In November 2011, the Office of the National Coordinator for Health Information Technology (ONC) began working with the nation’s 62 Regional Extension Centers (RECs) to create a comprehensive dataset of challenges that providers are experiencing in the journey toward electronic health record (EHR) adoption and meaningful use.

RECs represent 136,000 primary care providers, approximately 45% of all United States providers, and serves as an early-warning system to ONC and others about what providers across the country might be experiencing as they work to achieve meaningful use of certified EHR technology. The dataset is also an important tool that the RECs use to target interventions that will help their providers achieve meaningful use.

Challenges Reported by Regional Extension Centers

The challenges [Excel – 14.6 KB] reported by the Regional Extension Centers are broken into four primary categories:

• Practice issues,
• Vendor issues,
• Attestation process issues, and
• Meaningful Use measure-specific issues.

Within each primary category, secondary and tertiary classifications are available for further refinement of the information. The current summary of the aggregated challenge data is also available online [PDF – 861 KB].

Under each category, the Regional Extension Centers report:

• A description of the problem faced by the practice site,
• The level of impact the problem creates,
• Stage in the EHR Incentive Program—whether the provider is just approaching EHR adoption (adopt, implement, or upgrade an EHR system), or if the provider has  an EHR system and is working toward meaningfully using the system,
• When the problem is resolved, and
• When the site is on track to meeting its Meaningful Use goal.

The information provides ONC and the RECs with the ability to examine problems among similar practice types, for example, small practices of less than 10 providers, Community Health Centers or Critical Access Hospitals, by vendor, or by region. Because these groups have different internal resources (technical, financial, and staffing etc.) the problems, impact, and solutions can vary dramatically.

Wisconsin Health Information Technology Education Center (WHITEC)

WHITEC, the Wisconsin REC, was able to develop specific Medicaid registration assistance tools for particular practice types. “With the launch of the Medicaid EHR Incentive Program, WHITEC health IT specialists immediately found many practices experienced issues with registration, often because of discrepancies in data among various systems. In response, we created a clear, step-by-step guide that walks practices through the Centers for Medicare & Medicaid Services and state-specific requirements,” says Stacey Novogoratz, Field Operations Manager at WHITEC.

WHITEC was able to further identify Medicaid registration problems specific to federally qualified health centers (FQHCs). WHITEC worked with the state Medicaid agency to create a document for FQHCs to help explain the difference between individual and group patient volume calculations. “Such tools, coupled with one-on-one assistance, have resulted in more than half of Medicaid providers working with WHITEC receiving incentive payments by the end of June 2012,” said Ms. Novogoratz.

Health Information Technology Extension Center for Los Angeles County (HITEC-LA)

Ali Modaressi, Director of EHR Technology with HITEC-LA, the Los Angeles County Regional Extension Center, has been using the data to identify trends and develop solutions before the problems affect too many of its REC providers. “We have identified Meaningful Use reporting issues for some of the vendors and have worked with them to remove barriers (they may be experiencing),” says Mr. Modaressi. On one occasion, the challenges data showed that the reporting structure used by a particular EHR vendor would cause problems for all of its providers as they took steps to improve their workflows in a timely manner. “We identified this issue early on, and asked the vendor to refresh the meaningful use dashboard data bi-weekly instead of monthly,” says Mr. Modaressi. “This adjustment enabled us to find out the results of workflow changes and meaningful use measures in two weeks instead of four. As a result, we were able to bring our providers to meaningful use much faster.”

California Health Information Partnership & Services Organization (CalHIPSO)

“We’re using the information to determine how much of our resources we need to put toward helping providers meet specific Meaningful Use objectives,” says Dorian Seamster, Chief of Health Information Services from CalHIPSO, an REC in California.

CalHIPSO learned that many of its providers faced challenges in meeting the privacy and security Meaningful Use measure. The number of providers with the problem allowed CalHIPSO to devote resources to develop two different solutions:  a do-it-yourself guide to introduce providers to the tools available to assist them, as well as a more comprehensive solution, which involved developing a special pricing structure for members to access an online tool or direct assistance. The online system walked providers through a privacy and security checklist and helped them develop a risk mitigation plan. If the provider wished, he or she could opt to use the special pricing to gain direct assistance to meet the privacy and security requirements.

Addressing Challenges

All RECs have access to the functionality through the program’s ONC-supported customer relationship management tool. Each REC approaches its practice’s challenge mitigation differently, but the ability to systematically approach these challenges is an example of the nimble infrastructure developed by ONC to support the REC program. With this information, RECs can consistently track, review, and report on their practice portfolio, enabling continuous REC service-delivery improvement for providers. For ONC, the purpose of evaluating this information from a national level is to identify trends among provider types as well as to prioritize its own technical assistance resources, but most importantly encouraging the identification and spread of innovative solutions to problems discovered by sites and RECs.

Sites that have solved a problem or that are on track to reaching their goals, can readily be identified through the dataset and queried by other users as to how a particular problem was solved. One such example is with vendor selection, which was identified as one of the top ten problems among REC providers. REC and ONC staff worked together to identify the tools and resources that best assisted the provider in selecting an EHR vendor and these selection tools are now available within the HealthIT.gov website. As more solutions to various challenges are identified (along with other important resources) they too will be posted to HealthIT.gov, providing a single website that presents specific challenges with a variety of possible solutions to choose from, depending on the site’s capabilities and needs.

We Want to Hear From You

ONC welcomes other input on solutions – if you have a solution that works, please share it with us in the comment section below!

For More Information

• HealthIT.gov – Regional Extension Centers
• EHR Adoption