Any of us that had some part of our childhood in the Midwest especially you may remember the Cooperative Extension Service that was established by the federal government via the Smith Lever Act of 1914.   The program was originally tasked with education, assistance and distribution of tools to provide access to increased agricultural production.  Their most famous incarnations may have been the Victory Gardens of WWII and the governance of the 4-H program. Well healthcare may be repeating the Cooperative Extension Service with The Regional Extension Center or R.E.C. (not to be pronounced REC or wreck as to not take on a negative connotation).

The REC as established by a division of ARRA called the HITECH Act is tasked with making Primary Care Providers (PCPs) Meaningful User’s via the use of certified Electronic Health Records (EHRs).  While there are volumes, in HITECH, that detail the mandates and expectations of The REC, the above sentence really boils all those volumes to their collective essence – The REC must make meaningful user’s of PCP’s.  Easy to say, but executing the mandate for The RECs is going to be an industry goal for at least the next two years.

Again harkening back to the Cooperative Extension Service, The RECs must provide education, outreach, and technical assistance, to help PCPs in their geographic service areas become meaningful users via the selection and successful implementation of certified EHR technology. The RECs will also help PCPs and other providers leverage networking infrastructures, e.g., the Internet, to achieve HIPAA compliant exchange of patient-centric data or health information exchange (HIE).  The RECs’ focus on HIE was designed to dovetail with the existing plans being built and executed in many States (via the cooperative agreements issued by The Office of The National Coordinator (ONC) pursuant to the Public Health Service Act (PHSA) Section 3013, as added by ARRA). 

In order to have maximum impact, The REC’s have a prioritized audience. The RECs’ top priority is providers that are PCPs, (i.e., physicians and/or other health care professionals with prescriptive privileges, such as physician assistants and nurse practitioners) in any of the following settings:

• Individual and small group practices (<10 PCPs) focused on primary care delivery 
• Public and Critical Access Hospitals
• Community Health Centers and Rural Health Clinics
• Other settings predominantly serving uninsured, underinsured, and medically underserved populations. 

The challenge is that in a REC’s service area, some top-priority PCPs may have already acquired or implemented EHR technology (certified or not).  Despite their EHR status, these PCP’s are still a focus of The REC although that focus may shift from technical assistance to helping the PCPs ensure they become meaningful users of the certified EHR technology. The services provided by The RECs span significant geographies and populations.  It is expected that each REC will provide services to a minimum of 1,000 priority PCPs.  In aggregate it is expected the all RECs nationwide will provide services to 100,000 priority PCPs – a huge task!

HIE could provide some of the most significant challenges to any given REC.  HIE as arguably been around for a while in one incarnation or another, but success and ubiquitous use seems elusive.  In today’s world the REC’s are starting to pair up and affiliate with HIE’s to provide the greatest impact on the healthcare community. According to Craig Brammer, Deputy Director, Beacon Communities Program, ONC the preeminent example of a R.E.C and HIE is HealthBridge that serves the Greater Cincinnati Ohio area. HealthBridge was established in 1997 and currently connects to more than 28 hospitals, 5,500 physician users, 17 local health departments and 700 physician offices and clinics. HealthBridge has gained tremendous notoriety across the industry and continues an upward growth trajectory by collaborating with other HIEs and other stakeholders such as University of Kentucky, Northern Kentucky University, Collaborating Communities Health Information Exchange, HealthLINC, Northeast Kentucky Regional Health Information Organization, Health Care Excel and Ohio KePRO.  In addition Healthbridge ensures sustainability via a successful business model and grants – most recently $9.7M to serve as the Tri-State Regional Extension Center that serves southwestern Ohio, northern and northwestern Kentucky and southeastern Indiana.

I recently met with Collaborating Communities HIE (CCHIE) Executive Director Marty Larson.  CCHIE is an independent HIE that has signed a collaborative agreement that enables CCHIE to leverage HealthBridge’s business experience and technology capabilities.  Marty has been a part of CCHIE for almost 3 years now and believes the timing of the ARRA/HITECH focus on HIE is perfect. Marty described his current agenda’s for all the organizations he is working with and he is staffing, marketing and contacting physicians to participate in the services they offer that will help them achieve meaningful use. When I asked Marty what his philosophy was with working with the physicians he said “it’s about setting expectations, it’s not an apology, and it’s about enthusiasm”

The REC’s are in a formative stage, establishing their respective cultures and discovering the needs of their service areas.  Organizations such as Santa Rosa Consulting, and the healthcare vendor community at large, can provide the insights and experience needed to make The RECs the go-to resource for information technology for many years to come.  We at Santa Rosa Consulting can offer experience-based insights regarding HIE and the collaboration with The RECs.  Please contact us at http://www.santarosaconsulting.com.