In December I got an email newsletter from one of the RECs (REACH) that had some interesting information in it.

The first thing that was interesting was the number of providers that this REC had signed up along with critical access and rural hospitals. A decent number I’d say for this REC. I also love the part at the end where they said that Doctors had to sign up by the end of the year to get their “deeply discounted rates.” I’d be interested to know what the rates were before and after. Here’s the section that applies:

The Regional Extension Assistance Center for Health Information Technology (REACH) is only able to offer the federal discounts for electronic health record (EHR) services for a little while longer, under its current agreement with the Office of the National Coordinator for HIT (ONC).

REACH is currently working with 520 priority primary care providers, 56 in North Dakota and 464 in Minnesota. The program is also working with 20 critical access/rural hospitals, six in North Dakota and 14 in Minnesota.

All new REACH contracts need to be initiated before December 31 to receive the deeply discounted rates. Contact us to determine if REACH is right for you, 877-331-8783, ext. 222. Register for services >

The other interesting part from the newsletter was the ONC Meaningful Use Vanguard Program. Here’s the details as they describe it below.

Health care clinicians who have begun to make the successful transition to an EHR and are using their system as a clinical management tool have an opportunity to participate in a national movement developed by ONC called Meaningful Use Vanguard (MUV).

This exclusive group of champions of EHR adoption and meaningful use will be recognized as local leaders, advisors, and role models in the move toward an electronically-enabled health care system. There are no mandatory requirements if one is identified as a MUVer.

In addition to being recognized as a leader, MUVers can:
• Get access to an exclusive online community of EHR leaders to collaborate, participate, and advance knowledge
• Join a conversation on related topics with other MUVers regionally and nationally
• Be an advisor to REACH and ONC on testing of new tools and materials
• Give feedback on meaningful use and other policy developments

MUVers are health care clinicians who meet any of the following criteria:
• Made the transition to paperless records
• Applied experience in using EHR as a clinical management tool
• Experience with data exchange (eRx or labs)
• Experience with advanced application of EHR (e.g. population health management)
• A willingness to share their experience and knowledge with others

REACH may be contacting you about becoming a MUVer. REACH clients who are interested in this recognition, should contact their REACH consultant.

I’d love to hear some ongoing feedback from someone in the meaningful use vanguard (or should I say a MUVer) program. I’ll be interested to see what information and resources are provided to the MUVer doctors.

I don’t know about you, but I’m absolutely loving this holiday season. I’m not sure why it’s any different than past ones, but for some reason it’s been a really fantastic holiday for me already. We’ll see if that changes once my blogs go into their usual holiday slow down.

I’ve been getting a bunch of different holiday greetings from people. Although, the one I received today just made me laugh. So, I thought I’d share it and hopefully you’ll get a good holiday chuckle as well. This greeting is from the REC for Minnesota and North Dakota.

There are a TON of meaningful use resources for those physicians and clinics interested in showing meaningful use of an EMR in order to get the EMR stimulus money. Here’s one such resource that I thought gave a nice summary of what’s required. Here’s a small sample of the content they offer about meaningful use:

Core Set Measures

• Use CPOE (Computerized Physician Order Entry) to order medications for more than 30% of all unique patients with at least one medication in their medication list.
• Enable drug-drug and drug-allergy interaction check functionality on the EHR for the entire reporting period.*
• Maintain an up-to-date problem list of current diagnoses for 80% of all patients. If there are no problems, indicate no problems are known.
• Maintain an up-to-date list of active medications for 80% of all patients.
• Maintain an up-to-date problem list of medication allergies for 80% of all patients.
• Generate and transmit prescriptions electronically for 40% of prescriptions written by the provider.
• Record demographics for at least 50% of patients.*
• Record and chart changes in vital signs for at least 50% of patients.*
• Record smoking status for 50% of patients 13 and older.*
• Report ambulatory clinical quality measures to CMS.*
• Implement one clinical decision support rule relevant to the provider’s specialty.
• Provide at least 50% of patients with an electronic copy of their health information, upon request, within 3 business days.*
• Provide at least 50% of patients with clinical summaries of their office visit within 3 business days.*
• Perform at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information.*
• For the EHR and its related IT network, conduct a security risk analysis and implement security updates as necessary; correct security deficiencies.*

Menu Set Measures

• Enable drug-formulary checking functionality and have access to a formulary for the EHR reporting period.*
• Incorporate clinical lab-test results into the EHR as structured data for at least 40% of all lab test results.*
• Generate at least one report listing patients with a specific condition.*
• Send reminders to 20% of all patients, 65 years or older, per patient preference for follow-up care.*
• Provide at least 10% of all unique patients timely access to health information within 4 business days of the information being available to the provider.*
• Provide patient-specific education resources to at least 10% of all unique patients.*
• Perform medication reconciliation at least 50% of the time for patients transitioned from another setting of care.
• Provide a summary care record for at least 50% of patients for patients being transitioned to another setting of care.
• Perform at least one test of the certified EHR’s capability to submit electronic data to immunization registries.*
• Perform at least one test of the certified EHR’s capability to submit syndromic surveillance data to public health agencies.*

*These functions may be performed by nursing, administrative or IT staff

It is expected that EHR vendors will provide the capability to generate much of the above mentioned information within their software and they will also assist physicians in conducting data exchange testing.

In another great comment from BobbyG (who works for a REC), he talks about the realization that states have the option to opt out of doing the Medicaid part of the EMR stimulus if they want. The following is the full explanation of the discovery and why they’d make such a decision. Plus, it highlights the challenge of understanding all the regulations around the HITECH act.

Here’s just one example of the difficulty you run across. Yesterday we were on a CMS conference call MU incentives presentation in which they said that states’ participation on the Medicaid side was “voluntary.”

