Health IT Support Centers Get Their Own Advocates

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The newly formed Association of Regional Centers of Health Information Technology (ARCH-IT) plans to represent and provide technical assistance to the 62 federally funded regional extension centers (RECs). ARCH-IT also intends to encourage Congress to provide additional money to the RECs after their funding runs out in 2013, ARCH-IT president Jonathan Fuchs said in an interview with InformationWeek Healthcare.

In ARCH-IT's first month of existence, he said, the association has signed up about a fifth of the RECs, including centers in Arkansas, California, Florida, Nebraska, and Texas. ARCH-IT has also hired an executive director, David M. Bergman.

Authorized by the HITECH Act and launched by the Office of the National Coordinator of Health IT (ONC), the RECs are mostly helping small primary-care practices select and implement electronic health records (EHRs) and achieve Meaningful Use so they can receive government incentives. While the RECs are supposed to be financially self-sustaining after 2013, they're still trying to find a business model that works.

Some RECs cater to specialists to raise additional funds. For example, the Arkansas Foundation for Medical Care (AFMC), of which Fuchs is chief operating officer, runs the Arkansas REC and has enrolled about 60 specialty practices in it. These practices pay the same amount that the REC receives from ONC for working with primary care practices, Fuchs said.

While that's an additional revenue stream, Fuchs noted, the RECs could sign up many more specialty and dental practices if their government funding were expanded to include those providers. To date, ONC has spent $677 million on the REC program.

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In addition, Fuchs said, the RECs could play an important role in helping to prepare practices for stages 2 and 3 of Meaningful Use. The stage 2 requirements, which go into effect in 2014, are considerably more difficult to meet than those for stage 1, he pointed out.

Moreover, RECs are supposed to help critical access and rural hospitals get up to speed on health IT, Fuchs noted. But many of these facilities have trouble finding the upfront capital to invest in EHRs, and it takes hospitals longer than physicians to implement and show Meaningful Use of these systems.

That said, the RECs have already signed up more than 140,000 eligible professionals, of whom 77,000 have gone live on their EHRs and 11,500 have attested to Meaningful Use. Recently, Farzad Mostashari, national coordinator of health IT, told InformationWeek Healthcare that he believed all of the REC enrollees would probably attest to Meaningful Use by the end of next year.

Fuchs said that sounds reasonable. In Arkansas, for example, 70% of the 1,300 REC members have gone live on their EHRs. "We're finding that many are attesting to Meaningful Use and there isn't much difficulty in that regard. So [Mostashari's] statement is probably correct."

Besides representing the REC viewpoint to state and federal lawmakers and regulators, ARCH-IT also plans to provide technical assistance to its members. ONC already offers online educational resources to RECs and holds regional meetings, but Fuchs said he believes that his organization could do more than ONC has in spreading best practices among RECs that have diverse strengths.

In addition, he said, the association will offer discounts on supplies, possibly including EHR software and computers. Some RECs, he noted, are "agnostic" on software vendors and so can't obtain discounts. Other RECs have issued RFPs and whittled down the list of recommended products, but are too small to negotiate significant discounts. Medicare-contracted quality improvement organizations (QIOs) that operate RECs have a conflict of interest that prevents them from seeking price cuts, he added.

Some RECs are part of the same organizations that operate regional or statewide health information exchanges (HIEs). Fuchs said the two kinds of organizations have common interests, and eventually his association might include HIEs. But in terms of funneling REC members into HIEs, he said, "I don't think you need to be a unified organization to do that."

In the long run, Fuchs said, the RECs could serve a valuable purpose by continuing to work with physician practices to increase efficiency and improve population health. Teaching providers how to use data effectively to improve the quality of care, he said, "is going to be part of our value-added success," and ARCH-IT can help its members move into that area of clinical informatics.