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Three Good Questions on Regional Centers

September 9, 2009
by David Raths
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On Aug. 27, Dr. Farzad Mostashari of ONCHIT hosted a web conference for more than 1,200 participants to detail the Health Information Technology Extension Program. Nationally, the regional centers are expected in their first two years of operation to help more than 100,000 primary-care professionals become meaningful users of certified EHR technology. Full applications are due Nov. 3, with award processing scheduled for early December.

During the QandA session following his presentation, I heard three especially good questions about the application process, sustainability and the role of regional centers in vendor selection and group purchasing:

1. There is one requirement of the application process that isn't sitting too well with some prospective applicants: that they include a letter of recommendation from the state Medicaid director.

Dr. Lawrence D. Ramunno, chief quality officer of the Northeast Health Care Quality Foundation, noted that many HIEs have Medicaid directors on their boards. He asked if ONC had considered the conflict of interest problem of someone writing a letter of support for an organization they're a member of or even part of the governance of? That person may not write a letter for a potentially competing organization, even though it may be more qualified.

Mustoshari admitted that Ramunno had identified a potential conflict. He added that ONC hopes that the state Medicaid directors will be acting in the best interest of the Medicaid providers. He also said that perhaps in the future the letter of recommendation could come from either a state HIE coordinator or the Medicaid director.

2. Amanda Parsons, director of medical quality for the Primary Care Information Project, which supports the adoption and use of EHRs among primary care providers in New York City's underserved communities, asked about the sustainability model for the extension centers. She noted that her group is having a difficult time meeting the sustainability metrics based on projected payments from providers. She asked about the possibility of including payers in the funding equation.

Mostashari admitted that providers working with underserved communities initially might not be willing or able to pay the extension centers for the services they are receiving. But he expressed the hope that once the meaningful use payments start flowing and the extension centers show their value, more providers will sign on.

He said regional groups might be able to get funding from payers if it is presented as helping build a sustainable community infrastructure for quality improvement.

3. Kimberly Love, a project manager at the University of Pittsburgh Medical Center, asked about the regional centers' role in narrowing down the vendor options for providers. "How can the regional extension centers deliver a cost-effective and quality set of solutions to the provider community, and do that to maintain as many options to that provider community?" she asked. "Is it possible that the regional extension centers can actually go through a selection process that involves the participating members to get down to one or two preferred options?"

Mustoshari responded by saying that the vendor selection is a critical aspect of the regional centers' role. He added that while it is up to each center to decide how many solutions it wants to support, ONC expects that many will have "just two or three preferred options and they'll work very tightly with those vendors." There is a requirement, he added, that there be no business arrangements that have the appearance of conflict of interest.

In May editor Anthony Guerra wrote a great blog post that raised some interesting questions about how this process will play out. "It would seem there will be tremendous temptation here for RCs to play favorites," he wrote. "Vendors will soon understand that the key to moving software will be not convincing practices and small hospitals of their worth, but making friends with decision makers at the RCs."

Anyway, it's easy to see that lots of people in the vendor community are going to be unhappy with the selection processes chosen by the regional centers, whether they are transparent or not.



I don't wake up each day planning to be at odds with ninety-eight percent—I'm probably being overly generous assuming two percent of the people are as jaded as me—of the HIT community, maybe I just come by it naturally.

The first time I heard of RECs (regional extension centers) the first thing that came to mind was playgrounds, something akin to what the Police Athletic League might find useful. Five hundred and ninety-eight million dollars. They tried 597 and determined it wouldn't be enough and figured 599 would be too much, but 598 million was just right. Then Goldilocks made her way over to the porridge—sorry for turning left at the fairy tale ramp.

A large part of the success or failure of reform hinges on the success or failure of EHR. Accordingly, the government made the egregious decision to manage the process of building and rolling out a national EHR down at the molecular level. They have involved themselves at the front-end, at the vendor level, and at the back-end. The more anxious they become, the more money they waste, adding another guise to get the healthcare providers to take their eyes off the ball. Five hundred ninety-eight million "we're just here to help you" dollars.

This money could be spent to pay the top EHR vendors to create one set of standards and modify their systems to fit those standards.

Meaningful Use. Don't get me started. How can I fault thee let me count the ways. Those tested early for Meaningful Use will be examined less rigorously than those tested later. This is like the IRS saying that if you file your taxes in February, don't worry about those silly little math errors. Healthcare will be the only industry whose software quality assurance check occurs after they pass the fail-safe point, the point of no return.

With good leadership providers should know EHR will pass meaningful use before implementing the system. If they fail to pass Meaningful Use, shame on them.

Thanks for the post David. From my post that you cite, it's obvious I'm not a fan of the REC plan, or any plan that calls for government creating a business that will compete with existing private businesses. I mean, talk about re-creating the wheel. If anything, these funds should have been put in the hands of providers to hire the existing consultancy which offered the most appropriate services for their needs.

Besides, where is all this healthcare IT talent coming from? Who is going to staff these organizations?