Home Forums Discussions General Discussion Regional Extension Center (REC) Program

I'm interested to know what providers/practices opinions are of the REC program and if you are taking advantage of their services?

ONC List of Regional Extension Centers

I looked at one of these in NYS and looked like they wanted me to buy a certain emr of which AC was not a choice so I just left the site.

Although the concept of the RECs is great - the way and manner they have been implemented and funded is a huge mess. Here are the facts (as I see them):

? As part of the ARRA/HITECH legislation, 60+ Health IT Regional Extension Centers (RECs) have been funded primarily to assist individual and small group practices of 1-10 providers in selecting a certified Electronic Health Record (EHR) that offers the best value for provider's needs (see HHS.gov | HITECH Priority Grants)

? The Office of the National Coordinator (ONC) within HHS is tasked with the selection, management, and oversight of the RECs.

? The RECs have each developed their own process to evaluate EHRs and have begun recommending selected vendors to physicians.

? The REC selection process is not transparent and appears to be based on an application process that is poorly designed and fails to take into account evidence-based data on EHR quality and usability.

? The result is that RECs are selecting EHR systems that neither offer providers the best valued software (i.e., more affordable systems) nor software that meets providers' needs (i.e., usable, easy to learn, promotes office productivity, etc).

? Several EHR vendors offer significantly less expensive EHR programs that are rated higher by users in multiple independent studies than REC-selected systems.

Thus, I believe immediate action is thus required by the ONC to mandate that the REC process is fair and that physicians are able to make an informed decision before adopting Health Technology:

1. Require Full Transparency. The ONC should require that RECs make full disclosure of who is making the decisions, their credentials, and their current relationships with EHR vendors; all of this information should be published in a standard way on a public website.

2. Include Practicing Physicians In The REC Selection Process. The ONC should require that a majority of each REC selection committee be composed of practicing physicians working in 1-10 provider practices.

3. Standardize the Application Process. The ONC should require RECs to aggregate their individual applications into a single document, much like the universal college application, and each vendor?s response to this common application must be available for scrutiny by the public.

4. Apply Evidence-Based Analysis. The ONC should require RECs to base their selection on data from scientifically sound studies of providers and staff using these systems.

5. Require Vendor Neutrality. The ONC should require that all physicians being assisted by RECs must be provided pricing and usability data for all ONC-ATCB certified EHRs and that any specific REC marketing collateral be based on publically available information.

Thus I went to Washington DC in January to discuss my concerns personally with Mat Kendall, the Director of the Office of Provider Adoption Support (the person in charge of the RECs) and Chris Muir of the ONC and have also discussed my concerns with Congressman Jim Langevin (D-RI), Senator Jack Reed (D-RI), and Senator Sheldon Whitehouse (D- RI).

I would like to believe that these meetings played a role in a subsequent memo I heard about, sent from the ONC to all the RECs reiterating the need for an appeals process for EHRs not selected as well as transparency of the selection process. It is also interesting to note that the head of the ONC, Dr. Blumenthal (appointed by President Obama in 2009), announced last week he would be stepping down. While it is being spun as not related to problems within the ONC or REC process, it seems to me that the RECs are failing their mandate, and that over 600 million taxpayer dollars are being wasted. Of course I'm biased, but the following seems blatantly obvious:

1. In multiple studies (summarized here) Amazing Charts is rated easier to implement, easier to use, and has a significantly higher user satisfaction rating than the EHRs being pushed by the RECs.

2. Amazing Charts is much less expensive than the EHRs being selected by the RECs.

3. Amazing Charts is used in more small practices than nearly every other EHR selected by the RECs.

In my mind, Amazing Charts should be on every single REC list as it clearly is the best value for providers in small practices - and is also easier to use, implement, and our clients are more satisfied with us than the clients of the EHRs that are being selected by the RECs.

So why is Amazing Charts not the choice of every REC? Just as Occam's razor is the principle which recommends selecting the competing hypothesis that makes the fewest new assumptions - there is a principle that explains the illogical results seen in the REC process, Hanlon's razor:

Never attribute to malice that which is adequately explained by stupidity.

I believe that in the rush to obtain the taxpayer funding for health technology (aka HITECH), RECs reasonably concluded that they should use IT consultants to make their choices. Unfortunately, unlike medicine that is based on the scientific method comparing outcomes in different groups, IT consultants (in general - not you, Indy) base their decisions on case studies and anecdotes. They read a beautiful case study written by the marketing department of the expensive EHR company, and buy it hook, line, and sinker. Alarmingly, even when there is evidence to the contrary - see the user survey studies referenced above - they are not trained as we are to look at the facts and draw non-emotional conclusions. And thus, the best and most affordable EHR gets ignored.

Since the RECs are paid for by us, I was not willing to just accept this and thus have been quite vocal. This certainly may further alienate us from the RECs, and we are trying to work with them to build HIEs and other connections since many of the RECs clients are already Amazing Charts users. The success of the RECs (and the entire Health IT taxpayer-funded initiative) is based on how many providers reach Meaningful Use by the end of 2012 - something we are focused on currently and which our V6 ONC-ATCB certified version should make a (relatively) painless process later this quarter. My goal is to prove to the ONC that Amazing Charts is not only the best value, we also can bring our clients to meet Meaningful Use guidelines faster than the RECs.

More on getting to Meaningful Use is coming soon... stay tuned. But in the meantime - email your local REC right now and tell them your experiences with Amazing Charts and why they are doing a serious disservice to you and your colleagues by pushing overpriced and inferiorly rated products (and please CC/BCC us); we have been informed by many RECs that the feedback from existing users is important to them, though I'm not sure if this is just lip service in response to my concerns. And if you've previously used another EHR, let the REC know how your experiences with us compare.

Jon

Jon,

Thanks for making a point of excluding me from the majority of the herd.

As a tangential subject, are HIEs part of HITECH, or are they a separate initiative? I am hearing increased 'chatter' about them, and I have wondered if they might be a means by which AC could be part of the larger disparate EHR eco-systems.

Just as I suspected!!

So I just attended a seminar by our REC and have been lead to believe that AC will be fine for meaningful use and they are coming to meet with me in the near future. There were two tracks at the seminar one for those already using emr and one from those who weren't. They were not pushing AC but I was told I would definitely be eligible. In fact they will waive some $750 fee for solo primary care like me.

I feel a need to contradict some of Jon Bertman's post. My partner was on our state selection committee and spent some time researching the available products at the time (1 1/2 yrs ago.). The main reason AC did not make the cut is that it was not certified at the time. Additional reasons were that several hospitals had partnered with other EHR vendors to give an attractive price to a system which would allow for freer data exchange if adopted by all physicians in their service area as well as extensive IT support, and the rather small size of the AC company. As to the latter, a number of members of the group had been burned when one or another software vendor went out of business. In the eyes of the selection group, it was both a strength and a weakness of AC that it is so dependent on one person. What happens if Jon Bertman is hit by a train?

Having said that, you will notice that we chose AC. Our hospital was not interested in providing a group purchase and support program, and we ourselves do not need to look to long term support and enhancements as much as our practice horizon is relatively close. But, the group had to make a recommendation for the entire state, and that is how they chose.

It is precisely because the working group was comprised of practicing physicians that there is no big move afoot to revisit this. Everyone volunteered their time (lots of it), and no one is anxious to do it all over again.

Would things have been different if AC had been fully certified? Very likely. But it is unfair to characterize the choice as foolish or uninformed because AC was a day late and a dollar short.