The Regional Extension Centers (RECs) are one of the efforts supported by the Office of the National Coordinator for Health IT (ONC), as it tries to lay a foundation for widespread adoption of Electronic Health Records (EHRs). An REC is a local organization that tries to help physicians implement an EHR. Funding for these RECs was part of the 2009 ARRA/HITECH act, amounting to $643 million in grants to 60 RECs around the country.
Each REC is charged with reaching out to 1,000 physicians in order to help them choose, implement and meaningfully use an EHR. Their particular target is the small practice end of the spectrum, especially primary care physicians and safety-net facilities, where EHR adoption has been particularly out of reach.
Can the RECs succeed, or will they become another failed federal/state program that falls into the dustbin of “good ideas poorly executed?” RECs were a focus of a recent symposium, the National REC and HIE Summit West, in San Francisco. And some observers, such as Chilmark Research, have expressed pessimism that RECs will achieve their intended goal. A survey of RECs by the eHealth Initiative done this summer showed that 18 of the 32 RECs that responded to the survey had no providers who had signed a contract with them, and an additional 7 reported that fewer than 20% of the providers on their target lists had done so.
Why have the RECs struggled so? One factor is that the RECs have been very traditional in their approach to EHRs. They surveyed the landscape of legacy-certified (CCHIT-certified) enterprise systems through an RFP process, and came up with a “short list” (different list for each REC) of preferred vendors to offer to their physicians. Nearly 75% of the RECs surveyed stated they were proceeding that way. What systems are on these “short lists?” The very ones who offered the kinds of high-cost, high-needed-infrastructure, locally installed systems that have been in the market for some years – the very systems that have failed to achieve adoption in the small-practice end of the spectrum in the first place!
By dramatic contrast, fully web-based EHRs (like Practice Fusion) have had a startling rate of adoption precisely by the small-practice end of the spectrum being sought. Why? Lowered cost (no need for servers, local secure networks, local data backup, etc), and in the most-sought implementation of Practice Fusion, the EHR is free (supported by ads) – there is a paid-subscription option, but most adopters have gone for the free, ad-supported offering. Additionally, ease-of-use, fast on-boarding (“Live in Five”), and intensive support (in the product, by phone and webinar, and by live chat) have helped facilitate meaningful adoption, and have turned “dabblers” into “power users.”
For physicians who want a more direct on-premises assistance, Practice Fusion has assembled a nationwide Certified Consultants Network that (for a low fee) can help the practice address workflows, set up the minimal hardware needed (Internet-connected computers, a reliable broadband Internet connection, document scanners and printers), and do on-site training if needed. This is exactly the kind of work that the RECs are supposed to be offering.
The result of this approach? Practice Fusion is signing up and on-boarding 150-200 new practices every day, and now has over 45,000 users working on over 5,000,000 patient records in all 50 states. And the bulk have been small physician practices, particularly primary care practices – the precise target of the REC effort.
Why such a disconnect in the experience of the RECs to date, and Practice Fusion to date? It is clear from our experience that a web-based approach is the most appealing to the smaller practices. Furthermore, web-based technologies are where many of the new breakthroughs are occurring (like mobile App Store web-API plug-ins, or Chart Sharing across practices, to name a few). Most of the RECs have taken a traditional approach to vendor selection – the one that may have worked for hospitals and larger clinics, but has utterly failed the market for the small physician practice. The RECs need to recognize that small physician practices are a “different beast” than the institutional settings, and a different technology approach (web-based rather than traditional locally-installed client/server-based) is needed.
Can the RECs succeed? We certainly hope so. We are all united in our desire to facilitate the widespread adoption of EHR technology across the land – better, more coordinated health care delivery relies on this vision coming to pass. However, continuing to offer an approach that has failed their target physician sector in the past, hoping that “it will be different this time,” will doom the REC effort, as some have warned. Recognizing that small practices are best served by web-based solutions is critical – experience to date supports this. HHS Certification – what is needed for access to Meaningful Use dollars – has the effect of leveling the playing field: web-based EHRs (and we are in the pipeline for Certification ourselves) as well as traditional client/server EHRs will all need to have the same set of functions. The differentiator is cost, local technology burden, ease-of-implementation, and support. We hope the RECs will join us in an approach that works – the numbers speak for themselves.
Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR
