Reckless Rec Wrecking
John Moore aptly predicts, the relaxation volition non hold upward roughly later 2012.
Free Market
Here is my favorite gripe against the REC concept. The RECs are selecting a handful of preferred EHR vendors to recommend to their clients as well as thence are interfering amongst the complimentary market. Particularly since most RECs look to select the same commons EHR suspects. Along the same lines it tin hold upward argued that every infirmary Group Purchasing Organization (GPO) is interfering amongst the complimentary marketplace as well as and so are Sam’s Club as well as Costco as well as whatever other discount for book program. Why are the RECs consistently selecting EHRs from a minor grouping of almost a dozen products when nosotros all “know” that in that location are 400 EHRs out there? Perhaps it is because in that location are non 400 feasible EHRs out there. There never were. There really good may hold upward 400, or more, companies selling, or trying to sell, EHR software, but really few of those companies always made it into the master copy current as well as fifty-fifty fewer guide maintain plenty stability, or appeal, to hold upward a feasible selection for an informed consumer. It is worth noting that the EHRs the RECs are selecting are the same ones that physicians independently selected prior to the RECs creation, as well as thus the ones amongst the largest existing marketplace share. Perhaps ane size does non check all, but sure sizes do check most, as well as anyway, RECs are past times Definition committed to piece of work amongst whatever EHR a physician chooses, whether recommended past times the REC or not. When y'all compare this amongst the non-profit train wreck” they represent, it may hold upward beneficiary to guide maintain a closer aspect at the program.
Overview
The HIT Extension Program consists of 62 RECs, at to the lowest degree ane for each State as well as territory, as well as ane national Research Center (RC). The stated goal of the plan is “to supply outreach as well as back upward services to at to the lowest degree 100,000 priority primary attention providers inside 2 years”. The private RECs are supposed to comport outreach as well as didactics campaigns inwards their respective States as well as inform physicians on the latest HIT developments as well as available programs as well as incentives. The RECs are also chartered to offering back upward as well as guidance to physicians selecting as well as implementing EHRs, specially Primary Care docs inwards minor practices as well as inwards underserved areas. These are the doctors that were left out past times the regular marketplace procedure because they were difficult to reach, likewise expensive to implement as well as likewise misfortunate to bother with. While the private RECs are locally oriented, amongst feet on the Earth inwards each State as well as each County, the RC is basically a National forum for RECs to portion information as well as commutation lessons learned.
Funding
Other than a minor amount of seed money, RECs are non handed out all those hundreds of millions of dollars of grant funds. RECs are paid for performance. For each physician they impact as well as deal to recruit, the RECs are paid almost $1500. If as well as when the provider implements an EHR, the RECs have some other equal payment. The concluding 3rd of the coin is handed to the REC if, as well as only if, the provider achieves Meaningful Use. This organisation is only inwards consequence for 2 years. All those who believe that RECs are jump to neglect should hold upward reassured past times the fact that inwards that dire instance most of the allocated funds volition remain amongst ONC. The RECs are expected to exercise the ONC seed coin as well as discovery a agency to travel past times sustainable businesses later ONC ceases to back upward them financially.
Effectively, ONC is funding the start-up of 62 Social Businesses. Influenza A virus subtype H5N1 Social Business is a work concern whose purpose is non to amass profits for its founders as well as shareholders, but instead to ameliorate social club as well as solve ane social problem; a profitable as well as sustainable business, non a charity. As whatever venture capitalist knows, funding a startup is risky work concern as well as most startups never acquire inwards to the goal line. But some do, as well as in that location are strategies that investors employ to both minimize their ain opportunity as well as maximize the likelihood of success for the entire portfolio. By providing the RECs amongst centralized operational oversight as well as past times instituting milestone funding, ONC is doing precisely what a careful investor, managing other people’s money, would do.
Timeline
The declaration goes something similar this: The RECs are running out of fourth dimension as well as in that location is no agency they tin create thousands of Meaningful Users inwards a curt 2 years, or what is left of those 2 years. The mutual wisdom is that it takes many months, sometimes over a year, to transition a practise from newspaper to EHR, allow lonely Meaningful Use. That may hold upward truthful for your average xxx docs practice. The RECs are non dealing amongst large multi-specialty practices inwards suburbia. They are dealing amongst the solo doc inwards Booneville, Arkansas. It shouldn’t guide maintain longer than iii to 4 months to acquire a solo primary attention practise from newspaper charts to Meaningful Use, if the doc is willing. Granted, the fourth dimension left for collecting maximum Medicare incentives is rather short, but the RECs constituents are those administering wellness attention to the misfortunate as well as underserved, many of whom volition hold upward receiving incentives from Medicaid. There is plenty of fourth dimension for Medicaid incentives. And if some RECs fail, equally some inevitably will, as well as are unable to deliver Meaningful Users, they volition forfeit most of their allocated grant money. Tax payers inwards this instance volition non human foot the neb for failure.
