Health Information Technology Regional Extension Centers
By Michael Stearns, MD, CPCFebruary 2, 2010
Introduction: One of the major goals healthcare goals of the American Recovery and Reinvestment Act of 2009 (ARRA) is to foster the greater use of electronic health records (EHRs) and health information exchanges (HIEs) throughout the country. In support of this effort ARRA created the Health Information Technology Extension Program. This program has two major components: the formation of approximately 70 Health Information Technology Regional Extension Centers (Regional Centers) and a national Health Information Technology Research Center (Research Center).
Health Information Technology Regional Exchange Centers
Approximately $643 million dollars have been allocated to support the development of 70 or more HITRECs in the first three quarters of fiscal year 2010 (which started October 1, 2009). Each center will provide technical and other assistance to least 1,000 practitioners that will help them attain meaningful use of electronic health records. This includes the EHR selection process, contracting, project management, implementation, and support. (The certification process and the meaningful use requirements are being developed by the Office of the National Coordinator and are expected to be finalized in early 2010).
Regional Centers will target primary care physicians that work in small practices (1-10 providers) in underserved areas or those who work with underserved patient populations. The HHS expects HITRECs to “…offer technical assistance, guidance and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records (EHRs).”
The first 20 HITRECs, two from each of ten national regions, were schedule to be operational by January of 2010. Approximately 50 additional centers will be launched by June 30, 2010. All HITRECs need to be fully operational by the end of 2011 and will eventually need to become self sustaining. Each Center will be required to support a minimum of 1,000 providers and in aggregate all centers are expected to help 100,000 providers attain meaningful use of EHRs in the first two years of the program.
Each center needs to be sponsored by a nonprofit organization and initial government funding for each center may vary from $1,000,000.00 to $30,000,000.00
Functions and Duties of the HITRECs
The Regional Centers will be fully operational value added centers that will provide on-site and other forms of technical assistance to providers, including;
• Selecting an EHR product - Each Regional Center will identify two or more certified EHR products that they have fully evaluated; Assist in indentifying the product that is a best match for the providers’ needs;
• Achieving effective implementation
• Enhancing clinical and administrative workflows to optimally leverage an EHR system’s potential to improve quality and value of care, including patient experience as well as outcome of care
• Observing and complying with applicable legal, regulatory, professional and ethical requirements to protect the integrity, privacy and security of patients’ health information
• Helping providers achieve, through appropriate available infrastructures, exchange of health information in compliance with applicable statutory and regulatory requirements, and patient preferences.
• Supporting priority primary-care providers who have existing EHR systems
Additional duties of the Regional Centers include:
• Educational outreach to Providers – Support their regions through educational programs and materials that focus on “effective strategies and practices to select, implement, and meaningfully use certified EHR technology.” Training events may be cosponsored by other organizations.
• National Learning Consortium - All Regional Centers will be required to participate in a National Learning Consortium and work closely with the Health Information Technology Research Center to develop materials and tools that foster EHR adoption.
• Vendor Selection & Group Purchasing – The Regional Centers will help providers select and negotiate contracts with EHR vendors, hardware vendors, and other IT service vendors. They are expected to design group purchasing plans that leverage volume discounts and service level agreements tied to volume. “The selection process for these vendors must be open and competitive; the selection committee must include representatives of the priority primary-care providers actively practicing within the Regional Center’s geographic service area.”
• Implementation and Project Management - Regional Centers must provide end-to-end project management support over the entire EHR implementation process, including:
o Individualized and on-site coaching
o Consultation
o Troubleshooting
o Other activities required to assure that the supported provider is able to:
› Assess and enhance organizational readiness for health IT
› Assess and remediate gaps in IT infrastructure
› Configure the software to meet practice needs and enable meaningful use
› Ensure adequate software training for all staff
› Track and adhere to implementation timelines
• Practice and Workflow Redesign - Regional Centers will must provide support for practice and workflow redesigns necessary to consistently achieve:
o Documentation of essential clinical information in a structured format
o Electronic administrative transactions
o Electronic prescribing
o Electronic laboratory ordering and resulting
o Sharing key clinical data across practice settings
o Providing patients with access to their health information
o Public health reporting
o Policies and practices that protect the privacy and security of personal health
information.
• Functional Interoperability and Health Information Exchange – Regional Centers will focus on meeting the functional interoperability needs of practices, including, but not limited to:
o The electronic exchange of administrative transactions
o Laboratory orders and results
o Medication prescriptions
o Quality and public health reports
o Patient summaries
• Privacy and Security Best Practices – Regional Centers will support providers with the implementation and maintenance of physical and network security, user-based access controls, disaster recovery, encryption and storage of backup media, human resources training and policies; and identification of state laws and regulatory requirements that impact privacy and security policies for electronic interoperable health information exchange.
• Progress Towards Meaningful Use – The Regional Centers’ personnel shall participate in program training and be able to provide their clients effective assistance in attaining meaningful use.
• Local Workforce Support - The Regional Centers will be expected to partner with local resources, such as community colleges, to promote integration of health IT into the initial and ongoing training of health professionals and supporting staff. Regional Centers may provide internship opportunities for local training programs, provide instructors for didactic programs, and use local training programs’ graduates to fulfill the workforce needs of their extension activities and the implementation, maintenance, and use needs of the centers’ participating providers.
Regional Center Selection Process
Proposals from organizations that wish to serve as Regional Centers will be received during fiscal year 2010. Regions may consist of area within a state, a single metropolitan area, several states, or contiguous portions of multiple states.
Health Information Technology Research Center (HITRC)
The Health Information Technology Research Center (HITRC) and the Regional Centers together are referred to as the Extension Program and form the National Learning Consortium. A single HITRC will be established to provide technical assistance and share information on best practices between the Regional Centers and other stakeholders. It will also provide technical assistance for the establishment and evaluation of regional and local health information networks to facilitate the electronic exchange of information across health care settings and improve the quality of health care. The HITRC will receive approximately $50 million in funding over a period of 4 years.
For further information please refer to the following references: healthit.hhs.gov/extensionprogram
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About Michael Stearns, MD, CPC, CFPC™
Dr. Stearns, e-MDs president and CEO, is a board certified neurologist and one of the more experienced physician health care informaticists in the nation. He has won several teaching awards and has 15 years of experience in clinical and academic medicine where his responsibilities included educating medical students and neurology residents. With more than 10 years of experience in the health information technology sector, Dr. Stearns has provided leadership to several high profile projects at the National Library of Medicine, the National Cancer Institute, and the College of American Pathologists. Dr. Stearns played a key role in the development of SNOMED Clinical Terms, an evolving standard for the electronic transmission of clinical information being adopted worldwide. He also has over 8 years of direct experience with the design and implementation of electronic health records. Dr. Stearns is a Certified Professional Coder and Certified Family Practice Coder.
He has given numerous presentations at national and local venues on a diverse array of topics related to health information technology including electronic health records, health care information technology standards, health information exchanges, coding, clinical terminology, structured data capture, data integrity in information systems, the history of ICD-9-CM, SNOMED CT, quality of care improvements related to technology, clinical efficacy research, practice optimization, and genomic medicine. He is a member of the American Society of Health Information Managers Health IT Industry Advisory Panel, the Health Information Technology Standards Panel, and the American Association of Professional Coders’ Family Practice Steering Committee.
For more information, please visit e-MDs.