There are 62 ONC-funded Regional Extension Centers (RECs) across the country, and although their models may differ, their aim is the same – to help more than 100,000 providers enroll, implement and meaningfully use electronic health records.
It has been nearly two years since ONC began funding the first RECs, and many are starting to meet their enrollment goals and see providers attest for meaningful use. Last fall, the Maine Regional Extension Center (MEREC), which is operated by HealthInfoNet, the state's health information exchange (HIE), met its enrollment goal of 1,000 providers. MEREC's services are free and for enrolled providers the fee is waived for the first year of being a part of the HIE.
HealthInfoNet enrolls providers through its wholesale partner organizations – providers associated with larger organizations that already have an EHR deployed, and retail organizations – smaller providers that may be paper-based or do not have access to IT support. Retail organizations must be under contract with MEREC's supported vendors. According to Rob Cook, MEREC program coordinator, (pictured above, at right) 70 percent of providers enrolled have implemented an EHR and 7 percent have met meaningful use. “We expect to have the bulk of providers meet meaningful use this year,” Cook said.
“This is a complicated time for providers,” with so much changing on today’s medical landscape, said Gemma Cannon, MEREC service coordinator (pictured at left). “RECs are well-situated to clarify things for providers and give them a roadmap to look at,” she said. Being enrolled in a REC gives providers “someone in their corner,” Cannon added.
The website operated by the Centers for Medicare & Medicaid Services, which administers the meaningful use incentive programs, offers extensive guidance, Cannon said, but providers can get lost in it. “RECs can provide clear and good information” to providers. When the REC can't answer a particular question, it can submit it to the national office, serving as “a bridge to government entities that are in charge of these programs,” Cannon explained.
Through its partnership with Quality Counts, a regional healthcare collaborative based in Manchester, Maine, MEREC can help providers develop a “gap analysis” as to where they stand for attesting for meaningful use. “We can give providers a granular, deep dive of each of the measures to meet meaningful use,” Cannon said.
“I'm sure we will still need and use the resources available through the Maine REC, not just for meeting Stages 2 and 3, but for staying apprised of all the changes that continue to happen even with Stage 1,” said Kathryn Galbraith, MD, of Galbraith Family Medicine, LLC, in Limerick, Maine. “The healthcare environment is rapidly changing with the switch to electronic media for documentation, communication and tracking, and the evolution of quality-based payment programs. Meaningful use is just the beginning,” said Galbraith. “We also would hate to give up the chance to network further with others like us who struggle in this changing environment just to keep up, much less thrive,” she added.
The REC of New Hampshire (RECNH), which is operated by the Massachusetts eHealth Collaborative (MaeHC), doesn't charge an enrollment fee for its providers either, but is “vendor-neutral,” said Jeff Loughlin, project director with the Massachusetts eHealth Collaborative and director for the RECNH (pictured below, at right). This means the ONC pays the grant funds directly to the REC if they are working with a small provider that does not have the internal resources to implement an EHR. For larger organizations, like Dartmouth-Hitchcock, “we pay their implementation staff the milestone payments to support their own providers,” he added.
“We were one of the last RECs to be funded,” he said. But he added that coming in a bit late actually worked to their advantage. By that time, Loughlin said, “the market was driving the pricing model” and there was “no need for us to strong-arm vendors to decrease their prices.” With 1,140 providers enrolled in the REC, he said they have exceeded their enrollment goal and reached the cap on their funding. However, Loughlin is encouraging providers to continue to sign up because of the resources and networking the REC can provide. Currently 850 enrolled providers are using an EHR and 300 have met meaningful use. Loughlin said RECNH is working on getting a secure Web portal up on their site where enrolled providers can share information and communicate with each other.
Providers should “absolutely take advantage of their RECs,” said Loughlin. “There are so many confusing messages,” he added, and RECs provide a “single, trusted advisor.” There is “no down-side to connecting with the REC. We still can provide guidance on meaningful use, and we can help with technical questions – or have the connections to get the answer,“ Loughlin said.
“The RECNH was very hands on – they came for the implementation, stayed for all the training and helped make the start-up seamless,” said Robin Hallquist, MD, the first solo-practicing physician to work with RECNH as well as the first in the state to achieve meaningful use Stage 1. “When it came time to attest, I truly could not have done it without [our rep] Jaime Dubois. She knew that the numerators and denominators changed midstream. I would have missed that. She also helped with the security policies and procedures required for meaningful use, essentially writing the entire manual. She had worksheets and guidelines, and the knowledge of what was needed to meet the requirements,” Hallquist added.
Vermont Information Technology Leaders (VITL), which is both the designated HIE for the state of Vermont and the federally designated REC, has also met its enrollment goal with 857 providers signed up, said Steve Larose, vice president of external affairs at VITL. Larose encourages more providers to sign up though because he said the funding is there. Out of enrolled providers, 579 have gone live with an EHR, and out of those 35 have achieved meaningful use, he said. VITL also has not contracted with any vendors, but has a list of preferred partners that have to meet criteria set up by VITL.
The REC in Vermont is unique in that it hired its own employees – most of which were former practice managers, to serve as implementation specialists that travel to provider sites to provide hands-on help, Larose said. These specialists start by mapping out a work plan – one that is right for the provider, he said. If the provider hasn't chosen an EHR, the specialist will aid in the selection of the vendor and help them to negotiate terms as well as help with implementation. “Once it is live we will stick with them and help them get to the third milestone – achieving meaningful use.”
VITL does not charge providers for their services said Larose, but because there is a set amount of money allotted for each provider, they have to “maximize the time spent on site.” He said their website also aims to give providers “full-service” help. For example, a video posted on VITL’s website shows an implementation specialist walking a doctor through filling out the meaningful use attestation form.
Please see the companion article, “8 ways a REC can help,” for specific pointers from an experienced practitioner.