed the link in this response which sent me to an article discussing the value of putting XBox units in hospital rooms. The idea is creative indeed, but does not explain the reference to “data pooling”. Kind of a non sequitur don’t you think? Can you clarify, perhaps, where you were headed? Just curious….
I understand your concerns about how data pooling might help you as a practitioner versus helping society or population health. The reality is that probably 50% of our medical decisions are based on our best guess and not excellent evidence. That is why the stimulus package included comparative effective research (CER). Can you really say that brand name Lipitor is really better than generic simvastatin??
A recent article attempted to correlate how busy a practitioner was and the quality of medical care delivered. They concluded that most medical practices are too small to generate any meaningful results, hence the need to combine or pool data from disparate practices. Large organizations (integrated networks with EHRS) such as Kaiser-Permanente probably have the best data to show lots of data changes how you practice medicine.
Although I am somewhat academic at this point, I practiced in a very small rural community for 15 years so I understand the unique problems and issues experienced by those clinicians…….Bob
I have to disagree. I think CER is going to over-reach and make everybody’s lives miserable. Just look at how the PBMs are manipulating physicians to get them to agree to their “stepped-care” approach, driven exclusively by some rigid algorithm. And try to explain to a clerk at the other end of the phone line why Glyburide is not a substitute for Repaglinide even if their algorithm says so. The best care is provided by attention to individual needs, whether based on ethnic background or co-morbid conditions or occupation, etc. Simply saying that Simvastatin is equal to Lipitor in lowering LDL-C is insufficient and inappropriate. Perhaps, Lipitor has less side-effects than Simvastatin or a lower dose does the same job as a higher dose of the other.
As far as large integrated networks are concerned, their data is hardly relevant to the communities in general because their model of care so vastly different than what occurs in the community. Such data will be nearly impossible to apply to the world of small community practices.
I think you are arguing my point. If we could generate much more data from typical small community practices we might be able to make better recommendations for the average clinician in the trenches and not someone located at the ivory tower or a huge integrated network. You would have to design studies to look at all variables such as ethnicity, co-morbidities, side effects, etc. The only way to accomplish that is to digitize and share medical data, which is what is lacking today
I agree with all the goals stated above. However, the proof will be the actions that the ONC takes. Just as an example, our small practice has achieved almost all the stated goals for years without any financial help. Yet there has been absolutely no outreach to either use us as a teaching model or help us improve our model. We will wait and see what comes of this initiative.
Hi, I am a physician and I am working with the local REC. We are developing a workshop to get small practices on board with EHR adoption. You said that you had a good implementation experience. Would you be willing to share your story with us?
Thank you,
Technology in the future be Haa medical science to develop highly human life may be more. But above all else to maintain physical health or chest is more important, it would regularly.
I agree with the contain regarding the several practises and information regarding small caps taking proper activations.The environments regarding different centres and their course of work is different in regard of the proper Regional Extension Centres.I like the plan of HIT centres which makes new resolution in the several services.I want to say that Federal funding may be benefited and move towards the EHR.I want to know more such aspects of the policies.
I have been involved in helping community health centers ( FQHC) transition into EHR systems. There are barriers and challenges but in our year’s of experience I have known that all of these if managed well can be opportunities. Its often not how much money is available but how well the “implementation dollar” is spent. Over the years we have seen our pie chart changing its composition. There needs to be a blended implementation plan considering all stake holder requirements. An EHR system is not an IT project and not a plug-and play product. The socio-technical aspects are key to avoid unintended consequences
We completely agree that we need to figure out how to best spend resources. We enthusiastically welcome input from you (and everyone else!) about what these socio-technical issues are and how to best address them. This input will be valuable as we build the HITRC and other infrastructure to support our regional extension program.
These are applicable to ambulatory settings and FQHC in specific who are the most complex of ambulatory settings with their multi specialties, diversities and disparities. Here are some key ones (1) the importance of a focused and customized readiness assessment, (2)leadership engagement, (3)change management and continues improvement, (4) managing diversity, (5) managing heterogeneous skill sets and competencies(6) managing productivity loss (7) Risk assessment and mitigation etc. These in our experience keep the project on track/time/cost which we have learnt and found successful , advise our clients, and are part of the lessons learnt, best practices we have collated.
