Regional Extension Centers: Advancing Health Information Technology Adoption and Use

It gives an overview of future plans for the NYC Regional Extension Center for New York City (REACH) along with insights from Accenture’s Electronic Health Record (EHR) implementation and provider adoption experiences, to guide other Regional Extension Centers (RECs) nationally as they launch.

In this paper, we differentiate recommendations that fit a particular type of REC model. We will also discuss several of the most common challenges that the different types of RECs are likely to face in the coming year, and provide lessons learned and insights where appropriate:

• Community Provider Engagement
• Vendor EHR System Selection
• Supporting Tools for the REC
• Sustainability
• Life after Meaningful Use

Promoting universal adoption of electronic health records (EHRs) has been a federal objective since President Bush established the Office of the National Coordinator for Health Information Technology (ONC) in 2004.

The passage of the American Recovery and Reinvestment Act of 2009 (ARRA) created the first national program to directly reward EHR adoption and use. ARRA created separate federal funding to create 60 Health IT Regional Extension Centers (RECs) across the country, drawing on the success of community EHR adoption projects such as the Primary Care Information Project (PCIP) at the New York City Department of Health and Mental Hygiene as a model.

Through PCIP, more than 2,000 providers that serve Medicaid, patients and the uninsured now use EHRs. After implementation, PCIP provides on-site consulting to establish clinical workflows that leverage the EHRs to improve measured health outcomes. This network of engaged practices works with PCIP to pioneer initiatives that use the power of technology to accomplish public health goals, with a focus on prevention, continuity of care and cost reduction. The impact of these efforts is captured by automated, aggregated quality reporting from each practice to the Department of Health.

PCIP achieved high levels of meaningful adoption at small practices through five major initiatives:

• Broadcasting expectations to vendors.
  
  
• Investing resources in outreach and communications to providers.
  
  
• Creating accountability for vendors through close project management of the implementation process for PCIP, helping ensure that implementation drives measurable improvement in public health outcomes.
  
  
• Establishing multiple revenue sources, including contributions from providers and health plans.
  
  
• Linking EHR adoption to measurable public health and health care system goals.

Regional Extension Centers have an unprecedented opportunity to extend care delivery leading practices into small office providers while helping them adopt interoperable EHRs.

Additionally, they will assist HIE state-designated entities to help implement statewide governance and technologies to pro-mote patient-centric care. As health care reform evolves, Regional Extension Centers can provide valuable implementation resources, given their local relationships and breadth of services provided.

To be more successful, RECs should engage providers that are not only the “low-hanging fruit” that are easily engaged, but also those currently contemplating whether EHR adoption is in their best interest. Moving providers along the adoption path will likely require RECs to team with leading EHR vendors that will be there for the long term. RECs will likely need to develop vendor-agnostic and vendor-specific tools to support their activities in order to help confirm that all providers are delivered quality service.

While RECs have been given a limited scope of services to provide to providers today, they should keep future demands and anticipated needs in mind when developing a sustainability plan. We recommend that the REC sustainability plan focus in the short term on enhancing clinical processes through value-added services with a long-term eye on improving quality and health care reform initiatives.