Regional extension centers: Worth another look?
■ A practical look at information technology issues and usage
Early success of some regional extension centers -- consulting services created to help physician practices meet "meaningful use" standards for health information technology -- indicates that physicians may be more willing to work with people they already know and trust, or ones who offer their services for free.
More than $640 million was allocated from the Health Information Technology for Economic and Clinical Health Act, a part of the 2009 economic stimulus package, to create 62 regional extension centers across the country. The centers develop their own models for advising physicians on health information technology issues. Although some received grants as early as February, many received funding only in September, leaving little time to recruit physicians.
A survey published in September by Washington, D.C.-based eHealth Initiative found that many RECs, including the early awardees, are struggling to sign on physicians. But two centers -- CO-REC, the Colorado REC managed by the Colorado Regional Health Information Organization, and the Mississippi Regional Extension Center, operated by eQHealth Solutions -- have found early success, and their similarities may explain why.
Both centers credit their relationships with the physician community before receiving their REC designations as key.
In July, CO-REC set a goal of signing up 600 physicians within six months. By October, it had exceeded that goal, with more than 800 physicians signed on. As of this article's deadline, the number of physicians signed on with CO-REC numbered more than 900.
Mississippi REC has been recognized by the Office of the National Coordinator for Health Information Technology, with more than 600 physicians signed on.
The Colorado Regional Health Information Organization contracted with six other groups to help deliver services, said Robyn Leone, director of CO-REC. Those groups are paired with clients they had relationships with, such as the Colorado Community Health Network, the membership arm of the Federally Qualified Health Centers, which is contracted to work only with FQHC centers.
"Our numbers of having 920-plus providers enrolled speaks to the fact that these six organizations have their stakeholders and the knowledge they bring to a certain part of the provider community," Leone said.
Diane Jones, vice president for policy and programs at the eHealth Initiative, said several RECs planned to use subcontractors to handle the workload. She wondered if the subcontractors with local connections might have better success. "Part of the challenge is building the trust," she said.
Experience a plus
Robert Johannessen, corporate director of communications for eQHealth, which operates the Mississippi REC, said his organization had previous experience working with the physician community. The group was a federally contracted vendor through the federal Doctor's Office Quality-Information Technology program, which relied on the Centers for Medicare & Medicaid Services Quality Improvement Organizations to help physicians choose and implement IT systems, across the border in Louisiana, where eQHealth is located. EQHealth is also the QIO for Mississippi.
Sean Marchiafava, chief information officer for eQHealth, who has spent time with other RECs in regional conference calls, said many of the centers haven't yet defined what their service model will look like, so physicians are reluctant to sign a contract.
Leone says the services each REC offers will depend on the organizations' experience. REC awardees include universities, existing health information exchanges and some QIOs. Each will approach the work differently depending on the skills they bring, she said.
Meanwhile, Mississippi and Colorado offer their services at no charge, which the centers also believe has contributed to their success. The organizations behind these RECs are using their grant money and funds from other businesses to underwrite the free services.
"RECs aren't seen as particularly helpful for some physician practices, because the information they provide is limited, and in many cases they are charging for it," said Brenda Gleason, president of M2 Health Care Consulting, which has offices in Denver and Washington, D.C.
Leone said the decision to offer the services for free was based on the organization's altruistic point of view coming into the project. She said the business model was built around the commitment to offer the services at no charge, but she said physicians are informed that there are limits to what can be offered.
Cathy Davis, executive director of the Kansas City Quality Improvement Consortium, one of several subcontractors hired by the REC covering Kansas City, Mo., said her group, which is just getting started, decided not to charge after it saw the problems other RECs were having when they decided to do so.
Davis said that as a subcontractor, her organization is taking a cut in the amount of money it is paid from the REC grantee to provide services for free.
Though physicians can't dictate how their local RECs operate, there are things they can do to help ensure that centers accomplish their mission of helping primary care physicians.
Each RECs has goals to meet in terms of how many practices they need to sign on. If those goals are not met, they don't get paid. Therefore, they have an incentive to sign up doctors. But Davis said there's nothing wrong with a physician asking, "What's in it for me?"
She said the REC should be able to articulate how it is going to help each physician, given individual circumstances.
Gleason advises doctors to check back with the RECs if they decided they don't have much to offer right now. "As time goes by, and there is more pressure to enlist physicians, benefits could be added down the road. Decide now, and put a reminder on your calendar to check back in three months and six months to see if anything has changed," she said.
Jones, of the eHealth Initiative, said she plans to conduct a survey in early 2011 that is similar to the one published in September.
But the survey will look at specific challenges some RECs face and some lessons learned from those considered successful. February will mark the one-year anniversary of the HITECH Act, and she said it would be a good time to check back in with the RECs to see how far along each one has come.