Resources
We all know that the Meaningful Use aureate rush is creating a shortage of qualified EHR implementation resources, as well as so how are all those RECs going to staff their operations? They for certain cannot compete amongst private marketplace salaries, since the ONC seed working capital missive of the alphabet comes upward really short. Strangely enough, most RECs managed to construct their infrastructure already, but volition in that location hold upward plenty funds to hire HIT experts as well as volition anybody desire to guide maintain a labor which may bear witness to hold upward really temporary indeed? It is really unlikely that RECs volition attract experienced EHR implementers who are used to flight out to client sites, staying at prissy hotels, renting cars as well as having all their expenses paid patch on the road. RECs cannot afford these resources, as well as RECs do non demand these types of resources either. RECs are non selling as well as implementing EHRs. They are in that location to encounter that the vendor does a goodness labor as well as serve equally the physician advocate during the process. Many RECs are University based as well as others were created past times traditional Quality Improvement non-profits. None of them are starting from scratch and, similar every startup, they volition guide maintain to come upward up amongst innovative solutions. Some already have, others volition larn from those examples and, equally John Moore aptly predicts, the relaxation volition non hold upward roughly later 2012.
Free Market
Here is my favorite gripe against the REC concept. The RECs are selecting a handful of preferred EHR vendors to recommend to their clients as well as thence are interfering amongst the complimentary market. Particularly since most RECs look to select the same commons EHR suspects. Along the same lines it tin hold upward argued that every infirmary Group Purchasing Organization (GPO) is interfering amongst the complimentary marketplace as well as and so are Sam’s Club as well as Costco as well as whatever other discount for book program. Why are the RECs consistently selecting EHRs from a minor grouping of almost a dozen products when nosotros all “know” that in that location are 400 EHRs out there? Perhaps it is because in that location are non 400 feasible EHRs out there. There never were. There really good may hold upward 400, or more, companies selling, or trying to sell, EHR software, but really few of those companies always made it into the master copy current as well as fifty-fifty fewer guide maintain plenty stability, or appeal, to hold upward a feasible selection for an informed consumer. It is worth noting that the EHRs the RECs are selecting are the same ones that physicians independently selected prior to the RECs creation, as well as thus the ones amongst the largest existing marketplace share. Perhaps ane size does non check all, but sure sizes do check most, as well as anyway, RECs are past times Definition committed to piece of work amongst whatever EHR a physician chooses, whether recommended past times the REC or not. When y'all compare this amongst the non-profit North Shore Long Island Jewish Health System spending $400 ane thou 1000 to gyre out ane item EHR to 7000 physicians, I don’t intend the RECs are skewing the “free market” likewise much.
For anybody wondering almost the beingness of a night side inwards the RECs EHR selection process, I would propose reading the latest EHR selection press publish from the Ohio REC. The selection criteria for Ohio look pretty direct forward: adequate functionality, capacity to do the work, willingness to hire as well as develop Ohio citizens, back upward provided alone inwards the USA as well as commitment to ongoing certification. Looks rather reasonable to me. By the way, the Ohio REC reported almost xl vendor applications, which makes ane wonder where precisely are the other 350 EHR vendors hiding.
Innovation
How almost “stifling innovation”? Are the RECs belongings dorsum the time to come of HIT past times selecting quondam “legacy” EHRs? There is no inquiry that the RECs are selecting what they, as well as most reasonable folks, consider prophylactic products, products that guide maintain been roughly for a while, products amongst a sizeable install base of operations as well as products backed past times financially stable companies. Would y'all purchase a motorcar from Stimulus Motors, Inc., who’s been inwards work concern for 12 months, has five employees inwards the USA as well as iii customers, only because they advertise usage of “latest technologies”? What are “latest technologies”? If y'all aspect at the “legacy” EHRs selected past times the RECs, most boast .NET or the latest Java software, manufacture measure databases, browsers, rich sparse clients as well as fifty-fifty Natural Language Processing engines. The supposition that all invention must come upward from 2 guys inwards a garage is largely a fallacy. Besides, a really valuable invention should hold upward able to brand its agency through whatever market, whether it is a completely novel epitome or the much exulted iPhone proprietary model. Personally, I promise nosotros don’t devolve dorsum to days when a item software production was inextricably tied to a item slice of hardware, as well as for lack of a ameliorate term, telephone phone it innovation, but this is ameliorate left for some other twenty-four hours as well as some other post.
