Time again for the weekend EHR Twitter round up. Some interesting stats in this weekend roundup.

RECs surpass 100,000 physician goal on #EHR adoption | #Healthcare IT News http://t.co/Fa6qAIzT

November 18, 2011 7:00 am via HootSuiteReplyRetweetFavorite

@HITNewsTweet

Healthcare IT News

It’s an interesting thing to note that they have 100,000 physicians signed up. The real numbers we need to know is how many of those 100,000 have achieved meaningful use, how many have implemented an EHR, and how many still need to select an EHR. Then, we’d really have an idea of how well the RECs are doing.

CMS Publishes Lists of Medicare EHR Incentive Payment Recipients – 147 EHs & 3724 EPs thru Sept. http://t.co/8KYXtgPj #HealthIT #EHR

November 18, 2011 11:12 am via Tweet ButtonReplyRetweetFavorite

@ElinoreBoeke

Elinore Boeke

These numbers seem a little small for me. However, I think we’re going to have a flood of meaningful use attestation at the end of the year, so these numbers are likely a bit misleading.

RT @RH_DScott: Variation in care team usage of EHR makes consistent quality reporting and metrics challenging – in #PCMH panel #ONCMeeting

November 17, 2011 12:34 pm via TweetDeckReplyRetweetFavorite

@pjmachado

Paulo Machado

This is an interesting point. Plus, it’s even more interesting when you think about care teams that are part of different organizations. The inconsistency becomes even more difficult.

When I learned that HITECH included funds setting up the regional extension center system to support small medical practices in implementing EHRs, I thought, well, that sounds OK.

I wasn’t thrilled, mind you, as I wasn’t optimistic that a government-sponsored organization would produce the quick EHR adoption process HITECH demands, but it wasn’t a bad thing.

Since then, I’ve gone from mildly interested to downright irritated.  While I wasn’t expecting the RECs to blaze a path to glory, I thought it would be nice if they produced great educational materials and sessions, made themselves highly accessible to physicians and offered clear guidance on vendor selection. As far as I can tell, we’re largely zero for three.

Yes, as a recent a recent study notes, the RECs are doing better at some of these things of late. According to a recent study by the eHealth Initiative, they’ve now reached most of the 100,000 PCPs they’d hoped to enroll, and they’ve developed better vendor specifications.

That being said, they really don’t seem to be that focused. Hey, if a privately-funded organization took this long just to begin to get started with their work, they’d already be out of business.

Not only that, when I made one completely unscientific mystery-shopper call to a REC, the staff member I spoke to didn’t seem to have much on the ball. He didn’t have anywhere to direct me for further information, didn’t have any informational meetings pending, couldn’t define clearly what his group could do for me and didn’t even bother to get my contact information.

Of course, that may have been a freak instance, but I’m beginning to doubt it. The buzz I hear is that the RECs have barely a clue as to how to reach their target population, and don’t really speak their language. Some of my EMR-savvy buddies think they’re just about useless.

I do truly hope that the RECs get their act together — maybe all they need is better marketers — but I’m not holding my breath.  My advice to doctors: Keep pushing on your local medical society, your IPA, your hospital partners and your practice management consultants to shed some light on the EMR adoption process. You’ll get further, faster.

As many of you know, I get a lot of interesting emails. I generally try to respond to all the emails I get. In many cases, the topics work great for a post on this blog and will extend the discussion beyond the email. This is one such case. The following is an email from a student in one of the HITECH funded healthcare IT education programs and my response to them (published with permission). I’ll be interested to hear what others think about the topics we discussed and if you have any other suggestions for Jojo.

I would like to ask your opinion about what will the graduates of the HIT education grant do after fiishing the 6 month course ?

I am one of these students and I want to freelance after. I have 13 years of IT experience and none of heallthcare (except for my medical appointments where I make my own process workflow analysis). As for me, I have not seen much of IT companies specializing in HIT, in the Northern Sacramento / Placer county region. HIT does not even ring a bell to them, I think. IT companies know about Windows, Office, VMWare, networking, Sharepoint, etc. but not HIT. HIT is an old lurking industry given prestige nowadays because of the HITech act and the $19 billion fund. In 2 more months I will finish the HIT grant school and nowhere to go.

I want to plan ahead. So, I looked at the NorCal REC and I see that they have pay-for registrations for IT providers (IT companies). The IT provider list is supposed to be a match for clinics wanting to implement EMR. I look at these IT provider’s website and I don’t see much information about what they do for HIT. So, how does a REC know that an IT provider knows how to do HIT ? Sure IT companies know the IT part of HIT but not necessarily the H part (for healthcare). This was the same notion I have before I was a HIT student. How hard can HIT be ? Not until I went through the HIT education prgram then I understood that it is not as easy as I thought. HIT is much like specialty field of IT (akin to doctor specializing to a specific field of study).

