Trendspotter: Doctors Question Regional Extension Centers

Besides providing incentives for doctors to acquire EHRs, the American Recovery and Reinvestment Act (ARRA) provides $677 million for regional health IT extension centers (RECs) that are supposed to help small primary-care practices choose and implement EHRs so that they can show “meaningful use” of these systems.

Recently, David Nash, MD, a health policy expert from Thomas Jefferson University in Philadelphia, wrote a blog post urging physicians to take advantage of the 62 RECs that have been established. The responses to his post reveal physician attitudes toward RECs and EHRs just three months before the government incentives start becoming available in 2011.

One physician, unconvinced that EHRs provide any value to medical practices, wrote that the purpose of RECs is to make money by recruiting as many doctors as possible and getting them to buy EHRs. Well, for starters, many RECs are not-for-profit organizations or educational institutions, and the for-profit RECs have to earn money to stay in business. As for tying payment to results, the government certainly wouldn’t want to spend all of this money and have the doctors involved refuse to buy EHRs. Sure, there’s an element of salesmanship involved, but most small practices will need a lot of persuading.

Another doctor raises a more serious objection: He points out that some RECs picked a short list of EHRs to recommend before the Department of Health and Human Services finalized its criteria for “qualified” EHRs or designated the bodies to certify them. In another post written last May, Glen Laffel, MD, a vice president at Practice Fusion, an EHR company, pointed out that New York State REC demonstrated seven uncertified EHRs to doctors without a competitive bidding process and after pre-arranging discounts from the vendors of those EHRs. He called on the RECs to recommend only certified applications and to explain how they selected particular EHRs.

This is entirely reasonable. Physicians have a right to know on what basis they’re being advised to buy certain products. The stakes are very high, especially for small practices, and they wouldn’t want to purchase an EHR that’s wrong for them because a REC got a great deal on it or even a kickback.

On the other hand, it’s important to recognize that REC personnel can help practices implement and show meaningful use of only a limited number of certified products. Every EHR is different, and a health IT consultant can’t know how more than a few of them work in any detail. So, even if a REC is totally honest and above board, it will naturally provide physicians with a short list to choose from. It’s impossible to predict how many of the 600 or so products on the market will be certified by one of the HHS-sanctioned certification bodies. But it’s a safe bet that dozens of certified EHRs will not make the REC cuts.

The doctors who responded to Nash had a more substantive critique, however, that went beyond complaints about how the RECs will function. Basically, they don’t like EHRs and see no value in them. So they resent the fact that the RECs will try to “seduce” them (to use one responder’s term) into purchasing an EHR. As far as they can tell, the RECs are a jobs program for IT consultants, and the $27 billion of potential ARRA incentives are a gift to software vendors.

What all of this tells me is that, despite the $44,000 to $64,000 that each doctor can get for showing meaningful use, and despite the extra help promised to small practices, many physicians are simply opposed to EHRs on principle. They see no reason to practice any differently than they do now, and they don’t see how EHRs can help them improve the quality of care.

There are legitimate questions about whether current EHRs are really up to the job the government wants them to do. However, EHRs can improve quality and safety if they’re used properly. Moreover, if most physicians had EHRs and were able to exchange information with each other, their ability to coordinate care and reduce waste would be greatly enhanced. When Medicare and private plans start paying doctors on value, rather than volume, this will be increasingly important.

That said, the government should give the RECs an additional responsibility: They need to lead a massive educational effort to explain why EHRs will benefit physicians and patients. Until doctors are convinced of that, they will continue to resist the siren song of ARRA incentives.