Some examples:
Importance of a focused and customized readiness assessment which leads to a “project charter” ( blue print for the EHR project) can save a lot of time and money and keep project on track.
Stake holder (especially Provider) buy-in is crucial.Often younger providers prefer or want EHR systems. This becomes a negotiating point during their recruitment. We saw this tipping point about 2-3 years ago. Whereas others are resistant to change. Managing this diversity and heterogeneous group ( not only among providers) is crucial.
Leadership engagement and project committee (PC) composition is critical. Advisable to have CEO chair the PC and it has been seen by us that EHR projects where Board of Directors are involved (oversight) are more successful. HRSA OPR/health IT (now abolished) team has validated this.
Use some kind of complexity calculator during assessment stage this include volume (visits), locations, cultural diversities (clinical, operations and other departments), computer proficiency, learning curves of employees etc. We used a mathematical complexity “tool box” which gave you ranking.
Identify or budget for an EHR specialist (post go live). This is not an IT job category but involves understanding of clinical, IT and good interpersonal skills.
Workflow must consider mapping, analysis and redesign incorporating health IT (optimum blend). We had a workflow process where we recorded barriers ( red flags) in Visio flow charts ( hundreds of them) and identify barriers that may go off with an EHR system . This also gives an opportunity for organizations to boldly taken on some change management under the banner of “EMR project”. Also these red flags are converted into grid and used as pointed negotiation tools with the vendor during demos.
Budget and life cycle of an EHR project: Have you considered a five year period with upgrades, support, redundancies, model (SaaS, ASP etc)
Vendor selection: We suggest only an integrated EHR ( with EPM and EMR). Over the years we have seen and seen that interfaces (development and management) are not successful. Far from what it used to be 5-6 years ago, with an effective negotiation, good pricing can be obtained for an integrated product.
Productivity management: I kept being asked again and again (by Clinical directors, CFOs and others) what the industry norms for loss or productivity are. Depending on who is asking they want this number to be high or low. There are none but there are definite ways by this risk can be mitigated. Simple things like wireless, remote connectivity, training ( small groups/champions train-the -trainer)etc. ( to complete charts)
Suggestions for assistance/ help from ONC could include among other things (1) standardized set of definitions for terminologies, (2) guidance documents for implementations by REC( in turn by their subcontractors and consultants), (3) guidance around what data should be abstracted into an EHR ( from paper) among other things.
We also did an independent critique on AHRQ/HRSA Health IT adoption toolkit for its currency, relevancy and accuracy.
I am not hearing much discussion about any requirement for medical practices to properly evaluate and implement correct ergonmics when they finally go with Electronic Records Systems. Without going into details, I am facing partial permament disability as the doctor’s assistant, after 2 decades in my profession, due to ignorance by my employer of this important part of implementing EMR in our large practice.
I am fearful that many more will follow this long painful road as I have, if someone does not address this very important issue in clinical care as it relates to the set up of EMR systems that will eventually be a mandatory requirement for all medical practices.
I am an osteopath who has found that a lot of today’s younger reception staff are suffering with neck, shoulder and back problems that they shouldn’t be suffering from at such a young age. This is mainly due to the introduction of modern computer systems for the use of electronic patient record management in the doctor’s office environment. They may help to keep track of patient billing and make the transfer of patient information instantly over the internet, but the ergonomics of using computer terminals for data entry means that they encourage bad posture leading to a variety of neck, shoulder and back pain syndromes, wrist injuries (due to repetitive strain) and also deteriorating vision due to fixed focal length on a computer screen for eight or more hours a day. Without some preventative education of how these new time saving (?) systems will affect our lives and the lives of our children, I feel I am going to be seeing a lot more of these type of problems in my clinic every day.
As a physical therapist I see much of the same patient population. As electronic records and billing increasingly become the norm it is important for office managers to not only train their staff about the operation of the office but also about office/computer ergonomics and maintaining good seated posture for data entry tasks in order to minimize repetitive motion and postural related injuries.
There are four main issues in implementing electronic medical records.
