Speranza Avram, the CEO of CalHIPSO, the largest of the 62 federally designated regional extension centers, has spent three years helping physicians in small groups to achieve meaningful use. Going forward, being able to continue to help providers beyond the end of this year will mean developing new models of sustainability.
The Oakland, Calif.-based California Health Information Partnership & Services Organization, CalHIPSO, is the largest of the 62 federally designated regional extension centers (RECs), serving more than 6,100 providers eligible for stimulus support under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act.
Working with providers in 56 of California’s 58 counties, CalHIPSO works with community clinics and federally qualified health clinics, rural hospitals, public hospitals, and other patient care entities, including very small physician practices. Like all of the RECs, CalHIPSO has been operating through a three-year grant; all the REC grants run from Jan. 1 2011 through Jan. 1 2014, after which all the RECs will need to operate based on new business and governance models. CalHIPSO’s grant has been for $35 million, based on the same model on which all the RECs have received their grants, with the Office of the National Coordinator for Health Information Technology (ONC) providing grants at a level of approximately $5,000 per assisted eligible physician/provider.
What’s more, CalHIPSO does its work as a statewide REC in the context of professional networking, keeping its own staff lean at 18 employees, and subcontracting some of the core technical work to local extension centers.
One area of particularly exciting promise: CalHIPSO has been developing analytics capabilities for its physicians and other providers, and has been working with the Emeryville, Calif.-based MedeAnalytics to develop the IT foundations for that work.
Speranza Avram, CalHIPSO’s CEO, spoke recently with HCI Editor-in-Chief Mark Hagland regarding her organization’s work helping physicians and other providers to implement electronic health records (EHRs) and help them to then leverage the capabilities of their EHRs for performance improvement and population health work. Below are excerpts from that interview.
Most of your participating organizations are small medical groups?
Yes, and also community health centers, and public hospitals. Not surprisingly, there continue to be some challenges with EHR adoption. My chief quality officer and I recently identified some core challenges, including the following: difficulty accessing and running in a timely way the reports from EHRs to assess and monitor their meaningful use work; meeting certain meaningful use objectives such as providing after-visit summaries to 50 percent of patients, documenting tobacco use, etc., objectives that to be met require complicated changes to physician workflows; and understanding some of the complex requirements of the EHR incentive program, including meeting the eligibility requirements for the Medicaid EHR support program.
Tell me about some of the vendor platform issues you have to deal with.
We love working with our vendor partners. But of course, they’re all on different systems. The top two EHR vendors we work with are NextGen and eClinicalWorks, but there are literally dozens of them in total. So that’s one of the challenges. Another challenge is that many clinics adopted EHRs two, three, four years ago, and they’re having to upgrade because of meaningful use, and often, there’s no standardization even within their own organizations, because of intensive customizations that they’ve engaged in in the past. So in many cases, the upgrades have been even more complicated than just buying a new EHR. And MediCal [MediCal is California’s Medicaid program] providers, which most of ours are, even if they were ready, could not have attested until September. About 65-70 percent are attesting under the Medicaid program, and the rest are attesting under Medicare. So the attestation is going to happen early this year.
Where do the analytics come in, in relation to this work?
In our pilot project with MedeAnalytics, we discovered that data analytics aren’t really designed to help providers with meaningful use, because meaningful use really is a straightforward data collection process; the analytics really come after achieving meaningful use, because they support providers under value-based payment. So, first, you need the foundation, you have to have the software, and demonstrate that you can use it meaningfully, to get the payments. Now, you’re ready to participate in any kind of value-based payment, whether ACO [accountable care organization], PCMH [patient-centered medical home], PQRS [the federal Physician Quality Reporting System], or value-based purchasing.