Full Disclosure: I guide maintain a fiscal involvement inwards EHRpathway, LLC which is currently providing consulting services to the Missouri State REC.
Free Market
Here is my favorite gripe against the REC concept. The RECs are selecting a handful of preferred EHR vendors to recommend to their clients as well as thence are interfering amongst the complimentary market. Particularly since most RECs look to select the same commons EHR suspects. Along the same lines it tin hold upward argued that every infirmary Group Purchasing Organization (GPO) is interfering amongst the complimentary marketplace as well as and so are Sam’s Club as well as Costco as well as whatever other discount for book program. Why are the RECs consistently selecting EHRs from a minor grouping of almost a dozen products when nosotros all “know” that in that location are 400 EHRs out there? Perhaps it is because in that location are non 400 feasible EHRs out there. There never were. There really good may hold upward 400, or more, companies selling, or trying to sell, EHR software, but really few of those companies always made it into the master copy current as well as fifty-fifty fewer guide maintain plenty stability, or appeal, to hold upward a feasible selection for an informed consumer. It is worth noting that the EHRs the RECs are selecting are the same ones that physicians independently selected prior to the RECs creation, as well as thus the ones amongst the largest existing marketplace share. Perhaps ane size does non check all, but sure sizes do check most, as well as anyway, RECs are past times Definition committed to piece of work amongst whatever EHR a physician chooses, whether recommended past times the REC or not. When y'all compare this amongst the non-profit train wreck” they represent, it may hold upward beneficiary to guide maintain a closer aspect at the program.
Overview
The HIT Extension Program consists of 62 RECs, at to the lowest degree ane for each State as well as territory, as well as ane national Research Center (RC). The stated goal of the plan is “to supply outreach as well as back upward services to at to the lowest degree 100,000 priority primary attention providers inside 2 years”. The private RECs are supposed to comport outreach as well as didactics campaigns inwards their respective States as well as inform physicians on the latest HIT developments as well as available programs as well as incentives. The RECs are also chartered to offering back upward as well as guidance to physicians selecting as well as implementing EHRs, specially Primary Care docs inwards minor practices as well as inwards underserved areas. These are the doctors that were left out past times the regular marketplace procedure because they were difficult to reach, likewise expensive to implement as well as likewise misfortunate to bother with. While the private RECs are locally oriented, amongst feet on the Earth inwards each State as well as each County, the RC is basically a National forum for RECs to portion information as well as commutation lessons learned.
Funding
Other than a minor amount of seed money, RECs are non handed out all those hundreds of millions of dollars of grant funds. RECs are paid for performance. For each physician they impact as well as deal to recruit, the RECs are paid almost $1500. If as well as when the provider implements an EHR, the RECs have some other equal payment. The concluding 3rd of the coin is handed to the REC if, as well as only if, the provider achieves Meaningful Use. This organisation is only inwards consequence for 2 years. All those who believe that RECs are jump to neglect should hold upward reassured past times the fact that inwards that dire instance most of the allocated funds volition remain amongst ONC. The RECs are expected to exercise the ONC seed coin as well as discovery a agency to travel past times sustainable businesses later ONC ceases to back upward them financially.
Effectively, ONC is funding the start-up of 62 Social Businesses. Influenza A virus subtype H5N1 Social Business is a work concern whose purpose is non to amass profits for its founders as well as shareholders, but instead to ameliorate social club as well as solve ane social problem; a profitable as well as sustainable business, non a charity. As whatever venture capitalist knows, funding a startup is risky work concern as well as most startups never acquire inwards to the goal line. But some do, as well as in that location are strategies that investors employ to both minimize their ain opportunity as well as maximize the likelihood of success for the entire portfolio. By providing the RECs amongst centralized operational oversight as well as past times instituting milestone funding, ONC is doing precisely what a careful investor, managing other people’s money, would do.
Timeline
The declaration goes something similar this: The RECs are running out of fourth dimension as well as in that location is no agency they tin create thousands of Meaningful Users inwards a curt 2 years, or what is left of those 2 years. The mutual wisdom is that it takes many months, sometimes over a year, to transition a practise from newspaper to EHR, allow lonely Meaningful Use. That may hold upward truthful for your average xxx docs practice. The RECs are non dealing amongst large multi-specialty practices inwards suburbia. They are dealing amongst the solo doc inwards Booneville, Arkansas. It shouldn’t guide maintain longer than iii to 4 months to acquire a solo primary attention practise from newspaper charts to Meaningful Use, if the doc is willing. Granted, the fourth dimension left for collecting maximum Medicare incentives is rather short, but the RECs constituents are those administering wellness attention to the misfortunate as well as underserved, many of whom volition hold upward receiving incentives from Medicaid. There is plenty of fourth dimension for Medicaid incentives. And if some RECs fail, equally some inevitably will, as well as are unable to deliver Meaningful Users, they volition forfeit most of their allocated grant money. Tax payers inwards this instance volition non human foot the neb for failure.
