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I’ve been really interested in the Regional Extension Centers (RECs) and been interested to find out how they’re going to work. So, I’ve started a resource on the EMR and EHR wiki to list the various RECs and over time to populate the list with links to the REC websites. Since it’s a wiki please feel free to login and add whatever information you know or leave a comment with the information.

I also found these links to information about the RECs in Kentucky, Ohio and Indiana and Oklahoma and New Jersey.

Please let us all know any other information you have or find about RECs and their help in EMR implementation.

On EMR and HIPAA I did a post about healthcare IT Projects you can implement today. The basic concept is that you can work on other IT projects if you’re not quite ready to implement an EMR (for example if you’re waiting to learn more about the EMR stimulus money). Dan Draper stopped by and left an additional comment about an additional side benefit of doing an IT project before implementing an EMR (emphasis added):

Besides the direct benefit these projects deliver, taking baby steps with technology will make a big implementation easier. In these small IT implementations, I would recommend clinics and offices take the opportunity to evaluate IT integrators, network engineers and value-added resellers.

Use these small projects to find out which IT reseller really understands the challenge of healthcare (critical data/no on-site IT support) and won’t leave a doctor or administrator with a hot closet, a mess of cables or an infrastructure that won’t easily expand. Use this opportunity to ask the integrator or reseller what the IT costs and scope would be for that future (eventual) EMR implementation.

Very fine points. If you don’t think your relationship with your IT support help is important, you’re in real trouble during an EMR implementation. Done right, you won’t really notice they’re there. Done wrong, and let the finger pointing begin.

In the comments of a previous post Fred gave the following advice about your IT support during an EMR implementation, “you can pay a little more upfront and be done with it or pay more over the long haul and never be happy.

My only caution with this is advice is that paying more isn’t always better. This is particularly true when you’re talking about what you pay for the advice you get from an IT person. However, I think Fred’s point is that if you scrimp on some of the technology up front it can come back to haunt you. Regardless of how much you pay, you need to make sure your IT person knows what they’re talking about.

An example of paying too little up front is if you purchase a computer with too little RAM. Some things you can cut back on. Feel free to get a smaller hard drive. Do you REALLY need the DVD burner with Blue-ray? Usually not, but skimping on something like RAM will make you miserable. Then, your computer will slow down your EMR and your next call to your EMR vendor you’ll say, “Your EMR is SLOW!!!” when in fact it’s just you spent too little money up front on the important things.

I just read Ryan Rick’s guest post on Phoenix, Arizona EHR Uninstalls and I remembered a New York City Health Department’s project called Primary Care Information Project (PCIP) headed by Dr. Farzad Mostashari. I see big problems for Dr. Mostashari’s project. I predict many uninstalls and ultimately a low successful implementation rate. They have good intentions but are making classic mistakes which will ultimately prove to be their undoing. I hope what they are doing will work (because I am a big fan of EMRs), but let me outline a couple of critical weaknesses in their plan and then we will see how things work out for them over time. I think all “top down” EMR implementation organizations will take note of this experiment.

I think Dr. Mostashari has bought into the notion that implementation has to be daunting and hard. “Our experience here is that it’s just hard,“ Dr. Mostarshari said. He thinks like Dr. Middleton, “A crucial bridge to success, according to experts, will be how local organizations help doctors in small offices adopt and use electronic records. The new legislation calls for creation of “regional health IT extension centers”. In a letter to the White House and Congress last month, Dr. Blackford Middleton, chairman of the Center for Information Technology Leadership, a research arm of Partners Healthcare in Boston, and 50 other experts emphasized the importance of these centers and pointed to the Primary Care Information Project in New York City as a model.” — Steve Lohr, How to Make Electronic Medical Records a Reality, New York Times, March 1, 2009.

Implementation is daunting and hard if you pick systems which are NOT simple, NOT easy to install, NOT easy to learn, and NOT easy to use. PCIP in New York City is using eClinicalWorks which has a good reputation, but I am NOT sure it is simple, easy to install, easy to learn and easy to use. If eClinicalWorks had all the “simple and easy” characteristics, then I don’t see why the implementation would be so difficult and daunting.

Dr. Mostarshari is also moving very aggressively and fast. Not a good idea in my opinion! He is rolling things out to the whole system before seeing what works and what does not work. “The city Health Department’s Primary Care Information Project (PCIP) has already converted over 1,300 physicians and 226 medical practices to EHRs”. Record Recovery, Center for an Urban Future, page 5, June 2009. www.nycfuture.org. I think the project is only a couple years old.

Ryan Ricks, of XLEMR, makes a series of suggestions in his post which I believe are extremely important. “It seems that Arizona physicians are scrambing to remove unusable systems due to poor selection or botched implementations.”. “Physicians need to be careful and not rush into a decision they may regret.”. “Physicians should focus on their needs … and select the simplest system that fulfills their requirements”. “Simple systems are easy to install, easy to learn, and easy to use.” “Ease of use is critical; complex and difficult systems can lead to spiraling maintenance and training costs, and may ultimately be discarded”. “They should take their time to find a simple, user friendly system that meets their needs.” — Ryan Ricks, XLEMR Update Newsletter, July 2009, www.xlemr.com. Mr. Ricks makes some excellent points. Water flows downhill very nicely, but it takes a lot of energy to pump it to the top of the mountain!

It is my feeling that implementations would be less daunting and more successful if the EMR systems were less complex, easier to install, easier to use and easier to learn. Doctors are smart people who can learn to do stuff without handholding and constant supervision and oversight. The fact that the New York City PCIP Project needs all this hard work and all this effort and all this money makes me suspect that they have made major mistake in choosing an EMR system that is too complex, too hard to learn and too hard to use. Their second mistake is moving very rapidly to roll it out to the whole system before removing the bugs (the bug may be eClinicalWorks).

This top down approach is doomed to fail. Doctors must be able to choose the systems which works for them. If you have to ram it down our throats, it will be regurgitated at some point when we just get fed up. This happened in Pheonix Arizona, is going to happen in New York City and, if we are not careful, may happen in the whole country if things are not managed in a smarter manner. This is also a warning to Hospital Systems which are working in a similar “top down” manner to provide EMRs to their employed physicians and their private physicians (via the 85% rebate model). We don’t need Regional Health IT Extension Centers and we don’t need large organizations forcing us to use THEIR preferred EMR. We need to be using EMRs which are easy to install, easy to use and easy to learn! We need to identify those EMRs and promote them aggressively.

Here’s a short summary of a survey on the impact of EHR adoption and the major challenges of EHR implementation:

Stamford, Conn.- based IVANS Inc., a provider of electronic communications services to insurance and healthcare companies, surveyed 508 healthcare providers throughout the United States in April 2009.

According to the survey providers do see the benefits of healthcare IT, with 66 percent of those surveyed believing that EHRs can have a positive impact on their business, and 74 percent believing EHRs can have a positive impact on the healthcare industry overall.

The biggest challenge to implementation cited by providers was, “lack of budget” (82 percent) followed by “lack of awareness and expertise.”

I’m not sure how well this survey was executed, but the results seem to match what I’ve experienced in the EHR industry as well.