Recs – Considerations For Ehr Rfps

Section 3012 of the HITECH act establishes Health Information Technology Regional Extension Centers (REC) that volition offering technical assistance, guidance in addition to information on best practices to back upward in addition to accelerate wellness attention providers’ efforts to give-up the ghost meaningful users of Electronic Health Records (EHRs).  Each REC shall aim to supply assistance in addition to pedagogy to all providers inwards a region, but shall prioritize whatsoever withdraw assistance rootage to the following:

• Public or not-for-profit hospitals or critical access hospitals.
• Federally qualified wellness centers (as defined inwards department 1861(aa)(4) of the Social Security Act).
• Entities that are located inwards rural in addition to other areas that serve uninsured, underinsured, in addition to medically underserved individuals (regardless of whether such surface area is urban or rural).
• Individual or modest grouping practices (or a consortium thereof) that are primarily focused on primary care.

So far, ONC has granted over one-half a billion dollars to lx RECs to attain these goals. One of the rootage steps the RECs postulate to convey is the evaluation in addition to subsequent recommendation of EHR technologies to their constituents.  Whether the REC selects 1 EHR to piece of occupation with, or a curt listing of preferred vendors, or simply a full general rating organisation for multiple vendors, chances are an RFP, or at the real to the lowest degree an RFI, volition locomote issued to EHR vendors.

Following the grant statement several RECs issued (Requests for Proposals) RFPs in addition to some completed the EHR alternative process, spell most are withal inwards the procedure of creating RFPs. The few RFPs currently published are past times in addition to large based on the DOQ-IT EHR RFP.  While the DOQ-IT document is first-class for an private practice, it needs some of import adjustments inwards guild to serve a REC’s objectives in addition to stated priorities.

1. Facilitate EHR adoption for several hundreds, to several thousands of providers, inwards a curt amount of fourth dimension – This objective volition require that for an EHR vendor to locomote considered, it must induce got the capacity to truly perform such large scale implementations, both inwards human resources (quantity in addition to quality) in addition to technical infrastructure scalability. The RFP should enquire well-nigh both aspects.
2. All REC providers must locomote eligible for Meaningful Use incentives – Any EHR selected past times the REC must be, or readily become, ONC certified for Meaningful Use. Since at that topographic point are currently no ONC approved certifying authorities, the closest an EHR tin come upward to satisfying this requirement is past times already existence CCHIT 2011 certified (comprehensive or Stage 1).
3. The rootage priority for RECs is modest Primary Care practices amongst less than 10 providers – There are ii concerns here. First, these practices are commonly non cash rich, thus the EHR licensing model, in addition to whatsoever additional fees, needs to locomote thoroughly explored. Second, at that topographic point are specific features that are to a greater extent than of import for Primary Care in addition to non ever available:
   
   a. Full ACOG documentation capabilities in addition to extensive prenatal pedagogy materials for OB
   b. Comprehensive Pediatrics module including immunizations schedules for children amongst exceptional needs in addition to catch-up schedules
4. The initial REC endeavor volition locomote directed at providers serving large Medicaid populations, rural areas in addition to other medically underserved patients. Physicians in addition to clinics providing services inwards these areas induce got real specific needs, non necessarily found inwards most EHRs.
   
   a. Behavioral Health – Any EHR used for underserved populations must include extensive behavioral wellness modules or functionality.
   b. Comorbidities – The EHR must allow documentation in addition to handling of multiple problems inwards 1 visit, i.e. loading of multiple templates simultaneously in addition to longitudinal tracking of multiple problems, including patient specific attention plans in addition to illness administration alerts.
   c. Outreach & Patient Education – In add-on to the minimum requirements of MU, underserved populations would locomote good served past times sophisticated outreach tools in addition to extensive, culturally adequate, patient pedagogy materials. Specific materials for people amongst disabilities are also desirable. Just having a PHR is in all likelihood non sufficient inwards areas where at that topographic point are few computers in addition to wellness literacy is low.
   d. FQHC functionality – Any EHR used inwards these settings must induce got all the regulatory reporting (UDS) in addition to billing capabilities to back upward federally qualified clinics.
   e. Substance Abuse, Smoking in addition to Obesity – It would locomote beneficial if the EHR would include content in addition to tools to facilitate counseling along amongst mightiness to deal grouping sessions.
   f. Home Care – Any functionality that allows integration of habitation attention activities into a exercise EHR would locomote beneficial.
   g. Medical Home – Functionality built to improve back upward medical homes creation in addition to operations, such every bit full general attention coordination in addition to collaboration, reporting in addition to referral administration should locomote helpful. RECs should enquire if EHR vendor has sense amongst whatsoever PCMH deployment.
   h. Rural Health Connectivity – Considering that most REC implementations volition tumble out inwards rural settings where broadband in addition to Internet connectivity are non yet every bit reliable every bit inwards urban areas, EHRs should supply contingency plans for Internet access provider outages or lengthy periods of impaired reply time.
   i. Patient Volume – Most clinics to locomote served past times RECs induce got real large in addition to complex patient volumes. EHR relaxation of exercise in addition to usability features volition locomote extremely of import for successful adoption. Other than testing in addition to evaluating recommended products, RECs should also obtain noesis of a vendor’s Quality Assurance procedure in addition to the number of Usability professionals straight involved inwards production development.
   j. Last, but non least, whatsoever EHR vendor selected past times a REC should locomote willing in addition to able to integrate amongst existing State specific technology scientific discipline efforts to back upward underserved populations. H5N1 goodness example volition locomote the Indian Health Services RPMS in addition to its Patient Care Component, or whatsoever other Medicaid sponsored networks such every bit MO HealthNet inwards Missouri.
5. RECs volition locomote engaging inwards the largest long term EHR implementation endeavor to date.  It is to locomote expected that despite best endeavor some implementations volition neglect in addition to some practices volition locomote de-installing EHRs. H5N1 detailed conception of activity for extracting EHR in addition to PMS information from recommended EHR systems is imperative. RECs should enquire about, in addition to contractually request, equitable information extraction processes.

Note 1: Regarding EHR Modules - Although ONC volition locomote certifying EHR Modules, it volition locomote prudent for RECs tol solely induce got RFP responses from consummate products or vendors aggregating modules into consummate products. It would non locomote advisable for RECs to engage inwards EHR Module aggregation due to the aggressive timelines in addition to shortage of expertise.

Note 2: Regarding Meaningful Use – At the fourth dimension of this writing CMS has non finalized the minimum requirements for Stage 1 Meaningful Use. It is real probable that the currently proposed requirements volition locomote reduced inwards scope. However, the 25 certification requirements for EHRs should rest unchanged. Guaranties notwithstanding, EHRs that autumn curt of those requirements today are less probable to locomote able to come upward up to speed in addition to certify inwards fourth dimension for the RECs to encounter their aggressive schedules. RECs deciding to recommend such EHR products should, at the real least, position in addition to clearly explicate the jeopardy to their providers.