We all went “WHAT?! How did we miss that?”

Sure enough: on the CMS website you see “The Medicaid EHR incentive program is voluntarily offered and administered by States and territories. States can start offering their program to eligible professionals (EPs) as early as 2011″

“voluntarily”, “can start”

Not “shall” or “must”.

Now, we knew from the IRF that (paraphrasing here) “there is no statutory basis for the manner via which states disburse incentive payments” but it somehow escaped us that states could simply opt out entirely.

I went back to the ARRA legislation itself (on the assumption that the FR cannot, beyond operational implementation mechanics, mandate additional requirements not in the legislation). Beginning on page 375 you see “Subtitle B—Medicaid Incentives SEC. 4201. MEDICAID PROVIDER HIT ADOPTION AND OPERATION PAYMENTS; IMPLEMENTATION FUNDING.”

You get to page 380 and then only see stuff about the administrative and reporting “requirements” for states getting the “FFP” money (Federal Financial Participation).

And that’s it.

I searched ARRA from beginning to end and found NO explicit wording that states’ Medicaid participation is “voluntary.” You just have to infer it from the Section 4201 language.

What is one potential adverse upshot? Your REC could be signing up a boatload of providers coming in on the Medicaid side, and if your state opts out, well you now have what’s known as “Reputation Risk” writ large (not to mention a torpedo below the waterline in your Ops plan and its milestone payments assumptions).

Why would a state opt out? Because they are only federally funded for 90% of their “reasonable” administrative expenses for the EHR incentive program. They have to find the other 10%. My state (NV) is currently wrestling with a three BILLION dollar budget gap. Similar relative woes exist elsewhere in statehouses (can you say KAHL-EE-FOR-NEEYA?).

You better know where your state stands before recruiting Medicaid providers if you’re a REC or a consultant or VAR, etc.

I know a good number of my readers are EHR vendors and so I thought it worthwhile to post the REACH REC’s Request for Information for EHR vendors. Here’s the information from the email I received:

The Regional Extension Assistance Center for Health Information Technology for Minnesota and North Dakota (REACH) is issuing a request for information to help fulfill our common mission to assist providers in their efforts to achieve meaningful EHR use in pursuit of healthcare quality and efficiency improvements.

This RFI is the first step in a process intended to select a group of primary care, ambulatory EHR vendors to be designated by REACH as “preferred.” Through the establishment of this preferred vendor program, REACH intends to maintain ongoing, healthy competition between  participating vendors but at the same time will establish a number of ground rules and standards that will make the vendor selection process more efficient and effective. The vendors that apply for this “preferred” designation should approach this project with a willingness to be judged based on accurate contract, functionality and price differentiation.

Please visit the REACH web site to download the full Request for Information.  The response to this RFI is required by 5:00 PM on Monday, August 23, 2010.  All questions should be directed tovendors@khareach.org at least one week prior to the RFI response date.

Check the web site often as answers to questions deemed useful to all respondents will be posted there.

Thank you in advance for your interest and participation in this important initiative!

Nice to see that at least one REC is trying to get the word out about their EHR selection process instead of the process that I’ve seen coming out of many RECs where EHR vendors don’t even know their doing an RFI.

A really interesting comment about the REC EHR selection process was made over on EMR and HIPAA:

It is beyond me how any REC could have already selected EHR vendors since no EHRs have yet gone through the HHS certification process. CCHIT certification in prior years simply isn’t relevant now. I bet ONC would be horrified to hear what people in this comment string are saying…or at least, I hope they would be horrified!

What ONC needs to do is establish a standardized and TRANSPARENT process by which the RECs select vendors. The RECs are supported by taxpayer dollars, so we all have a right to know how this vendor selection is going down.

I really love the idea of ONC requiring an open and transparent EHR selection process by the RECs that are getting millions of dollars from them. Remember, each of these RECs are non profit organizations that are suppose to be helping doctors show meaningful use of an EHR. Why wouldn’t they want to have a transparent EHR selection process? What are they trying to hide?

My fear is that many of the RECs are so worried about the short timelines they’ve been given that they’re just throwing darts at the wall instead of really involving people in the process. I’m a HUGE proponent of what’s been called crowd sourcing. It’s really amazing the type of information you can get to make a better decision when you involve a large group of people in the process. I hope the RECs will do just that and be transparent in their EHR selection process.

Side Note: We’re getting a lot of the RECs and their websites listed on this list of EHR Regional Extension Centers wiki page. Please add any others that you might know about.

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.

HISTalk had this insightful point:

From Day Tripper: “Re: ambulatory EMR vendors. I asked several EMR vendors if they have seen a big increase in buyers, especially now that we at least have the interim final use definitions. The general consensus is that many physicians are still dragging their feet.” I’ve heard that comment as well. Either because of fear or because it sounds like a good excuse, many physicians are waiting until the MU guidelines are truly final and the certifying entities are identified. Perhaps a minority of physicians are savvy to understand that the RECs will offer some free implementation services so they are waiting for those to ramp up. And, likely others are waiting to see what opportunities their hospitals may offer to affiliated physicians. In other words, if you are looking for an excuse to not move forward, there are plenty to choose from.

I ask a number of EMR vendors the same question. A few had seen some increase, but for the most part they were all still waiting. I think Inga’s comment that there being plenty of excuses to not implement is true. This is unfortunate, since before the EMR stimulus most of the excuses had played themselves out and nearly disappeared. It seems that the EMR stimulus offered up a new set.

I will say that I’m not so sure how much “free” help the RECs will end up giving. I really wonder what most of them are going to do. One of my projects since HIMSS is to make contact with a number of the RECs.