Therefore, I may have to freelance; capture the smaller niche market in my rural region. Test the waters, apply my learned skills and grow from there. Yes, I would want to satisfy the HITECH goal of building a HIT workforce. But I do not have any information as who is out there (clnics wanting an EMR and HIT providers). My only assumption is that by the end of two years, ONCs calculation is that there will be about 10,500 HIT professionals nationwide. It does not seem to be a lot considering that the California REC is expecting about 10,000 clinic registrants.

The REC is not catering to the upcoming HIT workforce. At least , I have not seen any projects or system that will provide information for a HIT professional that will be graduating this March. I would imagine that a HIT professional should be able to login to the REC website and browse a list of clinic that matches his locality and expertise. Something like that will justify the fund given out for the HIT education.

What do you think?

Jojo Pornebo

My email response was the following:

Hi Jojo,
You bring up some interesting points and thanks for sharing. Are you sure you’re looking in the right places? I don’t know your area of the country that well, but I know a couple IT vendors here in Las Vegas that do a ton of healthcare IT support. Although, you shouldn’t be confused by their website. Many have healthcare as a strong area of focus, but don’t necessarily put it on their website. In fact, in some cases I’ve seen them put the EMR part of their company as a separate company so as not to confuse their existing IT clients.

I’d also suggest you see if there are any VARs in the area you want to work. Many IT companies become VARs for specific EMR vendors and so you could leverage both your IT and healthcare IT skills with a company like this.

Also, I’m not sure it’s best to rely on the RECs. I talked with an IT vendor today who said that he referred people to our local REC for meaningful use and they were suppose to get referrals back for IT support. Yet, he hasn’t gotten any referrals from the REC (yet?). I’d look beyond the RECs which have a limited life anyway if I was in your shoes.

Your training could apply beyond IT companies and the RECs. You could work for an IT vendor itself for example. You can also find full time employment with a specific clinic. Many medium to large size clinics have full time IT support. It’s a great alternative to working for an IT company since you get to know the clinic very well and can effect change over a long period of time. Of course, hospital IT departments also need a lot of skilled healthcare IT employees (and may have the most shortage).

There are lots of options out there. What really matters is you deciding which career path you want to take. Working for an IT company, a hospital, a clinic, an HIT vendor or freelancing for yourself are all viable career paths with their own unique pros and cons.

You could also check out my EMR and EHR job board. It has a number of possible job options so you could see some of the types of healthcare IT related jobs that are out there.

I hope this helps.

Note: Please feel free to share your thoughts for Jojo in the comments. If you have a job for Jojo let me know in the comments or on our contact us page too and I’ll be sure to connect you.

I’m excited to announce the beginning of Meaningful Use Monday on EMR and HIPAA. I first came up with the idea when Lynn Scheps from SRSsoft commented on one of my previous meaningful use posts. Lynn provided such valuable information, I asked her if she’d be interested in becoming a regular guest blogger on EMR and HIPAA. As they say, the rest is history. Each Monday, Lynn (and sometimes myself) will be covering some topic related to the EMR Stimulus money and meaningful use. We hope you enjoy Meaningful Use Monday.
-John

With the impending start of the EHR incentive program on January 1, the results of a recent Health Data Management poll are troublesome. 72% of respondents feel that the meaningful use guidance provided by the government to-date has been either “inadequate and confusing” or “of little use,” with only 8% categorizing it as good.

It is critical to understand the requirements accurately because the regulations provide “no recourse” for providers whose attempt to demonstrate meaningful use is deemed unsuccessful. So where does a provider go for definitive information and answers to their questions?

• The most reliable source to-date has been the CMS website and its FAQ page, but as I learned when I submitted a question, the term “FAQ” is meant quite literally: An automated response informed me that only “frequently-asked” questions are answered! So, if your question is not a common one, this source will not provide the information you seek.
• Vendors and medical societies have offered numerous webinars and educational meetings since the legislation was passed in February 2009, but be aware that presenters have varied in their interpretations of some of the requirements.
• Regional Extension Centers exist to assist providers, but their focus is limited to hospitals and primary care physicians, and they charge for their services. UPDATE: As has been mentioned in the comments, not all RECs charge for their services.
• Knowledgeable consultants will be very busy and may also be costly.
• The most promising source:  CMS has just established the EHR Information Center: 1-888-734-6433. If it operates as well as the ePrescribing and PQRI Quality/Net Help Desk, it will be a great source of information. As of the writing of this post (12/23), however, that number is answered with a recording that refers callers back to the CMS website. Hopefully, the Information Center will be live by the start of 2011.

Lynn Scheps is Vice President, Government Affairs at EMR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

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.

Sorry if you’re bored, but I’m still completely obsessed interested in the RECs and how they’re using millions of government dollars. From what I’ve seen most RECs are really getting the cart before the horse.

