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Electronic Health Records


Is an EHR regional extension center right for you?


To assist eligible providers, regional extension centers were funded to move practices from paper-based to EHR-based documentation, but there are other ways to accomplish the same result.


By Arthur Gasch, founder, MSP; and Bill Andrew, executive VP, MSP U Ath G


.S. physicians who are eligible providers (EPs) will adopt electronic health records (EHR) in the next three to four years or face federal patient reimbursement penalties. To assist


EPs, regional extension centers (RECs) were funded to move practices from paper-based to EHR-based docu- mentation; but there are other ways to accomplish the same result, including independent EHR consultants and “do-it-yourself” approaches. This article contrasts these approaches and looks at how the change in the federal approach has affected EHR adoption processes overall. Be aware that RECs are not a homogeneous group of organizations, rather they vary a lot in their approach to the market, and so your local REC may be different than described here. According to a 2009 American Medi- cal Association news article, 30 percent of EHRs are aban- doned or unin- stalled within two years after deployment. Recent esti- mates of unin- stall rates are even higher.


Arthur Gasch and Bill Andrew are founder and executive VP, respectively, of MSP.


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For EHR developers, RECs recall the DOQ-IT Quality Improvement Organization (QIO) initiative of the Bush Administration. RECs were part of 2009’s $34 billion American Recovery and Reinvestment Act (ARRA). ARRA empowered the Offi ce of the National Coordi- nator (ONC) to establish RECs to assist thousands of EPs (collectively 100,000) to become meaningful users (MUs) of government-approved EHRs within three years. It’s the most expensive government EHR-adoption program ever, so the stakes are high. Washington’s actions in threatening to reduce Centers for Medicare & Medicaid Services (CMS) reimburse- ments to physicians are creating anger. Doctors who see Medicare and Medicaid patients are becoming extremely


14 August 2010


frustrated with these antics. Taxpayers are afraid of spending so much money and making a costly mistake that will harm America’s senior citizens and 33 million newly insured under the healthcare reform legislation just passed.


In the July issue of Health Management Technol-


ogy, the impact of 16 months of MU defi nition delays was discussed. Now that MU is fi nally defi ned, market confusion may abate, coaxing some EPs back into the market. REC revenues depend on that, but RECs face competition from independent EHR consultants. How can EPs decide who will guide them?


Uncle Sam is giving RECs about $5,000 to help EPs adopt EHRs. Here’s how it works: When a REC enrolls an EP it receives around $1,666, the fi rst of three ONC grant payments. The second payment is received after an EHR is deployed and provides computerized provider order entry (CPOE) functions, electronically receiving lab and other test results and implementing electronic prescribing (e-Rx). The REC receives the third payment after the EP demonstrates and is certifi ed as achieving MU for 90 days.


Each REC has the same payment deal with the ONC. Does this REC payment schedule distort the EHR plan- ning process by prematurely accelerating EHR adoption and deployment before other essential tasks are per- formed? Should an EP choose their REC or an indepen- dent EHR consultant to help them adopt an EHR?


Independent consultants


Independent EHR consultants (ICs) lay much ground- work before selecting EHR products. Product selection is not among their fi rst priorities, perhaps because ICs are not locked into the government’s three-payment scheme. ICs determine practice readiness, assess networking in- frastructure, determine EP user-interface preferences, determine facility renovation requirements and guide EPs to consider if patients should enter their own data via in-offi ce kiosks or Web portals. ICs discuss the server location (in-offi ce versus over the Internet), including remediation strategies for vari-


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