THE REGIONAL EXTENSION Centers (RECs) faced a near impossible mission.
Develop from scratch 62 RECs nationwide, staff them with in-demand health IT consultants, and then convince 100,000 small
physician practices and critical access hospitals to either implement an electronic health record system or amp up their current
one to meet the government’s meaningful use EHR incentive
program. And do it in 24 months.
The RECs were not asked to target large healthcare systems,
the types of providers most likely to pursue EHR implementations. Instead they were assigned a group historically reluctant
to splurge on health IT: small physician practices and hospitals,
which traditionally have found EHRs too expensive, too time-consuming, and too difficult to implement and manage.
One year after the RECs formally opened their doors to providers, however, they are expected to meet their first goal—as of
September, 90,000 providers had signed up with the RECs, with
the remaining 10,000 expected to be signed by year’s end.
While this feat is a big accomplishment, the RECs’ true mission is just beginning. It only gets harder from here.
Signing up providers is one thing. Getting them to “
meaningfully” use EHRs and meet the incentive program measures—
which is the REC’s ultimate goal—is another. Out of the 90,000
providers enrolled in September, only 1,000 had achieved
meaningful use with the RECs’ help, according to the Office of
the National Coordinator for Health IT (ONC).
“The ultimate goal here is to get
people to meaningful use, and we
recognize that is going to be a
hard, challenging process…”
Office of the National Coordinator
The Real Test Awaits
With the hard work just beginning, any impact on the healthcare landscape that the RECs will make is still a few years off.
“Enrollment is important, but it is only the first step of a longer
process,” says Mat Kendall, director of provider adoption sup-
port at ONC, the organization in charge of developing the REC
program. “The ultimate goal here is to get people to meaning-
ful use, and we recognize that is going to be a hard, challenging
process, especially given the people we are working on.”
Over the next three years of the RECs’ four-year government
contract they will help small physician groups and critical ac-
cess hospitals use EHRs that bring them government incentives
for improving patient care.
RECs on a Mission
IN SPRING 2010, with $643 million and a mandate from the
HITECH Act, ONC established 62 regional extension centers
across the country. During the four-year funding period, the
RECs would work to disseminate technical assistance, guidance, and information on best practices to at least 20 percent of their geographic area’s small-scale providers in order
to make them “meaningful users” of EHRs—an achievement
that would earn the provider incentives through Medicare
and Medicaid’s multistage EHR incentive program.
The REC guides providers on the selection, implementation, and use of certified EHRs as well as assesses provider
needs, negotiates with system vendors, creates and implements project management plans, and helps institute workflow changes.
While models vary, most RECs offer in-person and on-site
support. Many offer a subscription pay model with tiered services. Rates are typically heavily discounted due to government funding, with many RECs offering at least a basic set of
services without charge.
The Telligen HITREC launched in early 2010 in Iowa and
has been helping physicians and hospitals meet meaningful
use for months. It offers three levels of service with varying
prices, with the first level fully subsidized and no cost to the
provider. The “gold” service is 90 percent subsidized, much
less than a private EHR consultant would charge to get a
facility to meaningful use.
“By and large we are trying to change the healthcare workflow
for a lot of different practices, and the magnitude of the task
is—I don’t want to say daunting, I think we can do it—but it is
going to be a tremendously difficult, heavy lift,” Kendall says.
Small Practices a Tough Sell
The success of the 62 RECs has varied, according to Jennifer Covich Bordenick, CEO of industry group eHealth Initiative (eHI).
Overall, she says, it has been a slow start. Some RECs are fully
staffed, have exceeded their enrollment numbers, and have begun to see clients successfully attest to stage 1 meaningful use.
But other RECs have had a hard time finding providers willing to
enroll and still have open staff positions.
eHI has tracked the program since its launch, holding progress update webinars and conducting an annual REC study. It
is too early to tell how successful the REC program has been,
or whether RECs are having an impact on EHR adoption and
health IT use, Bordenick says. But she is optimistic that the program can work.
The real test for the program, according to Bordenick, is
whether the RECs reach the small physician practices and the
rural doctors, not the early adopters. The early adopters were
probably able to meet meaningful use by themselves, she says.
Attestation for the stage 1 meaningful use program opened in