Many people see the health IT regional extension center program as key to achieving widespread adoption among physician practices and smaller clinics. And because so much appears to be riding on it, people are projecting their own hopes, fears and doubts on the effort.

Some people argue that the $598 million for 70 individual regional extension centers isn’t enough; others decry a huge government takeover of the consultancy business will lead to bureaucracy and ineptitude.

I believe that many consultancies will find their services in high demand and make out just fine. I have come across several press releases from vendors that have created REC service practices. For instance, Newton, Mass.-based Hayes Management Consulting announced its services for ARRA-funded Regional Extension Centers (RECs). “We have been asked by organizations applying to be Regional Extension Centers for help should they receive funding,” said Peter Butler, president of Hayes, in a prepared statement. “As the funding becomes available, there will be an urgent need to help physicians across the country implement EHRs and Health Information Exchanges using best practices. We look forward to helping the Regional Extension Centers with implementation, interoperability, clinical adoption and training.”

ONC has reduced the two-year REC funding cycles from three to two and postponed the announcement of the first cycle of REC awards to Jan. 21.

One thing to watch as the application process continues is the variety of approaches and shapes RECs are taking. They are not cookie-cutter, one-size-fits-all.

I was interested to hear Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, describe at a recent meeting the different flavors of business model they have proposed in applications to ONC. He put them in three categories: One group, which he calls the implementers, will have the most centralized business model. They will own the relationship with customers and be heavily involved in service delivery. (These might be currently existing quality improvement organizations or QIOs.) Another, which he calls orchestrators, may authorize extension agents to recruit customers and deliver services under standards they have established. The third model he described is the matchmaker. Here the REC acts more as a clearinghouse and resource. It works to create a marketplace between vendors and providers and helps them contract for a set of services, although still being responsible for meeting terms of the federal contract.

Each of these models, Tripathi noted, has pros and cons. Each has different implications about uniformity and the use of outside sources.

No matter which model is used, Tripathi said that with an average of $6,400 per physician available, the RECs will have to leverage vendors as partners and figure out how to provide “just enough services” to get physicians to meaningful use, but no more.