When Congress passed the American Recovery and Reinvestment Act of 2009, it called on HHS to create from scratch a nationwide network of regional extension centers to promote the adoption and use of health information technology.
Extension centers offer guidance on health IT
HHS won't have to reinvent the wheel in rolling out the program: The Smith-Lever Act of 1914 established the U.S. system of cooperative agriculture extension services anchored in the nation's land-grant colleges and universities.
Funded by the U.S. Department of Agriculture, today's cooperative extension service centers do more than send agriculture agents into the field to serve as links between farmers and researchers. There also are extension programs in economic development and conservation and a host of consumer science programs. It is that successful extension service program that Congress used as a model when drafting language for the health IT regional extension centers.
At the federal level, the REC program for health IT will be run from the Office of the National Coordinator for Health Information Technology at HHS and its Office of Provider Adoption Support, where Mat Kendall is the acting director. The national program will oversee 60 health IT RECs, which are just getting started. The centers will cover all 50 states, the District of Columbia and Puerto Rico.
The stimulus law calls for the centers to provide health IT assistance to provider organizations and “support and accelerate” efforts to effectively use health IT in compliance with federally approved IT standards and the national strategic plan for health IT.
The 60 RECs were chosen by competitive application and were awarded a total of $642 million in grants for their first two years of operation in two funding rounds in February and April. A third round of $24.9 million in supplemental funding for RECs to assist critical-access hospitals and rural hospitals with fewer than 50 beds is slated to be awarded this month.
The RECs will draw against budgeted, quarterly allotments for their “core” functions, such as administrative and operational expenses, Kendall said. The bulk of their funding, however, is designed to come from performance-based payments—one-third from per capita payments earned when RECs sign up providers to receive their services, another one-third payment when those providers' EHR systems are installed and the final dollop when the providers meet meaningful-use criteria under the stimulus law.
“We have RECs already signing people up,” Kendall said. “There are a lot of people out there who are ready to do this.”
Purdue University is Indiana's land-grant college and home to the Hoosier State's cooperative extension programs. Purdue also has operated a technical assistance program, providing expertise to various industries, including healthcare, since 1986. Not surprisingly, Purdue will serve as home and early benefactor to the Indiana Health Information Technology Extension Center, which won a $12 million, two-year federal grant from the ONC in February.
Indiana also is awaiting word on whether it will receive a slice of some $25 million in supplemental federal funding targeted for aid to small rural hospitals and critical-access hospitals. Word on that grant is expected this month, according to Monica Arrowsmith, the Indiana center's director.
So far, the Indiana REC has yet to receive any of its federal grant funds, Arrowsmith said, even though it already has a handful of staff on the payroll and job postings up for about 20 more new hires. The center should be staffed up to its full complement of about 50 employees by December, she said. Purdue is willing to carry the new REC until the federal money arrives, Arrowsmith said. “We're in a position to chalk it up as a liability, knowing that the funding is coming,” she said. “We don't have to spend time worrying about that piece.”
Arrowsmith said the Indiana REC will rely on the vendors to be responsible for installing their electronic health-record systems at physician offices and hospitals, even if those providers have signed up for its health IT extension services.
“There is no need to replicate what the vendors already are doing successfully,” she said. “We're looking to enhance that.”
Arrowsmith said one area of concentration for Indiana health IT extension agents will be ensuring that office-based practices and the small hospitals they sign up will be able to achieve meaningful use of their EHRs once they're installed. Meaningfully using an EHR is a requirement providers must meet to get paid federal IT subsidies under the stimulus law.
Bill Bernstein, chairman of consultancy Manatt Health Solutions, said he wonders whether there will be enough qualified healthcare IT talent to staff up the REC centers.
“Going into a small business and doing consulting, which is essentially what this is—and these systems touch every part of the practice—the people who are going to be successful doing this are going to be hard to find and train,” Bernstein said.
One problem is timing. The first payment year begins Oct. 1 under the Medicare portion of the ARRA healthcare IT subsidy program, but an ARRA-funded healthcare IT workforce training program won't begin enrolling its first wave of students in six-month, junior college programs until September. First graduates won't come out armed with IT certificates until March 2011.
The ONC's Kendall said he's hopeful the 60 RECs will find their average staffs of 50 to 60 workers in the current labor pool. “While we won't have graduates until March, there will be enough people to start it up,” he said.
Physician informaticist Mark Leavitt , the recently retired chairman of the Certification Commission for Health Information Technology, isn't so sure. Getting the RECs and the federal EHR incentive payment program rolling before the first workforce-training class graduates is akin to putting the cart before the horse, he said.
“You need 60 expert leaders, and I don't think there are that many in the whole country,” he said. “It's probably why congressmen don't run construction projects, because they'd put up the building and then have the bricks delivered. But ONC is doing as much as they can. There is this reality that this is our one shot at it.”
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