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How One Regional Extension Center Gave Delaware Another “First”

September 26, 2013
by Gabriel Perna
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The “First State,” is a moniker Delaware wears well.

As is commonly known, it was the first of the original colonies to ratify the Constitution. Thus, it became the first state in the Union. This has trickled down in various ways. Throughout history, it’s had the honor of being the first state represented at Presidential inaugurations. Also, when the U.S. Mint began to release 50 original quarters representing each state, take a wild guess which one came was first.

Thanks to the work of leaders at the Delaware Regional Extension Center (REC), “The First State” can add another first to the list—and this one has nothing to do with what happened back in 1787.

Instead, Delaware is home to the first of the 62 federally funded RECs to reach 100 percent of its Office of National Coordinator for Health IT (ONC) mandated milestones. Those milestones included a) recruiting or engaging small-to-medium sized primary care providers, b) taking those providers through electronic health record (EHR) go live with their certified EHR and c) getting more than half of the primary care providers in the state to achieve Stage 1 of meaningful use.  

To get that last one, Delaware REC recently got its one-thousandth primary care provider achieve Stage 1 meaningful use.  In total, there are approximately 1900 providers in the state, and 1016 have achieved meaningful use through the REC.  

While some might say being in a smaller state is an advantage, Beth Schindele says that’s not exactly the case. Schindele is the REC director at Quality Insights of Delaware (QIDE), which is a nonprofit Medicare quality improvement organization (QIO) as well as the lead partner in the Delaware REC.

Beth Schindele

“If the same goal was applied in a larger state, we would have had more room for attrition, and we would have had a bigger pool of providers to select from. Of course, on the flip side of that, it was certainly geographically a smaller area, but that also meant our reputation had to be solid, we couldn’t afford to make one wrong turn because the impact would have been greater,” Schindele says.  To that point, she adds the methodology used by QIDE to achieve those milestones is scalable to even to the largest geographical area.  

Quality Improvement

Those strategies, according to Schindele, not surprisingly revolved around QIDE’s quality improvement culture. As a QIO, Delaware REC worked with many of the state’s small-time providers in a hands-on environment to not just implement systems to achieve meaningful use,   but change the entire provider culture and assist in workflow redesign.

Redesigning the workflow became a big part of this quality improvement, Schindele says. QIDE’s team went out in the field, training providers and their staff on the systems while figuring out ways that it would work for that particular environment.

“All of the changes to the healthcare environment, whether it’s becoming a patient-centered medical home or preparing for an accountable care organization, requires consistent, standardized workflow redesign. That’s what we pride ourselves on,” Schindele says.

Part of this quality improvement strategy was internal training. Due to the industry’s shortage of skilled workers, QIDE developed a “rigorous” training model for new staff members coming into the field. This ensured that consistent services were rolled out across the state and that everyone on their staff knew that this was more than just an IT project.

One of the major reasons the Delaware REC has had success, is its utilization of the region’s stakeholders. These stakeholders, Schindele says, have collaboratively worked with the nonprofit on various issues and barriers that have come up. For many of the RECs who are still a work in progress, this may be what’s holding them back.

“In some areas, the territory just wasn’t ready yet. I don’t like to say that those regional extension centers aren’t as successful, they are, that success is just coming later because the territory wasn’t ready. Some of these issues you have to marinate, you have to tend, and you’ve got to grow,” Schindele says.

Thinking about What’s Next

It’s impossible to not hear the exhilaration in Schindele’s voice when she discusses what’s going to happen next. Getting one-thousand plus providers attested with Stage 1 of meaningful use was just the foundation. The next focal point for the REC is to work with providers in achieving “bigger data” goals – sharing medical records across the continuum of care, using standardized datasets to capture performance measures and improve quality, engaging consumers, and integrating clinical systems.

Ultimately, the role of the REC, which was established as part of HITECH (Health Information Technology for Economic and Clinical Health Act), will evolve, Schindele predicts. The organizations will go from simply helping ensure providers are meaningful use attested through various means of education, workflow redesign, and training to becoming something even greater altogether.

“The beauty of the regional extension center program is that it began with meaningful use, but where it can continue to grow is beyond statewide or region wide collaboration with all quality improvement stakeholders…shifting to a nationwide approach that includes measuring for greater integration, transitions of care, consumer awareness, and population management. There is still a lot more work to be done and the REC program is the mechanism to carry us there,” Schindele says.