People trying to follow HITECH Act developments can be excused for getting a little impatient. Inevitably there is a delay between the government's announced intentions and implementations. But signs of activity are starting to bubble up at the local level. California, for instance, has taken several positive steps to take advantage of federal funding opportunities. It will soon choose a governance entity for a statewide HIE.
In late September, three California organizations cleared the first hurdle toward becoming regional extension centers (RECs) in the first of three planned funding cycles for that program. Cal-REC (a group representing the California Primary Care Association, the California Medical Association, and the California Association of Public Hospitals); LA Care Health Plan; and CalOptima all received notices from the Office of the National Coordinator that their letters of intent were accepted and they were asked to submit full proposals by November.
The California Health and Human Service Agency suggests that the state could support as many as seven REC applications. It recommends that they operate under a common governance structure.
CHHS also recommends that there should be centralized core services including procurement of EHR systems for hospitals, clinics and practices, but decentralized technical assistance services for local service providers to help hospitals, practices and clinics with system implementation, workflow redesign, and training.
To address work force issues, the state's Northern Rural Training and Employment Consortium (NoRTEC) was chosen as the lead applicant for a $5 million U.S. Department of Labor Health IT workforce initiative in California. NoRTEC is comprised of nine rural counties in Northern California.
Three California clinics — Clinic Sierra Vista, Family Health Centers of San Diego, and Alta Med Health Services — received a portion of the $27.8 million in ARRA funds being awarded to health center-controlled networks and large multi-site health centers to implement EHRs and other health IT innovations.
Of course, not everything is peachy in the Golden State. Due to the state's budget crisis, community clinics and other safety net providers are facing steep cuts and continue to remind health IT leaders in Washington that they need up-front and sustained support from federal sources to join other providers in health IT adoption.
In August, the Community Clinics Initiative and colleagues at Kaiser Permanente Community Benefit and the Kresge Foundation wrote an open letter to Dr. David Blumenthal at ONCHIT encouraging that community and free clinics be included in more HITECH opportunities. First, they stress that ONC must take steps to ensure the deliberate inclusion of safety net providers in the planning and implementation of health information exchange efforts. They also expressed concern that "a focus on the 2011 deadlines may lead providers to shortcut the very readiness activities that have been widely demonstrated to be critical predictors of success for HIT implementation."
Readiness assessments recently conducted in 51 Southern California community clinics demonstrated that only 2 percent were "highly prepared" for EHR adoption. The letter suggests that that preparation should be key to the work of Regional Extension Centers, loan funds and all aspects of HITECH that reach safety net providers.