The Health IT Regional Extension Center Program: evolution and lessons for health care transformation.

OBJECTIVE: Assess the Regional Extension Center (REC) program's progress toward its goal of supporting over 100,000 providers in small, rural, and underserved practices to achieve meaningful use (MU) of an electronic health record (EHR). DATA SOURCES/STUDY SETTING: Data collected January 2010 through June 2013 via monitoring and evaluation of the 4-year REC program. STUDY DESIGN: Descriptive study of 62 REC programs. DATA COLLECTION/EXTRACTION METHODS: Primary data collected from RECs were merged with nine other datasets, and descriptive statistics of progress by practice setting and penetration of targeted providers were calculated. PRINCIPAL FINDINGS: RECs recruited almost 134,000 primary care providers (PCPs), or 44 percent of the nation's PCPs; 86 percent of these were using an EHR with advanced functionality and almost half (48 percent) have demonstrated MU. Eighty-three percent of Federally Qualified Health Centers and 78 percent of the nation's Critical Access Hospitals were participating with an REC. CONCLUSIONS: RECs have made substantial progress in assisting PCPs with adoption and MU of EHRs. This infrastructure supports small practices, community health centers, and rural and public hospitals to use technology for care delivery transformation and improvement.

Promoting electronic health record adoption among small independent primary care practices.

OBJECTIVES: To describe the benefits and limitations of incentive arrangements used to engage small primary care practices to adopt electronic health records (EHRs). STUDY DESIGN: Retrospective review of program outreach efforts and EHR enrollment rates. METHODS: Comparison of benefits and limitations of various promotional strategies in addition to a city subsidy. Measures of enrollment progress include the mean number of outreach attempts, the mean number of days from first attempt to enrollment, and the enrollment yield. Selected practice demographics were collected for comparison purposes. RESULTS: Of 890 providers representing 217 practices who were eligible for the city subsidy, 37.7% enrolled, with a mean of 96.6 days from first attempt to enrollment and a mean of 10 outreach attempts. The offer for full payment of technical assistance fees and hardware yielded an additional 100 providers representing 43 practices, a 14.1% enrollment rate. This group also had the highest mean number of days from first attempt to enrollment (236.0 days) and the highest mean number of outreach attempts (22 attempts). The offer for a partial rebate had the lowest yield (a 6.2% enrollment rate), a mean of 169.3 days from first attempt to enrollment, and a mean number of 19 outreach attempts. CONCLUSIONS: Because of diverse needs and levels of awareness in the EHR adoption process, a flexible milestone-based process is needed to engage primary care providers. In particular, community influence and additional funding were necessary for increasing enrollment among providers in medically underserved neighborhoods. These providers also required persistent and numerous follow-up attempts. Because billions of dollars in federal aid are being offered, effective local recruitment strategies are needed to facilitate provider engagement to increase EHR adoption rates.

The regional extension center program: helping physicians meaningfully use health information technology.

Many physicians face financial and organizational barriers that inhibit their adoption of electronic health record (EHR) systems. The 2009 Health Information Technology for Economic and Clinical Health Act included provisions to facilitate the transition from paper to electronic records, including Medicare and Medicaid incentive payments to support the adoption and meaningful use of EHR systems. It also created the Health Information Technology Regional Extension Center (REC) program to ease the barriers faced by primary care physicians and rural and critical-access hospitals seeking to implement EHRs. The 60 RECs will administer individualized assistance to primary care practices and rural and critical-access hospitals as they implement new EHR systems or upgrade existing ones. In aggregate, the RECs aim to help 100 000 primary care physicians, physician assistants, and nurse practitioners to effectively implement EHR systems and qualify for incentive payments for meaningful use. This article describes the rationale for the REC program and describes how the 60 RECs promote the meaningful use of EHR systems.

A tale of two large community electronic health record extension projects.

The Massachusetts eHealth Collaborative and the New York City Primary Care Information Project have provided financial subsidies and extensive support to help hundreds of independent medical practices successfully adopt electronic health records. Their efforts address overcoming key barriers such as the amount of start-up funds needed, productivity lost during implementation, and the difficulty of choosing the right system. Their approaches differ: the Massachusetts project emphasizes continuity of care within selected communities; New York emphasizes improvements in preventive care and chronic disease management across a population. Both, however, offer valuable insights that can be applied elsewhere.

The New York City eClinician Project: using Personal Digital Assistants and wireless internet access to support emergency preparedness and enhance clinical care in community health centers.

The New York City Department of Health and Mental Hygiene, The Community Health Care Association of New York State and Clinical Directors Network are collaborating on the "eClinician Project," which has distributed seven hundred public health-friendly, wireless (WiFi) enabled Personal Digital Assistants (PDAs) to primary care clinicians working in New York City, federally funded, Community Health Centers (CHC) which serve minority underserved communities that suffer a disproportionate burden of chronic disease and lack access to health promotion disease prevention services. Each participating health center also received a wireless router to create an onsite internet hot spot to enable clinicians to have internet access. The goals of the eClinician Project are to: 1) To encourage adoption of information technology among providers in Community Health Centers in New York City by providing PDAs as a first line strategy towards achieving this goal, 2) enhance access to information on emergency preparedness, 3) improve patient outcomes by providing PDA-based clinical decision-support tools that support evidence-based care, 4) encourage chronic care management and health promotion/disease prevention activities, and 5) increase productivity and efficiency. CHC clinicians have received a hands-on, on-site orientation to PDAs. Ongoing training has continued via online CME-accredited webcasts (see www.CDNetwork.org). Clinical decision-support tools are available for download via the eClinician project web portal (see www.eClinician.org ). Public health alerts can be delivered to the PDAs or to the clinicians' desktop computers. Pre and post training surveys, in addition to a case study, have been used to evaluate the population demographics, PDA adoption by the clinicians, clinician attitudes towards using PDAs, PDA influence on clinical-decision making and barriers to adoption of PDAs and information technology in general.