I know that many of you don’t read all of the past comments made on this site. So, I’m sure many of you missed when DonB asked Bobby Gladd the following question:
Could you explain your statement at the end of the fifth concern: “I would have added another MU criterion: require working with the RECs as a condition of incentive money eligibility;”

Bobby, from this REC blog, offered the following well thought out answer:

HHS is spending nearly a billion dollars on us RECs, yet we then have to go out and “recruit” providers, doing months of cold-call sales?

That just opens the government up to right-wing charges that Obama is simply blindly throwing money around at cross-purposes.

Many vendors and VARs see us as “competition,” which, in my view, is why we’re seeing some of the RECs doing “preferred EHR vendor” deals — basically trying to ensure that they don’t get cut out of the picture. Were I a viable vendor in a REC state that had excluded me, I might want to consider suing. It reeks of potential conflict-of-interest. Moreover, what about the true interest of the clinician? (Which is why we are officially and assiduously “vendor neutral.”)

Why should a practice work with us? Because we have broad and deep expertise available, soup-to-nuts, at a pittance of the cost of private commercial consultants.

It just begs the question of why RECs are even necessary. Maybe we’re not. Maybe docs can go it alone, or pay commercial consulting rates (that would eat up all their incentive money and then some). However, having decided that RECs are a value-adding thing, I fail to see the wisdom in making us optional.

Many of the RECs are going to fail. They won’t even get to demo their implementation/adoption support chops, they will fail because of the recruiting resistance, and will have burned through most of their initial HHS funding, and will have to start laying people off (I won’t be allowing mold to accrue on my CV).

To date, the leading REC in terms of recruitment is Qualis. Halfway through the expected recruitment period, they are at 9.2% of goal, notwithstanding a Code Red All-Hands-On-Deck recruitment effort.

I’ve been meaning to write a post linking to BobbyG’s blog for a while and just never got around to it. If you follow the comments on here, you’ll have seen many of BobbyG’s comments as well. The thing that first struck me about Bobby was his sincere and thoughtful comments on the challenges that the RECs face. Here’s some of his thoughts on REC Challenges:

• Critics bemoan a lack of prior HIT deployment and QI experience among some REC awardees (as well as the heterogeneity of business models);
• While 60 REC contracts have thus far been awarded, with the newly chartered RECs frantically ramping up to meet the rather compressed Stage One Meaningful Use incentive payment timelines, both the requisite Meaningful Use reporting criteria and the EHR (Electronic Health Record) certification regulations remain unresolved at this writing. The cart is seriously out in front of the horses in many respects;
• The anticipated huge and short time-frame new demand for HIT installs may well overwhelm the capacity of HIT vendors, resulting in lengthy, problematic implementation queues (not to mention a severe shortage of qualified installation, training, and support personnel);
• Notwithstanding that HHS is spending hundreds of millions of dollars on REC contracts, physicians and hospitals are not required to engage REC services in order to qualify for federal incentive payments. Consequently, RECs are having to spend significant time and money hawking their services (the polite term being “enrollment.” I did not know when I signed on that I would be required to do what amounts to hastily and minimally trained cold-call sales). Moreover, REC services are not fully subsidized, the upshot of which is often skeptical ”we’ll pass” pushback, especially in light of the hyperbolic claims of virtually all major EHR vendors “guaranteeing” that their products will get the provider to MU (with the glossed-over disclaimer, well down in the fine print”When Used As Directed”);
  • At this writing, the aggregate Final Rule for MU criteria is still under HHS consideration, with myriad professional stakeholder groups arguing for relaxation of both the compressed compliance timelines and the all-or-nothing approach, countered by a broad array of equally vocal consumer/patient advocacy organizations arguing for MU criteria adoption “as-is” as set forth in the Interim Final Rule.

    I would have added another MU criterion: requireworking with the RECs as a condition of incentive money eligibility;

• The relatively sparse per-provider federal REC funding may force the RECs to focus simply on assisting their client physicians with hitting the MU criteria in pursuit of the incentive reimbursements — to the practical exclusion of broader and more sustainable, internalized quality improvement efforts;
• There is to be a “Health IT Research Center” funded by HHS and intended to “gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Extension Centers (RECs) collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support. The HITRC will build a virtual community of shared learning to advance best practices that support providers’ adoption and meaningful use of EHRs.”

  It is not even slated to be up and running until FY2012.

I think most of these points hit the nail on the head. RECs are in for some major challenges. It will be interesting to watch those that creatively confront those challenges and those that fold under the pressure of it all. I still stand by my opinion that they could be a tremendous force for good or bad. Considering there are so many RECs all over the US, I’m sure we’ll have plenty of both types.

There was a pretty interesting thread posted to a LinkedIn group about the RECs. Here’s some comments that will make you think a little bit about the RECs and in particular the RECs working together (or not).

It is understandable that REC’s must adapt their programs to the communities they plan on serving….Healthcare is local. However, living in Florida, where there are 4 REC’s, I expect some things to be consistent…for example the implementation process should include the same pre-implementation workflow worksheet. Unfortunately, this may not happen.

We know that ONC is asking that the REC’s play nice and share best practices. However, as a consultant that is talking with 3 of the 4 REC’s about a role….one REC leader in Florida asked me…”Make no mistake, we are competing with the other RECs, so as a consultant, how will you keep our secrets from the other REC’s you are working with in the State? This was a valid question, which I will address in my agreements, however, it made me think. What are they competing for..additional funding that isn’t there yet? Reputation? Most innovative?

