Regional Extension Centers: Helping You Achieve Meaningful Use

One of the major components of the HITECH Act, Regional Extension Centers (RECs) will provide a wide range of technical support, education, and assistance to primary care practices that adopt EHRs with the goal of achieving meaningful use and qualifying for federal financial incentives.

It’s well known that the federal government is aggressively pursuing a strategy to encourage the implementation of health information technology (HIT) in the everyday

practice of medicine in this country. Many physicians, legislators, public health officials, and other observers believe that the quality of medical care delivered and the efficiency of the care delivery system depend upon the successful incorporation of technology initiatives at the point of care. To this end, the Health Information Technology for Economic and Clinical Health Act (HITECH) has dedicated a large amount of funding toward a nationwide HIT infrastructure. A key component of this initiative is to create an electronic health record (EHR) for everyone in the country by 2014.

A large portion of the responsibility for implementing the provisions of the HITECH act rests with the Office of the National Coordinator for Health Information Technology (ONC), which has been tasked with distributing a portion of the HITECH funds. In order to foster the implementation and meaningful use of EHRs, ONC has $598 million at its disposal to establish Regional Extension Centers (RECs; http://hcp.lv/cjxg21). Of these, 60 have been awarded grants (up to $25 million) in order to promote the adoption of EHR systems in their local geographic areas (http://hcp.lv/bIgtbV). It is expected that each will be fully functional by December, 2010. The grants are to last for two years, and by December, 2012, each REC is expected to be functioning independently of any federal funds.

In addition to these centers, a Health Information Technology Research Center (HITRC) was funded at $50 million to oversee the RECs and serve as a national learning community for best practices of IT adoption (http://hcp.lv/a6Z4a2). This process is developing at an extremely rapid pace; in fact, the HITRC website is still under development at writing.

Meaningful use of EMRs

The ambitious mission of the RECs is to have at least 100,000 primary care providers (defined as physicians or other healthcare providers, such as physician assistants or nurse practitioners, with prescriptive privileges in family medicine, general medicine, ob/gyn, or pediatric practices) be “meaningful users” of EHRs by early 2012 (http://hcp.lv/bIgtbV). The RECs will assist primary care physicians not only in the selection and implementation of an EHR, but also help to ensure that the software is used in such a way as to qualify the practitioner for the ARRA stimulus funds (ie, in accordance with “meaningful use” guidelines).

The recently released final guidelines on what constitutes “meaningful use” of an EHR define which eligible providers will qualify for the stimulus incentive for EHR adoption: a maximum of $44,000 under the Medicare program and nearly $64,000 for the Medicaid program (http://hcp.lv/cWPFpt).

Each REC will provide the support necessary to Regional Extension Centers:

1,000-2,000 primary care physicians to become meaningful users of an EHR. In fact, the strategy is to target those providers who are statistically least likely to adopt technology in their office—those in small, rural regions that treat the traditionally medically underserved; these are the so-called “priority primary care providers,” which include:

• Solo and small group practices (10 or less primary care providers) primarily focused on primary care

• Public and critical access hospitals

• Community health centers and rural health clinics

• Other settings that predominately serve un-insured, underinsured, and medically underserved populations

Once the eligible providers have been identified, what strategies will the RECs use to maximize the adoption of EHRs and ensure their “meaningful use?” It is envisioned that there will be a wide range of services offered with hands-on educational, technical, and logistical support. A selection criterion for the REC determination was their proximity to the eligible providers so that support could be provided on a face-to-face basis. Anticipated methods of lowering the current barriers to IT adoption include outreach and education, workforce support, tools and resources in all aspects of EHR and HIT adoption, vendor selection and preferred pricing, project management, practice and workflow redesign, system implementation, interoperability and health information exchange, and privacy and security.

Vendor selection

Many RECs are currently selecting favored software vendors to facilitate the most cost-effective and user-friendly products to offer to providers. Due to the large number of potential installations offered, the RECs can negotiate discounted rates and favorable service guarantees with vendors and pass them on to their physician members. Therefore, much of the work in selecting the best systems and ensuring fair treatment can be spared the individual practitioners. Other RECs have decided not to adopt this strategy and will not be offering the service of suggesting “preferred” vendors.

Implementation and project management

Most small practices do not have the management expertise for the complicated changes that an EHR implementation requires. RECs can offer on-site readiness evaluations and participate in the process to prepare a small practice for the culture change that the conversion from paper to electronic workflow entails

Practice and workflow design

RECs will help practices to map their current office workflow and suggest how it can be reconciled and/or modified to better fit the requirements of a given EHR system.

Health information exchange

A major benefit of HIT adoption is that it enables coordination of care among different health provider entities. The HITRC FAQ page on the ONC website (http://hcp.lv/d2GRd1) says that the REC program “offers providers access to information and assists them with selecting and implementing certified EHRs, and integrating HIE [health information exchange] using those EHRs into provider care delivery and administrative workflows to enhance the quality and safety of care while protecting patients’ privacy.”

Privacy and security

RECs will work with member practices to enure that patient data remains secure and the practice remains HIPAA compliant.

Finally, the REC can monitor their members’ utilization of the EHR to ensure that meaningful use is accomplished, thus serving the federal government’s goal of improving the quality of patient care. It is anticipated that multiple educational strategies will enhance each REC’s outreach. These could include CME seminars held in each region, webinars, and even individual office in-service sessions. Furthermore, the HITRC will oversee a national educational network and work in the development of best adoption practices to be shared among the RECs.

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Steven Zuckerman, MD, is the chief of neurology and medical information officer at Baton Rouge General Hospital, Baton Rouge, LA, and the physician editor-in-chief of MDNG: Neurology/Psychiatry edition.