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Community Health Center Perspective

January 19, 2011
by Jennifer Prestigiacomo
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Insight into the special challenges of EHR implementation

Last week’s HIT Standards Committee Implementation Workgroup hearing “Real World Experiences Working with Meaningful Use,” sponsored by the Office of the National Coordinator for Health Information Technology (ONC) culled together voices from around the country to share what’s really going on with the meaningful use of electronic health records (EHRs). Lisa Levine, M.P.H., vice president-operations, Family Health Center of Worcester, Mass. shared her thoughts on her panel “Implementation Support – Regional Extension Centers,” as well as some insight into the special path that community health centers must tread toward meaningful use.

Healthcare Informatics: What did you find most interesting about the Implementation Workgroup hearing?

Lisa Levine, M.P.H.: What was nice to hear is that there were lots of other people that were nervous about meaningful use Stages 2 and 3 as I was. What I found most interesting was how different each state experience was. Each of us had a different experience and view of the REC [regional extension center] and the whole implementation strategy. When you’re coming at it from the point-of-care, you know the broader framework of the HITECH [The Health Information Technology for Economic and Clinical Health] Act and meaningful use, but your actual experience is built on the REC in your state. So, I had this assumption that they all operated the same way. And what I found was there was a lot of individuality. There is a whole difference in charges for enrollment. Our REC [the Boston-based Massachusetts eHealth Institute, a division of the Massachusetts Technology Collaborative] charges $800 for specialists and $600 for primary care providers. The physician that was sitting next to me from Arizona [Dan Nelson, Desert Ridge Family Practice, Phoenix, Ariz.] said the Arizona REC charges nothing for primary care providers. And the enrollment charge for the RECs appeared to be part of their long-term sustainability strategy.

The other thing I found interesting is there seemed to be different vetting processes. There was some discussion about if you could have a preferred vendor list and the implementation optimization organizations, and again, there didn’t seem to be a huge agreement or consistency state to state. And there was discussion around if it made sense to have as many vendors as you could fit on a list, or do you try to narrow it a little? I believe the gentleman from the ONC [Mat Kendall, Director, Office of Provider Adoption Support, Office of the National Coordinator] said there was a feeling in the ONC there should be vendor agnosticity [sic] in the way RECs were choosing [vendors].

HCI: What kind of workforce initiatives would you want to see coming out of your REC and implementation optimization organization to help out with the HIT professional shortage?

Levine: I’d like to see some of the RECs develop some kind of a job training program, somehow working with the community colleges and universities. People don’t necessarily think of community health centers when they think of job opportunities, especially in information technology. Sometimes if you train at a place, it can make you realize that they are really good places to work. For the health centers it becomes a nice recruitment stream. Especially in Massachusetts, it’s very hard for us to compete on a salary level when we’re competing with some systems in our state with some very deep pockets.

HCI: Can you talk a little bit about the hindsight of your EHR implementation? You spoke in your testimony about wishing you had had a full-time, on-site dedicated project manager and a faster implementation strategy.


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