How to get EMR help from regional extension centers
■ A practical look at information technology issues and usage
If a regional extension center intended as your federally funded outpost for electronic medical records assistance hasn't opened yet, it will soon.
The purpose of these centers, funded by the 2009 stimulus package, is to help physicians adopt EMRs and qualify for meaningful use incentives, which give doctors Medicare and Medicaid bonuses for their approved use of information technology.
But what do these centers do, exactly?
The nonprofit centers are designed to pair practices with a team of consultants, most of whom have clinical backgrounds in small physician practices and experience in shopping for and implementing EMR systems in that setting.
If a practice is not yet using EMRs, the centers can walk it through the entire process of choosing a system, implementing it, mapping work flows and optimizing the system to help achieve meaningful use. For current EMR users, the centers can help create a plan for optimizing current systems to meet meaningful use guidelines.
Unlike many consultants, the centers do not select a system for a practice. Rather, they assist in evaluating, choosing and developing strategies right for each practice.
Mat Kendall, MPH, acting director of the Office of Provider Adoption Support at the Health and Human Services Office of the National Coordinator, said each center will offer a unique menu of services. Those services could include getting a practice connected to a health information exchange or letting physicians subscribe to a center's own EMR system. Many services will depend on the expertise of center employees. Practices will need to seek help from other consultants for services not offered, Kendall said.
Phyllis Torda, vice president for strategy and the Quality Solutions Group with the National Committee for Quality Assurance, recently published a study in the April Health Affairs on existing centers and similar assistance programs.
Initially, she found, many centers had not planned to offer a broad range of services but now do because of the demand. But the limited number of experts, especially those with small-practice experience, means that some centers will find offering a broad array of services a challenge.
Finding a center near you
The first step to establishing a relationship with a center is to locate your local center. With the last round of federal grants awarded in April, there are now 60 extension centers across the U.S., with at least one covering each state, although not all are operational yet.
The centers that are up and running, many of which are connected with state universities or existing health information exchanges, have online links from the HHS website to their own sites, where contact information can be found. Some sites provide preliminary applications so that a center can assess the practice's needs before making contact.
Paul Kleeberg, MD, clinical director for the regional extension center serving Minnesota and North Dakota, said all that is really asked of physicians at registration is the number of primary care physicians at the practice; the number of sites; and what their Medicare and Medicaid share is.
"Once we have that information, we will come up with a plan -- based on whether they have or haven't implemented an [EMR] -- that will help them become meaningful users. And we'll let them know if they qualify for federal subsidies and how much services may cost," Dr. Kleeberg said.
As each center will have its own business model, the price of services will vary from center to center, according to Kendall. Some may offer consulting services at no charge, while others may charge for all or some services.
Torda said that even though the centers are designed to walk a practice through every step of the process, practices can do some advance work. At a minimum, practices already should have evaluated both physical space issues and the attitudes about EMR implementation from all practice partners.
Practices also can start thinking about existing processes and work flows that don't work well in their current paper world, Dr. Kleeberg said.
Another task is completing "face sheets," which detail medical histories, medications and allergies for each patient. While this doesn't have to be done before contacting the center, it is information that eventually will need to be entered into whatever system the practice chooses. Having clean copies will help smooth the transition when it is time to implement and allow other staff, besides the physician, to key this information into the system.
The more preparation, the smoother the transition will be, Torda said.
Kendall said his message for practices is: Talk to the centers as soon as possible. Not only are practices on a deadline if they want to meet meaningful use standards in time to earn the maximum incentives being offered, but the extension centers themselves also are on a deadline for funding.
For centers to receive full reimbursement from the federal government, Dr. Kleeberg said, the practices they help must demonstrate meaningful use by October 2011. "If practices sign up with the [centers] after Jan. 1, , we likely will miss that deadline, and we will have to charge them more," he said. He estimates that prices will be about 90% less than other consultants as long as centers receive federal subsidies.