Reasons Specialists should consider using Regional Extension Centers

Last week I attended the Western States Summit and Trade Show sponsored by Arizona Health-e Connection. I learned a lot about several of the Regional Extension Center programs in the western states. Many specialists have been excluded from early participation. Reasons are both regulatory and financial. I gained some insights that I want to share. I think there are good reasons for specialists to engage the services of their Regional Extension Center.


The Regional Extension Centers (RECs) that have begun providing services to targeted Priority Primary Care Practitioners (PPCPs.) These providers are offered free or deeply discounted services to help them to adopt and meaningfully use EHRs. Services that are provided vary from one center to another but usually include vendor selection assistance, practice readiness evaluation, process improvement, change management, software and hardware contracting, discounted purchase plans, general information technology technical support, consulting on health information exchanges, and helping practices meet the challenges of achieving Meaningful Use so they can qualify for the CMS or Medicaid incentive programs. RECs so far have primarily focused on signing-up the required quota of PPCPs. To many it appears that specialists have been left to fend for themselves.


RECs are constrained by limitations of an adequately trained health information technology workforce. The workforce training program under HITEC were designed to solve this problem but it remains to be seen whether graduates will have the skills that the RECs need. Although the federal government has provided over $500 million if funding for the RECs, the program funding is limited when one considers the number of potential customers in the US. Furthermore, the RECs are having difficulty developing a business model that will sustain them once the grant funds are exhausted. They have difficulty determining fees they will charge providers not defined by the priority definition. Finally, non-covered clinicians have been reluctant to pay for the services that the RECs can provide. There are some real benefits that may be worth the cost.


One of the most difficult tasks with respect to health IT for clinicians is selecting an EHR vendor. Most small practices do not have the resources to go through the process of preparing requests for proposal and then vetting responders. Most busy clinicians just do not have the time or expertise to do a good job. However, many of the RECs are helping select one or more vendors to recommend to their clinician community. Another costly and time-consuming task is software licensing and hardware acquisition. Usually vendors offer boilerplate contracts that are slanted towards their benefit. Clinicians owe it to themselves to strive for a more balanced agreement. RECs often have invested in the preparation of balanced contract models for use by their enrollees.


Another advantage RECs can offer is lower licensing and hardware costs because they have the clout of volume purchasing. Think mini-Walmarts. The individual clinician would never be able to negotiate from this position of strength. Once a system is purchased the work does not end. Eligible providers are trying to qualify for Meaningful Use incentive payments. The training goals for clinicians and vendors often diverge once the system is configured and installed. Many vendors do not offer the services needed to help clinicians achieve Meaningful Use. The job for clinicians goes way beyond simply purchasing a certified EHR. The EHR must be used in a fashion described by the regulations with compliance on core and menu measures as well as reporting a variety of quality measures. The assistance of RECs will prove pivotal for many trying to qualify for Meaningful Use.


Finally, don't forget that we still are waiting to learn what the requirements will be for Meaningful Use stages 2 and 3. Software, hardware, and workflows will need to be periodically updated. This will probably require clinicians to seek ongoing technical assistance. The proposed stage 2 regulation most likely will be published in late December 2011. EHR users should expect an escalating list of requirements. Hopefully, the RECs will develop a sustainability model so they can provide needed services into the future for both primary care clinicians and their specialist colleagues.