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Is REC a Future Train Wreck

by John Moore | September 29, 2010

Yesterday, HHS’s ONC announced the final two Regional Extension Centers (RECs), one in California and the other for the state of New Hampshire. Much like the Land Grant College Program and the much smaller Sea Grant Program, the HHS RECs have been established to assist in the appropriate adoption and use of technology, in this case EHRs. Since the passage of the HITECH Act, there has been concern that harried physicians in small practices will struggle to take advantage of the HITECH Act and the incentives therein for the adoption and meaningful use of certified EHRs. (Geez that’s a mouthful). State RECs, staffed with IT specialists will be charged with venturing forth into the countryside and cities to help physicians adopt those EHRs and get those HITECH incentive payments.

Chilmark has some very strong reservations about the success of the REC program.  Well, we’ll go even farther to say that it is destined to go over the proverbial bridge, plunging into the abyss of failed federal/state programs.

Now the folks at Software Advice have outlined 5 reasons why they see the REC as “RECkless” and they have, for the most part nailed it.  Where Chilmark differs is more on emphasis, where we focus on three key points:

1) The RECs will not be able to staff themselves with strong HIT talent. There is a gold rush happening right now with software vendors, consultants and other HIT service providers flat-out.  Chilmark sees this first-hand in our daily conversations with numerous HIT companies, with many expressing that they are challenged to find good talent. So, if the private sector, which certainly pays far better than the public sector, is having difficulty getting talent, RECs will struggle even more. Which leads to the question: How competent will these REC advisors actually be in the field in assisting physicians in adopting best practices for HIT deployment and use? Yup, doesn’t look too pretty from this vantage point.

2) RECs artificially limit the market for EHR solutions. It would be a Herculean task to ask RECs to provide support for all 300 or so EHRs now in the market. To overcome this, RECs are picking just a few EHRs that they will take to market in their state.  For example, Massachusetts has picked 10 preferred vendors: AllScripts, athenahealth, eClinicalWorks, eMD, Epic, GE, Greenway, MedPlus, NextGen and Sage. Vermont has picked only three, AllScripts, athenahealth and Fletcher Allen. And then we have the great state of Virginia with also a measly three preferred vendors, AllScripts, athenahealth and MDland.  Sure, AllScripts is a national brand and known for their ambulatory solution, but so is eClinicalWorks that has been on a tear in the ambulatory market. And athenahealth, only recently released a version of athenaclinicals that is robust enough for a small to mid-size practices. So what about all the other EHRs, some quite capable in meeting a physician’s requirements?  Will they fall to the wayside simply because they were not politically savvy enough to get on-board with these RECs?  Talk about warping the free market upon which this country was founded.  Quite sure that Adam Smith is rolling over in his grave on this one.

3) Time or lack thereof. As part of the Stimulus Bill (ARRA), which was more about putting people back to work, the HITECH Act has a very aggressive schedule, so aggressive that it is likely that much of the federal largesse now beginning to be poured into this still immature market will be wasted (our guess: x > 35%). It takes time to recruit talent. It takes time to train and deploy them effectively.  The time horizons for physician adoption of EHRs to capitalize on the incentives are ridiculously short. Add all of this together and it’s not a pretty picture. This is not the fault of any government agency and the staff therein who are trying to do the best job they know how – no, they were just dealt a very difficult, if not un-winning, hand.

Unfortunately, the train has already left the tracks on this one and all we can do is sit-back and watch the inevitable.  But along the way towards that final plunge over the bridge, Chilmark does sincerely hope that in some small way these RECs will indeed have some impact on the effective adoption, deployment and use of EHRs by clinicians as even a little is better than where we are today.

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-Former SVP of PHM at Cerner