From what I’ve seen most (if not all) of the RECs are out their doing RFPs with various EMR vendors and they are trying to narrow down their list of EMR vendors that they’ll support. Ok, yes I know they’re going to support all EMR vendors, but there’s going to be a different level of support for those EMR vendors for whom the RECs do group purchases with and “promote” in their REC.

I just don’t see what kind of RFP a REC could be sending to an EMR vendor. How would an EMR vendor even respond? Does the RFP say, we need an EMR vendor that can support big clinics, small clinics, solo docs. We need an EMR vendor that supports every specialty. We need an EMR vendor that supports…oh wait, the RECs don’t really know what type of clinics are going to be interested in our services and so how can they select an EMR?

Should RECs ask their constituents which EMR software they should try to support instead of the RECs unilaterally making a decision?

Let me offer a simple plan that would be much more effective:
1. Educate the providers in your area on the EMR selection Process. Use vendor neutral materials (Shameless Plug: like my EMR selection e-Book) to teach physician’s offices the best way to select an EMR.
2. Let them all go through the EMR selection process with the best practices the REC provided and take a survey of which EMR software each clinic selected (possibly their top 2).
3. Based on their decisions, negotiate with the EMR vendors that have a large number of clinics interested in using their software.

Not only would the RECs be getting GREAT feedback from end users on the right EMR vendors they should be talking to, but it would also put them in a great negotiating position with the EMR vendor. They would go to the EMR vendor with a list of clinics interested in that software product.

The biggest question with this plan is will the government stimulus money allow these RECs to go through a process like this?

Tom Chernitsky has over 15 years experience in the fields of Document and Information Management. He is currently President of File Management Solutions, LLC, which offers a variety of solutions for helping Practices digitze their paper files to be linked into an EMR system.

As we SLOWLY progress towards the Government putting in place an actual plan to fulfill the goals set forth for Healthcare in the American Recovery and Reinvestment act of 2009, the backlash seems on the verge of overtaking the talk of actual good that would be achieved.

Perhaps it’s because without a clear plan, everyone has had the opportunity to focus on the negatives. Maybe it’s because many think that by the time a plan is in place, it will already be 2020. Or it could just be the general fact that no one likes when the government mandates change.

The fact is, the HealthCare Industry is one of the few remaining industries that seem to be intent on believing that a paper based system of record keeping is superior to an electronic one. Whether it’s a one Physician Practice or a large chain of hospitals, the fact that patient records are still in paper form, and so many believe this is still the best method, indicates the enormous challenge faced in succeeding in meeting these goals .

Let’s first look at the large clinics and hospitals. Any of these organizations that are still on a patient based record system undoubtedly use a variety of computer applications for billing, payroll, inventory, accounting, Human Resource, etc. Why? Because it works better and more efficiently than filling file drawers full of paper. It saves money, adds to the bottom line, and all and all makes life simpler for all involved.

To think that the same isn’t true with patient records is to believe that Healthcare is so incredibly different than every other “business” in the world that technology couldn’t possibly help them. Yes, Healthcare is different, but every industry that has made the change in the past 20 years has said the same thing. That’s why there are industry specific programs and platforms for each industry. Are they perfect? Of course not, but most are far more efficient than rooms and drawers full of paper records. And there probably isn’t an industry that has made the switch then decided after to ditch the digital and go back to paper.

As for the burden of meeting Meaningful Use criteria being too stringent for small practices to meet, this is again an excuse to avoid change. While some of the criteria may be excessive, overall it will be a roadmap to what practices have to do in order to use an EMR system in a way that actually provides the benefits it is designed to provide. Buying an EMR system and using only half the features will undoubtedly lead to the system not generating the ROI it is capable of providing. Being forced to meet Meaningful Use is a way of ensuring offices are using their EMR system in a way that will provide them with the benefits it is designed to provide.

No other industry has received the funding and support to make this transition that the Healthcare field has at their disposal. Perhaps many Physicians are unaware of exactly what is available to them to aid them with this transition. Most of the talk is about the money received for meeting Meaningful Use criteria. In fact, that is probably the least of the benefits.

The Regional Extension Centers are assembling teams of vendors to assist along every step of the way, which means it’s not just an EMR vendor plugging in a system, giving a bit of training, then walking away saying “good luck.” The REC’s have received a tremendous amount of government funding to ensure they provide the services they are supposed to provide. There are ramifications involved for those REC’s that do not meet their goals, giving them incentive to provide the services they have been tasked with providing.

Change is never easy. If it is, it’s probably not enough of a change to have much impact. These are big changes, and there will be many stumbling blocks along the way. But in the end, even small practices will see increased profits based on a more efficient system, while at the same providing patients with better all around care. It will just take some time, and the understanding that sometimes change is good.

I always love when smart people are interested in doing guest posts on my blog. They offer a different perspective than what I offer and I think that’s great. I definitely don’t have all the answers and there’s always a number of different viewpoints on every given situation. If you have something interesting to say or an opposing viewpoint feel free to drop me a note.