Centering on Hope

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Despite high expectations for HIT regional extension centers, questions remain.

There is a lot of hope riding on the HIT regional extension centers mandated by the American Recovery and Reinvestment Act of 2009. The centers are supposed to provide technical assistance, disseminate best practices, and support providers' efforts to adopt, implement, and effectively use health information technology. Is that all?

Less than 2% of hospitals have implemented comprehensive electronic health records, according to a March 2009 study by the Harvard School of Public Health, Massachusetts General Hospital, and George Washington University. Given the monumental task ahead for these centers, it's imperative to develop an effective design, with adequate geographic distribution and funding. The Office of the National Coordinator expects to award its first contracts between October and December, but there are still key questions to be answered.

Funding. The ONC and the White House announced in mid-August that it will allocate $598 million for 70 individual centers, with the average amount being about $8 million for each center, with a minimum of $1 million and a maximum of $30 million, says Brian Wagner, senior director of policy and public affairs at the eHealth Initiative, a nonprofit advocacy organization in Washington, DC. The funding would be spread out over four-years. But will these amounts be sufficient to provide the on-site support described in the legislation? "No," says Craig Lanway, chief information officer at Hill Physicians Medical Group, an independent practice association with 2,600 members.

That kind of funding will not provide enough "boots on the street" to help physician practices, much less hospitals, says Lanway. Wagner says the jury is still out. "The amount of money is now more adequate to get these centers off the ground. The big challenge is will they have enough money in the early years to provide time-consuming, hands-on technical assistance. That is by far going to be the most expensive piece."

Distribution. Healthcare executives are divided on the number of centers that should be created. Forty-one percent of executives surveyed by the eHealth Initiative said there should be 10 to 50 centers, 24% said 50 to 100, and 20% were undecided. Lanway argues that 70 centers may not be enough. "There is a lot of geography to cover and a lot of this needs to be done face-to-face."

Focus. While the legislation does refer to underserved areas, the focus of the centers isn't defined. "If you have to prioritize where you go first, I'd argue for primary care," says Lanway, explaining that they are "economically the most challenged right now." Alan Morgan, CEO of the National Rural Health Association, says the ONC should "strongly consider" creating a national rural technical assistance center to ensure there is expertise to assist rural facilities, which is also "one of largest challenges."

Design. The centers' longevity hinges on the selection and quality of services they offer. More than 90% of executives said the centers should provide best practices, technical assistance for clinicians, and help clinicians change workflow practices, according to the eHealth survey. Lanway is concerned the centers won't have expertise in the various vendor products to effectively help providers. Even with that expertise, it can take 12 to 14 weeks to install an EMR at a physician practice, says Lanway, who has helped install EMRs at 63 Hill Physician practice locations. "I'm concerned there might be an underestimation of the work that needs to be done," he says.

Carrie Vaughan

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