1.These systems cost a lot of money.
2.The purchasers of EMRs are not the ones to reap the benefits of the system; benefits accrue to the patients, employers, insurers and government.
3.There is no readily exchangable format, as there is no off-the-shelf Microsoft Office version of EMRs that works well for the various specialties and levels of hospital care.
4.There is no means of readily assembling the patient’s complete medical record from all sources from which they have sought care when they are sitting on the examining table in front of you.
The benefits of EMRs often touted are elimination of waste, fraud and abuse of the healthcare system. Yes, EMRs could decrease the costs of defensive medicine, estimated at 5-9% of total medical expenditures. They could decrease the need for repeated testing , lower perscription expenditures, facilitate authorization for procedures, verify services provided, shorten payment time, etc. But this does not necessarily occur just because an office or hospital has an EMR in place. There must be a way to access and assemble a complete record when needed. We don’t need necessarily EMRs, what we really need is an electronic medical filing cabinet. Similar to the way the credit bureaus assemble financial records, we need a way for verified credentialed providers of healthcare to access the system when a patient is biometrically identified in their office. While the intricate details are too much for a blogpost, suffice it to say it could be done for the price of a print scanner and biometric scanner at a penny or so per transaction. Please feel free to contact me, I will be happy to be of assistance.
It is always interesting to me to see the variety of opinions and concerns that come up in response to these blog postings. It is a great reminder of the diversity within our health care system — large practices and small; urban and rural; paper-driven, paperless, and everything in between.
Each practice has its own unique needs, and the successful implementation of meaningful use of electronic health records (EHRs) depends on our ability to understand and meet the entire range of those needs.
Providers will face challenges in implementing EHRs. Some will be common and some unique, but by sharing our experiences, our ideas, our best practices, and even our failures, we will lead American health care toward the fulfillment of the ultimate promise of health IT — improved patient care.
The dialogue that takes place here offers valuable insights that will, ultimately, help to determine the future of HIT, and all of us at ONC appreciate your engagement.
I agree to a IT health tracking system. I believe this system elimated going from doctor to another to received the same care, medications expenses mri’s and unneeded x-rays. Good medical care is very important. Having a reference system in place is great care. The social securty department system have an ID tracking that works. Why not health care!
The REC’s are critical resources to providers as Health Care reform marches forward. I work for primary care providers who treat patients in both Tennessess and Mississippi. We have offices in both states. The TN REC has been named, however I can’t find info on the Mississippi REC. Are providers able to contact the REC of their choice? Will the REC contact them? What mode of communication will ONC use to educated the providers on what to expect? When will the Mississippi REC be named? Thanks – we’re anxiously awaiting work!
I agree with all the goals stated above. However, the proof will be the actions that the ONC takes. Just as an example, our small practice has achieved almost all the stated goals for years without any financial help. Yet there has been absolutely no outreach to either use us as a teaching model or help us improve our model. We will wait and see what comes of this initiative.
The EHR is much needed, and we hope more remote healthcare attached to it in the areas of wireless broadband. Many communities have it, and having already built these systems and demonstrated their capabilities, they are the way to go. Plus, patients can be discharged so much sooner, if remote monitoring is available. This alone, will save billions, and all interfaces with EHR flawlessly.
Bobby Vassallo
Valley Wireless
I agree that electronic health records would improve the level of care patients would receive, especially when they have multiple doctors and health facilities. But what steps are being done to ensure the privacy of the data?
Sounds like a good program, except they have to make sure the patient’s privacy is always maintained. I sure wouldn’t like any random medical staff to know what kind of medical conditions I’m suffering from..
You mention “provide support to priority primary care providers”, who decides the priority. Surely this will be different from area to area, funding is always difficult and to blanket it to one area to suit all will fail. What protocols do you have to prioritize the funding and is this across the borad so to speak?
As an owner of a small physical therapy practice I do all my own billing in order to maintain some efficiency and keep costs down. My biggest problem with electronic billing is that cost of software needed to interface with the insurance companies and the clearing houses. The initial cost is high and so are the cost of the updates that are required. If there was a more cost efficient way to get into the electronic billing arena I would be interested.