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.

As I said before, I’m finding the EHR RECs very intriguing right now. Thus a few extra posts about the RECs. First, thanks for those who have been helping update the EHR REC wiki page. There’s still a ways to go, but little by little we’ll get all of the RECs listed in one space.

From what I can tell, and as evidenced by this CalHIPSO REC blog, these REC organizations have A LOT on their plate. First, they have to meet the mandates of the government (which I’ll talk about more another time). Second, they have to create an organization that didn’t really exist previously (for the most part). Third, they have to look at a long term business model for when the government funding for EHR RECs runs out. Not a simple task.

I find the third item pretty interesting since it might be the hardest of them all. In the post I did yesterday about rating top EMR companies, Brad made an interesting comment about the RECs providing this type of EHR implementation feedback loop.

Makes sense that these RECs are going to work with 1000 of doctors to meaningfully implement an EMR. Why not have these doctors whom they’ve helped (for free I might add) provide some feedback on the EMR software they implemented. This feedback on its own has little value, but in aggregate could be very valuable and could provide part of the business model for the REC going forward.

Let’s also make clear that even after these EHR RECs do great work and help thousands of doctors we’re still likely to only to be at 50% adoption range. Even if we reach the 70% EHR adoption as some EMR analysts predict, there will still be thousands of doctors that need to implement an EMR. Plus, there are going to be thousands of other doctors who didn’t like the first EMR they implemented and will want information on what other EMR software might be better.

Unfortunately, I see three potential problems with this idea. First, as part of the RECs requirements they have to help so many people. Yes, that means that we’re going to see many RECs obsessing over the number of people they can count on their numbers for the government. It’s just kind of a feature of government grant work. So, RECs will have to tread lightly in what they require from doctors. Remember the RECs are suppose to help the doctors and not the doctors help the RECs. Certainly in a perfect world it should go both ways. Definitely a challenge that RECs can overcome if they are careful in their approach.

The second problem is if RECs only end up recommending a small handful of EMR vendors (which sadly it seems many are going to do), then the RECs will only get back feedback for that small handful of EMR vendors. That makes the EMR implementation data much less valuable than if it were spread across a larger number of EMR vendors.

The third problem was something mentioned by Brad who inspired this post. In his comment he talked about many of the current ratings organizations rating based on “under the table offerings rather than credible data.” Sadly, this same thing could happen with RECs. It will depend on if the REC decides that it’s business model is built on the backs of the EMR vendors or on the backs of the credible data they get from the doctors they’ve helped. I could see it going either way.

Of course, this is just one possible business model. I’d love to hear people’s ideas on other sustainable revenue models for these EHR RECs.

Every day I’m seeing little pieces of information come out about the EHR Regional Extension Centers (RECs). Sadly, there’s not one central location that is covering the activity of these RECs so that doctors and clinics could quickly see what’s going on and enjoy the benefits of the millions of dollars that was given to these RECs as part of the ARRA EHR stimulus money.

Rather than just complain, I’ve started to create a wiki page that lists each of the EHR RECs, how much funding they’ve received and hopefully links to all of the REC websites. I have a long way to go, so I’d love to get your help in updating this list. So, leave a comment or feel free to update the wiki with the information you have about these RECs.

Unfortunately, I’d guess that 90% of doctors have never even heard that hundreds of millions of dollars has been given to these RECs to help them select and implement an EMR (73% of all stats are made up like this one too). Maybe that percentage is off, but the point is worth highlighting. Most doctors don’t know that there are possibly some resources that will be available to them in their EMR selection and implementation efforts.

The problem is that most of us don’t really know what type of resources these RECs are going to provide doctors. Will the RECs be providing unbiased information and resources? Will the RECs be EMR vendor salespeople dressed in non profit REC clothing? Will we see RECs who are truly doctor advocates? What type of on the ground, in your face and practical resources will these RECs provide doctors who’ve kicked against EMR (many, not all) for so many years?

This is going to be a really interesting period in the EMR world. If RECs get things right, they can have a tremendous impact for good on EMR adoption. I’m optimistically hopeful that they won’t let the money go to waste.

One area of the HITECH act that I haven’t heard discussed nearly enough is the Regional Extension Centers. Sure, I’ve heard them mentioned in passing plenty of times. However, I haven’t heard any real good information on what’s being done to make sure that these RECs are going to be successful in their goal of 100,000 providers becoming meaningful users of EHR’s by 2011.

Yes, that’s a pretty big hairy goal. Especially considering the EHR adoption rates up until today. Not to mention, these Regional Extension Centers (RECs) are going to have to find a way to effectively help doctors sort through the 300+ EHR vendors that are on the market with more coming out every day. This is not an easy task to accomplish and will require a lot of great tools to do it effectively.

Shahid, The Healthcare IT guy, created an interesting post about the Regional Extension Centers where he talks about the challenge these RECs will have to “offer unbiased advice on the systems and services best suited to enable the priority primary-care providers to become meaningful users of EHRs. Regional Centers will avoid entering into business arrangements creating an actual or apparent conflict of interest.”

Can you imagine the lobbying that will happen by the big EMR vendors towards these RECs? The reality is, who else can these RECs turn to for “unbiased” advice on EMR selection and implementation? I can’t imagine that the people behind these RECs just want to be a marketing front for EMR vendors who pay to lobby them. Seems pretty clear that you have to be really careful where you get your information.

Of course, this is just one of the many challenges that these RECs face. Personally, I hope that the RECs are incredibly successful and do a great job assisting doctors to find and implement the right EHR. However, if these RECs aren’t careful, they can actually have the opposite effect on EHR adoption.

If people have more information on these RECs, I’d love to hear more. I’m interested in doing what I can to help these RECs succeed.