At an eClinicalWorks (Westborough, Mass.) Northeast Users’ Group meeting last week in Brooklyn, N.Y., Amanda Parsons, M.D., assistant commissioner of the Primary Care Information Project (PCIP) and NYC REACH for the NYC Department of Health and Mental Hygiene, and Mat Kendall, M.P.H., director of the Office of Provider Adoption Support at the Office of the National Coordinator for Health Information Technology (ONC), discussed how they were continuing to encourage adoption of electronic health records (EHRs) on a federal and state level.
According to Kendall, 65,000 providers have enrolled in the 62 regional extension centers (RECs) across the country, on track with ONC expectations. Kendall mentioned that states like South Carolina and Massachusetts have already exceeded provider target numbers, while other states like Mississippi, Maine, and Rhode Island are close to achieving their goals.
Kendall emphasized that ONC’s focus is on small practices. “We’ve cornered the market on federally-qualified health centers, and that’s great—the challenge now is just spreading that success,” he said. “We still need to begin emphasizing critical access hospitals.”
One way Kendall discussed that the ONC would encourage EHR adoption was through the Meaningful Use Vanguard program that recognizes champions who are meaningful users of EHRs for clinical management, data exchange, and population health. These champions will serve as role models to share stories around their meaningful use, and will ultimately help the ONC reach its goal of connecting 100,000 providers by 2012. As a part of the Vanguard program, Kendall said that his office would hold Ed McMahon-style “big check ceremonies” to send a powerful message that providers are being recognized for all their hard work.
Another way to support provider adoption Kendall said is through the Health Information Technology Regional Extension Centers (HITREC), which will connect RECs across the country to share best practices around areas like recruitment/outreach, EHR vendor selection, and workflow improvement. Kendall noted that the ONC would set up a public website to share theses best practices as well. “The goal of the HITREC is really to accelerate the ability of RECs to support providers to get to meaningful use. If you’ve seen one practice, you’ve seen one practice,” said Kendall. “It’s really hard to develop a panacea; it doesn’t work. That’s where the hard part with the RECs comes in.”
Parsons said on the local level, NYC REACH, one of New York’s two RECs, has signed up 3,000 providers—2,186 which counts toward their goal—and still has about 2,300 more provider spots left. So far there haven’t been any Stage 1 meaningful use attestations in New York yet. She said most providers will attest next year through Medicaid, and of the Medicare attesters, Parsons predicts many will attest as early as June or July, since eClinicalWorks rolled out its certified version EHR in the March-May timeframe.
Amanda Parsons, M.D.
Challenges around Adoption
Parsons admitted that providers rather than having challenges around clinical decision support or computerized physician order entry (CPOE) are having problems surrounding workflows that involve the patient “because historically they haven’t turned on the patient portal or they haven’t gotten to the place where they’re printing the summary of the visits.” What is part of her job at NYC REACH is to dispel common myths circulating in provider communities that say patients don’t have access to the Internet or don’t want visit summaries.
Parsons also noted another challenge that providers faced was collecting race and ethnicity on every patient. “It’s not an easy conversation for your front desk person to have,” she said. “When you ask about race and ethnicity it can become uncomfortable, so there have to be good workflows in place to do that.”
Kendall noted that on a federal level, rural healthcare, especially linking primary care physicians and specialty care, is difficult to address. This is why his office is creating a supplemental program to address critical access hospitals because the ONC recognizes them as a priority. Other challenges his office is facing are systems hurdles like sharing data from laboratories, which the ONC seeks to remedy by publicizing tools like its DIRECT Project that allows providers to make point-to-point connections to share data for patient care.
“You need to really leverage economies of scale to help the provider,” said Kendall. “You need to drive toward quality. Having [local projects are] an amazingly powerful tools for us, the same way having meaningful use for us will be powerful for the extension centers. It helps add focus. Healthcare is so complicated, and if you don’t have goals, and standardize things, it’s a lot more challenging.”