RECs Won't Finish Mission Without More Funding

For many small and rural providers, Regional Extension Centers have been a low-cost or no-cost lifeline through the process of acquiring EHR technology and participating in the Meaningful Use incentive payment program. What happens to the stragglers as the RECs wind down?

Consider the plight of the nation's Regional Extension Centers, which serve as serve as support and resource centers to assist providers in EHR implementation and Health IT needs around the country.

Until late last year, the RECs' funding was due to run out. Recently, unspent portions of that previously allocated funding was freed up through February 2015 through an ONC ruling known as a "no-cost extension."

For many small and rural providers, RECs have been a lifeline of low-cost or no-cost source of advice and support through the daunting process of acquiring EHR technology and participating in the meaningful use incentive payment program.

But as we enter the fifth and final year of the RECs' life, there is a palpable sense that the assistance the RECs have given to healthcare's "last wagon" is still about to be snuffed out, leaving those at the rear of the technology adoption trail to fall further and further behind the leading edge of the IT-fueled transformation of healthcare.

For one thing, the RECs did not suddenly snap to life in Year One of the program. "They spent the first year letting contracts," says Bobby Gladd, author of the independently-published HHS Regional Extension Center Blog. "The second year was going out and recruiting. They've really only done boots-on-the-ground for two years, and the phrase was 'one and done'" meaning, just enough time and resources to help providers implement Year 1 of meaningful use Stage 1.

For those providers who attested early, say in 2011, had collected 70 percent of the money they were eligible to obtain through the Meaningful Use incentive program, by the end of that milestone, Gladd says.

A Long and Rocky Trail

Yet, that still left Year Two of Stage 1; and all the challenges of implementing Meaningful Use Stage 2, with all its disruptive changes to healthcare's workflows in order to effectively implement such objectives as coordination of care, patient engagement and health information exchange.

Without the help of the RECs, small and rural providers would be even more dependent on pricey consultants or EHR software vendors who might see such an opportunity as a sure way to lock in and lock up providers in their technology.

Gladd is more than just a blogger; until last year, he worked for the Nevada/Utah REC. And he recounted this story not just to me, but to the assembled press at the very conclusion of HIMSS, where new ONC chief Karen DeSalvo MD had agreed to take questions.

How did DeSalvo respond? The answer to that later. But first, a little more data to ponder.

According to Ryan Sandefer, chair of Duluth, MN-based College of St. Scholastica's department of healthcare informatics, as of last summer, only three percent of rural and critical access hospitals who could have performed their second year of Stage 1 attestation had done so. Sandefer had collected this data nationwide as part of his work with REACH, the Regional Extension Assistance Center for HIT, which serves Minnesota and North Dakota.

The same research found that only 20 percent of rural, non-critical access hospitals had only done 20 percent of second-year Stage 1 attestations.That's certainly better than 3 percent, but still nothing to celebrate.

Many of these hospitals are stuck in a queue waiting for vendors to upgrade to the 2014 certified version of their EHR software. Some of those providers are luckier than others, because their EHR software vendor does indeed have 2014 certified software to install, or even has the Stage 2-certified versions available to install.

Others are truly the last luckless wagons on the trail, as they can witness daily by visiting HHS's Certified Health IT Product List (CHPL), only to see once again that the EHR vendor they chose is still not compliant with Stage 1 2014 Edition, or with Stage 2.

'A Waste of Resources'

In January, Sandefer told me 3,000 vendors had Stage 1-certified products, but fewer than 100 vendors had certified for Stage 2. I'm sure the Stage 2 numbers are up since then, but the gap could not possibly have been narrowed that much.

REACH recently got its no-cost extension on the REC funding, and will be able to help many in its area cross various finish lines in the next 11 months. Still, REACH's ability to offer one-on-one advisement to its clients is more constrained than in earlier years, as it simply gets to spend more of the money it originally got, without any additional funding, other than what it can scrape together by expanding into other paying services such as IT consulting to healthcare organizations.

Other RECs, such as in Kansas, have also been the recipients of no-cost extensions recently. But come February 2015, any REC monies left unspent— and the requirements for spending the money is closely monitored— will no longer be available for those providers still bringing up the rear of the wagon train. "I just find it a waste of resources," Gladd says.

Now, back to that HIMSS press Q&A. DeSalvo acknowledged the role that her own local REC had played in helping clinics in New Orleans get up to speed with health IT.

"I'm a fan and I'm a supporter, and I'm trying to sort out whatever I can do to see that kind of support continue, because I don't think our work is done," DeSalvo told the press. "I don't think we quite understand how to do delivery right yet, and how to pay for it properly, and what are the workflow adaptations, and we're not going to decide that at 200 Independence [Avenue in Washington D.C.] entirely."

The answer, as former ONC chief Farzad Mostashari often suggested, probably lies a few blocks away, on Capitol Hill. Without more funding from Congress, the RECs will lose their ability to help those who need it the most. In this election year, let's see if that funding can be found before the money runs out for good next February.