2011 was a year of change and tumult. For a day by day look at the top stories of 2011, check out this impressive chart from the UK Guardian.
It was a year in which the economy sputtered worldwide, the Arab Spring toppled several regimes, and unprecedented acts of nature (severe weather, earthquakes) caused billions in worldwide damage.
What about the world of healthcare IT?
In 2011, Meaningful Use and Certification accelerated healthcare IT adoption and doubled implementation of EHRs throughout the country. Every aspect of the industry was stressed along the way
- Vendors were challenged to add the features necessary for certification resulting in some “haste makes waste” lack of usability and workflow integration. GE admitted its faults and should be congratulated for its honesty, since many other vendors had the same problems but did not communicate them.
- IT organizations created productivity miracles to meet meaningful use timeframes with limited staff and limited budgets. Many organizations will apply their meaningful use payments to general operations and not IT department budget increases, so the sacrifice of IT staff may remain unrecognized.
- Providers had to radically change workflows to accommodate new business processes, resulting in staff turnover and short term frustration.
Making clinical data liquid permeated a series of events I attended last week during Health Innovation Week in San Francisco. Monday and Tuesday found me at the HIE/REC conference. Wednesday was HealthCamp at Kaiser-Permanente’s Garfield Research Center (KP was extremely gracious in hosting this event and the opportunity to get a tour of the facilities prior to event kick-off was great). The week concluded with the annual and well-orchestrated Health 2.0 conference.
This first post will focus on the HIE/REC event as it was quite distinct from the other events: smaller audience, more staid, dominated by government officials and tied at the hip, for good and bad, to the existing healthcare system infrastructure.
The HIE/REC conference was an odd event with attendance hovering around 200 or so attendees. The event was focused almost entirely on what the States are doing with the federal funds coming their way to establish Regional Extension Centers (RECs) whose main objective is to get priority primary care physicians (PPCPs) to adopt and meaningfully use a certified EHR. Now, having been to this event and heard many of the State REC initiatives that are now underway via this program, sad to say that my original opinion has not changed. Rather than picking preferred EHRs and assisting with deployment, these RECs may be better off just helping to these PPCPs understand exactly what the HITECH Act is, what are their options, what questions to ask of a vendor or service provider and leave it to EHR consultants and vendors to take it from there.
The Health Information Technology Extension Program, created and funded by ONC, has completed funding for all 62 Regional Extension Centers (REC), with a grand total of well over half a billion dollars and, predictably, criticism of the program was immediately forthcoming. The RECs are supposedly an impediment to free EHR markets and doomed to failure from the start, which may seem a bit contradictory if you think about it. Anyway, before making further statements and assertions regarding the “recklessness” of the RECs, or the impeding “train wreck” they represent, it may be beneficiary to take a closer look at the program.
The HIT Extension Program consists of 62 RECs, at least one for each State and territory, and one national Research Center (RC). The stated goal of the program is “to provide outreach and support services to at least 100,000 priority primary care providers within two years”. The individual RECs are supposed to conduct outreach and education campaigns in their respective States and inform physicians on the latest HIT developments and available programs and incentives. The RECs are also chartered to offer support and guidance to physicians selecting and implementing EHRs, particularly Primary Care docs in small practices and in underserved areas. These are the doctors that were left out by the regular market process because they were hard to reach, too expensive to implement and too poor to bother with. While the individual RECs are locally oriented, with feet on the ground in each State and each County, the RC is basically a National forum for RECs to share information and exchange lessons learned.
Other than a small amount of seed money, RECs are not handed out all those hundreds of millions of dollars of grant funds. RECs are paid for performance. For each physician they touch and manage to recruit, the RECs are paid about $1500. If and when the provider implements an EHR, the RECs receive another equal payment. The last third of the money is handed to the REC if, and only if, the provider achieves Meaningful Use. This arrangement is only in effect for two years. All those who believe that RECs are bound to fail should be reassured by the fact that in that dire case most of the allocated funds will remain with ONC. The RECs are expected to use the ONC seed money and find a way to become sustainable businesses after ONC ceases to support them financially.
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.