Is REC a Future Train Wreck?

Yesterday, HHS’s ONC announced the final two Regional Extension Centers (RECs), one in California and the other for the state of New Hampshire. Much like the Land Grant College Program and the much smaller Sea Grant Program, the HHS RECs have been established to assist in the appropriate adoption and use of technology, in this case EHRs. Since the passage of the HITECH Act, there has been concern that harried physicians in small practices will struggle to take advantage of the HITECH Act and the incentives therein for the adoption and meaningful use of certified EHRs. (Geez that’s a mouthful). State RECs, staffed with IT specialists will be charged with venturing forth into the countryside and cities to help physicians adopt those EHRs and get those HITECH incentive payments.

Chilmark has some very strong reservations about the success of the REC program.  Well, we’ll go even farther to say that it is destined to go over the proverbial bridge, plunging into the abyss of failed federal/state programs.

Now the folks at Software Advice have outlined 5 reasons why they see the REC as “RECkless” and they have, for the most part nailed it.  Where Chilmark differs is more on emphasis, where we focus on three key points:

1) The RECs will not be able to staff themselves with strong HIT talent. There is a gold rush happening right now with software vendors, consultants and other HIT service providers flat-out.  Chilmark sees this first-hand in our daily conversations with numerous HIT companies, with many expressing that they are challenged to find good talent. So, if the private sector, which certainly pays far better than the public sector, is having difficulty getting talent, RECs will struggle even more. Which leads to the question: How competent will these REC advisors actually be in the field in assisting physicians in adopting best practices for HIT deployment and use? Yup, doesn’t look too pretty from this vantage point.

2) RECs artificially limit the market for EHR solutions. It would be a Herculean task to ask RECs to provide support for all 300 or so EHRs now in the market. To overcome this, RECs are picking just a few EHRs that they will take to market in their state.  For example, Massachusetts has picked 10 preferred vendors: AllScripts, athenahealth, eClinicalWorks, eMD, Epic, GE, Greenway, MedPlus, NextGen and Sage. Vermont has picked only three, AllScripts, athenahealth and Fletcher Allen. And then we have the great state of Virginia with also a measly three preferred vendors, AllScripts, athenahealth and MDland.  Sure, AllScripts is a national brand and known for their ambulatory solution, but so is eClinicalWorks that has been on a tear in the ambulatory market. And athenahealth, only recently released a version of athenaclinicals that is robust enough for a small to mid-size practices. So what about all the other EHRs, some quite capable in meeting a physician’s requirements?  Will they fall to the wayside simply because they were not politically savvy enough to get on-board with these RECs?  Talk about warping the free market upon which this country was founded.  Quite sure that Adam Smith is rolling over in his grave on this one.

3) Time or lack thereof. As part of the Stimulus Bill (ARRA), which was more about putting people back to work, the HITECH Act has a very aggressive schedule, so aggressive that it is likely that much of the federal largesse now beginning to be poured into this still immature market will be wasted (our guess: x > 35%). It takes time to recruit talent. It takes time to train and deploy them effectively.  The time horizons for physician adoption of EHRs to capitalize on the incentives are ridiculously short. Add all of this together and it’s not a pretty picture. This is not the fault of any government agency and the staff therein who are trying to do the best job they know how – no, they were just dealt a very difficult, if not un-winning, hand.

Unfortunately, the train has already left the tracks on this one and all we can do is sit-back and watch the inevitable.  But along the way towards that final plunge over the bridge, Chilmark does sincerely hope that in some small way these RECs will indeed have some impact on the effective adoption, deployment and use of EHRs by clinicians as even a little is better than where we are today.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

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7 replies »

  1. If the RECs stick around they are retarding the development of the market by selecting preferred vendors. To date, the bias to vendors with share and relationships have held sway. Under this scenario, we’re looking to the future with our solutions rooted firmly in the past. The scariest part of the RECs is that they’re supposed to become self sustaining. The only way to accomplish this is to seek added taxpayer funds or create shadow economic relationships with their pet vendors that rationalize their fees to MDs (e.g., discount to MDs who pay to be part of RECs). I suspect the quid-pro-quo with “preferred” vendors has already begun. Any practice that looks to RECs for guidance is not looking to where the practice of medicine is going but where its gone. Hopefully, the RECs will soon be in our rear view mirror along with their preferred vendors.

  2. Rick,
    We must take into account the potential liabilities, not just the good parts. Unfortunately, the playing field is NOT level, and the RECs (with their pots of public money and harried time schedules to produce deliverables) are political / business environments – not merely quality shops. I agree with your point that the prior strategy for proliferating EHRs was not adequate; and I don’t think the RECs are necessarily all bad…but they’re not all good, either, and every stakeholder needs to push for transparency, fair-play, and broad market openness – and not allow the well-connected or the EMRs with the best sales programs dominate. The more light of broad-based scrutiny that can be shed on these programs, the better for everyone involved…none of them merits a blank check of taxpayer money.

  3. I fail to see the problem. As to point No. 1, if HIT companies cannot find talent when there’s 10 percent unemployment, it’s no one’s fault but their own. They merely need to budget for more training. The RECs, much as the land-grant cooperative extension services did, will hire the young and inexperienced, and the private sector will pluck these people up when they prove themselves. It ain’t a bug, it’s a feature.
    As to point No. 2, sure, there may be 300 vendors of EHRs, but unless you believe in the Lake Wobegon effect, they can’t all be above average. The process of separating the wheat from the chaff will merely be accelerated by the RECs. Again, a feature, not a bug.
    And as to No. 3, the playing field is the same for everyone. Winners will rise to the top, and consolidation of the lesser competitors will likely follow. This also seems a desirable outcome.
    Will proliferating EHRs be hard? Yes, but if it was easy we would have already done it. And after all, wasn’t that always the big complaint?

  4. We don’t have to sit back and watch anything…these programs have good potential if all stakeholders remain engaged and steer it in the right direction. I agree, however, with the tenets of this article, but still believe it is possible to derive much good from the REC program – if all hands show up on deck, and speak up. Remember – the money funding this is taxpayer money. Therefore, everyone has a voice – and should use it.

  5. “State RECs, staffed with IT specialists will be charged with venturing forth into the countryside and cities to help physicians adopt those EHRs and get those HITECH incentive payments.”
    To adopt poorly usable devices being pushed by the Feds, in fact, to even let them in the door with their sound bites, doctors would have to be foolish. Why would anyone want to disrupt their patient care processes with devices that are known to cause adverse events, delays in care, and mayhem with work flow??

  6. “all we can do is sit-back and watch the inevitable”
    One scarcely know where to begin here. So, you’re summarily passing judgment that the RECs are going to fail en masse?
    I am certainly no Pollyanna REC cheerleader — nowithstanding that I work for one — but the truth of the circumstance is a good bit more complex (not to dismiss all of your concerns out of hand — read my blog). Moreover, I find some of this implicit schadenfreude disturbing. What RECs need is support — given the substantial taxpayer dollars invested in the initiative — in lieu of a chorus of straw man carping from the sidelines, much of it coming from commercial and political interests with axes to grind.

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