The HITECH Act authorized the Office of the National Coordinator (ONC) to establish and fund a network of Regional Extension Centers (RECs) whose job it is to help providers become meaningful users of electronic health records.
The ONC subsequently awarded $643 million in grants to 60 RECs and charged each one to assist at least 1,000 primary care providers, especially those who work in solo or small group practices.
HITECH also mandated the formation of a Health Information Technology Research Center (HITRC). Its role is to support the RECs by identifying and sharing best practices in provider support, meaningful use and EHR adoption.
To gauge early progress of these initiatives, the eHealth Initiative implemented an online survey between mid-June and the end of July, 2010. Forty-six of the 60 RECs responded to the survey.
Key Results from the Survey
So far, the RECs haven’t made much progress signing up primary care providers (PCPs) - To gauge the ability of each REC applicant to reach-out and communicate with PCPs, ONC asked applicants to include a list of PCPs with whom the applicant had signed commitment letters to work together. The eHealth Initiative followed-up in this regard by asking each REC how many of those providers had gone on to sign a contract to work with the REC. 18 of the 32 RECs that responded reported that no providers had signed a contract. An additional 7 RECs reported that less than 20% of providers on their original list had done so.
Nearly 75% of the RECs plan to offer PCPs a “preferred EHR vendor list” from which PCPs could choose - Among the RECs who said they would create such a list, the source of information used most frequently in creating the list was the Certification Commission for Health Information Technology (CCHIT, with 32 respondents). Government sources included the ONC (32 respondents), the Centers for Medicare and Medicaid Services (25) and the Agency for Healthcare Research and Quality (7).
Respondents listed the following criteria as most important in selecting a preferred EHR vendor:
- Price/total cost of ownership
- Guarantee of meaningful use functionality
- The number of local installations
- Use of an ASP hosted model
- Amount of the initial financial outlay, including licenses and implementation
- Current CCHIT certification
Most RECs do not intend to rely on assistance from the HITRC, at least as of now – Only 2 of 37 RECs said they would be very reliant on the HITRC. An additional 10 said they would be somewhat reliant. The remaining 25 said they would be not very reliant, not reliant, neither reliant nor not reliant, or “don’t know.”
In addition, 8 RECs said they will rely on other sources including “vendor and consultants, health plans and insurers, physician peers who are HIT Champions and hospitals.”
Take-Home Messages
The most important conclusion from this survey is that the RECs have an awful lot of work to do in not a lot of time if the hoped-for surge in demand for their services materializes later this year. EHRBloggers has heard anecdotal reports that many RECs face serious manpower shortages and can’t fill key staff positions even now. With each passing day it becomes more likely that many RECs will not be ready to race when the gun sounds.
Beyond this, many RECs continue to show a disturbing reliance on CCHIT and EHR vendors themselves as sources of information. EHRBloggers believes the RECs should rely instead on unbiased information from the ONC and other federal agencies. After all, they are being funded by federal dollars.
It is particularly disturbing that most RECs place little or no faith in the HITRC as a source of information and support, at least so far. We urge the ONC to re-establish the HITRC as the go-to source of information and support for the RECs.
On the bright side, the criteria listed by RECs as most important for an EHR to appear on their lists of “preferred” EHRs (see above) clearly favor Web-based EHRs. EHRBloggers has argued previously that these inexpensive, easy-to-implement, highly usable EHRs have already become the de facto EHR solution for providers in solo and small group practices…which are exactly the kinds of providers the RECs are required to support.
In closing, EHRBloggers notes that the eHealth Initiative plans to repeat its survey in the months ahead. We’ll be following with interest.
Glenn Laffel, MD, PhD
Sr VP Clinical Affairs
Practice Fusion EMR