Well..I think its all of the above. I believe, the REC, that employs the right people, have the right vendor PARTNERS, and think outside the ONC box, will rise above the rest. However, best practices must be shared and that is where the ONC project lead/coordinators (in Florida its Kelly), must step up and do!

RECs competing is kind of a sad idea for me. Something doesn’t feel right about that. Now take a look at the compensation funding model for the RECs:

The REC’s do get 500k upfront for marketing the REC, initial staffing needs, etc. Then they get $ as they sign up the physcians, in my area its 5k for primary physicians with no EHR. I think they get 3k for primary physicians that have an EHR, but needs to get too MU. Primary Docs are the main targets though. In terms of competing for physicians….they do not. The REC’s are assigned Counties in their State. The only time they would compete is if a doctor has two offices in separate Counties.

With this followup clarification from another user:

In my state, it’s $1500 for sign up, $1500 upon implementation, $1500 for meaningful use. Perhaps the competitiveness referred to in your conversation with the REC in FL relates to future grant awards…

When you see the $ signs in the RECs eyes, now you’ll know why. I appreciate that the government wants to try and reward results. However, something tells me that this isn’t heading down the path the government intended.

I’ve previously posted a number of posts about the RECs. However, I found this guest post by Bobby Lee was interesting since it looked at how the RECs could significantly influence the EMR vendor market. I’ll be interested to hear your thoughts.

There’s EMR shopping list being created across the country – about sixty of them. Whether or not your favorite EMR vendor makes these lists may determine the vendor’s future viability.

Let me explain.

HITECH Act established Health Information Technology Extension Program which in turn established Health Information Technology Regional Extension Centers (REC). ONC awarded 60 RECs across the country in two rounds of funding (first on 2/12/2010 and second on 4/6/2010) totaling $642 million. Collectively RECs are charged with getting 100,000 priority primary providers (PPCP) to “meaningful use” within 2 years.

These funds are directed for technical assistance and not allowed to be used for purchase of software licenses or any hardware.

So, these sixty Regional Extension Centers are faced with the challenge of guiding 100,000 PPCP to the promise land of Meaningful Use in less than 2 years. EHR is the tool the PPCP must use to achieve Meaningful Use. Given that the #1 barrier to adoption of EMR is cost (by most accounts), the natural tendency is to create a collective bargaining setup similar to Group Purchase Organizations — gather up as many customers (PPCP) as you can, negotiate on behalf these customers with vendors (EHR vendors) with the promise of attentive customers and thus easier sales to vendors.

For this to really work, the list of EMR vendors should be shorter rather than long and value proposition clearly spelled out (who gets what) between all the parties.

Add to this the requirement of ONC for all the RECs to work together and drive toward best practices should enable an environment of sharing amongst the RECs (e.g. similar EHR vendor selection process) such that fewer and fewer vendors should appear on the list ACROSS all RECs. I also believe there’s probably only 20 really “RFP viable” vendors out there for RECs out of 300 (or however many that’s being quoted lately) so called EHR vendors in existence today. These “RFP viable” vendors must be a player in the market with solid experiences ACROSS the States with enough cash and resources to invest ahead of the potential returns as dictated by the terms of agreement RECs will likely negotiate.

In terms of numbers, I guesstimate RECs collective influence at about $100 to $400 million per year (Assume 80% of PPCPs will need to purchase licenses and it costs $100 to $500 per month per provider). On top of that, good portion of the $642 million awarded to RECs will be spent on supporting the work forces across the country learning and doing the work with the EHR vendors that makes the list.

The natural force of RECs driving the “crowdsourcing” takes over and at the end of few cycles (e.g. stages 1, 2 and 3 of MU requirements), three to five vendors will bubble up to be the “it” vendors. If they don’t screw up too much, the infusion of licenses & revenue will further drive the divide between the “haves” and “have-nots” and will further solidify the vendor landscape with less number of EHR vendors in the market place.

What do you think?

About Bobby:

Bobby Lee is the Principal and co-founder of eRECORDS, Inc., Health IT consulting firm.  Prior to starting eRECORDS, Bobby was President & CEO of NGHN, Inc., a non-profit EHR management service organization started with a competitive grant award.  Bobby specializes in the application of connected technologies, information and processes to improve access and quality of care in community clinics and practices.  You can reach Bobby atbobby.lee@eRecords.com or visit www.eRecords.com.

I came across an interesting idea today from the Change Now 4 Health community where they are giving away $10k for the best healthcare idea. They are calling it Innovation xChange. Here’s a summary of what they’re trying to do:

Do you want to improve the U.S. health care system? Or at least be part of the much-needed dialogue?

If you have ideas or solutions to improve the system, submit your ideas through ChangeNow4Health’s Innovation xChange and you can win up to $10,000 or have your ideas published in the e-book, Tomorrow’s Health Care.

The Innovation xChange is looking for practical ideas and suggestions for improving the health care system. All participants in the system, from providers and health plans to consumers and government, are encouraged to join in the discussion.

$10k isn’t a ton of money, but for just submitting an idea it’s not too bad. It’ll be interesting to see what happens with the contest and what kind of creative ideas come out of it. I wonder if any EMR applications or EMR features will make it into the contest.