Resources
We all know that the Meaningful Use aureate rush is creating a shortage of qualified EHR implementation resources, as well as so how are all those RECs going to staff their operations? They for certain cannot compete amongst private marketplace salaries, since the ONC seed working capital missive of the alphabet comes upward really short. Strangely enough, most RECs managed to construct their infrastructure already, but volition in that location hold upward plenty funds to hire HIT experts as well as volition anybody desire to guide maintain a labor which may bear witness to hold upward really temporary indeed? It is really unlikely that RECs volition attract experienced EHR implementers who are used to flight out to client sites, staying at prissy hotels, renting cars as well as having all their expenses paid patch on the road. RECs cannot afford these resources, as well as RECs do non demand these types of resources either. RECs are non selling as well as implementing EHRs. They are in that location to encounter that the vendor does a goodness labor as well as serve equally the physician advocate during the process. Many RECs are University based as well as others were created past times traditional Quality Improvement non-profits. None of them are starting from scratch and, similar every startup, they volition guide maintain to come upward up amongst innovative solutions. Some already have, others volition larn from those examples and, equally John Moore aptly predicts, the relaxation volition non hold upward roughly later 2012.
Free Market
Here is my favorite gripe against the REC concept. The RECs are selecting a handful of preferred EHR vendors to recommend to their clients as well as thence are interfering amongst the complimentary market. Particularly since most RECs look to select the same commons EHR suspects. Along the same lines it tin hold upward argued that every infirmary Group Purchasing Organization (GPO) is interfering amongst the complimentary marketplace as well as and so are Sam’s Club as well as Costco as well as whatever other discount for book program. Why are the RECs consistently selecting EHRs from a minor grouping of almost a dozen products when nosotros all “know” that in that location are 400 EHRs out there? Perhaps it is because in that location are non 400 feasible EHRs out there. There never were. There really good may hold upward 400, or more, companies selling, or trying to sell, EHR software, but really few of those companies always made it into the master copy current as well as fifty-fifty fewer guide maintain plenty stability, or appeal, to hold upward a feasible selection for an informed consumer. It is worth noting that the EHRs the RECs are selecting are the same ones that physicians independently selected prior to the RECs creation, as well as thus the ones amongst the largest existing marketplace share. Perhaps ane size does non check all, but sure sizes do check most, as well as anyway, RECs are past times Definition committed to piece of work amongst whatever EHR a physician chooses, whether recommended past times the REC or not. When y'all compare this amongst the non-profit North Shore Long Island Jewish Health System spending $400 ane thou 1000 to gyre out ane item EHR to 7000 physicians, I don’t intend the RECs are skewing the “free market” likewise much.
For anybody wondering almost the beingness of a night side inwards the RECs EHR selection process, I would propose reading the latest EHR selection press publish from the Ohio REC. The selection criteria for Ohio look pretty direct forward: adequate functionality, capacity to do the work, willingness to hire as well as develop Ohio citizens, back upward provided alone inwards the USA as well as commitment to ongoing certification. Looks rather reasonable to me. By the way, the Ohio REC reported almost xl vendor applications, which makes ane wonder where precisely are the other 350 EHR vendors hiding.
Innovation
How almost “stifling innovation”? Are the RECs belongings dorsum the time to come of HIT past times selecting quondam “legacy” EHRs? There is no inquiry that the RECs are selecting what they, as well as most reasonable folks, consider prophylactic products, products that guide maintain been roughly for a while, products amongst a sizeable install base of operations as well as products backed past times financially stable companies. Would y'all purchase a motorcar from Stimulus Motors, Inc., who’s been inwards work concern for 12 months, has five employees inwards the USA as well as iii customers, only because they advertise usage of “latest technologies”? What are “latest technologies”? If y'all aspect at the “legacy” EHRs selected past times the RECs, most boast .NET or the latest Java software, manufacture measure databases, browsers, rich sparse clients as well as fifty-fifty Natural Language Processing engines. The supposition that all invention must come upward from 2 guys inwards a garage is largely a fallacy. Besides, a really valuable invention should hold upward able to brand its agency through whatever market, whether it is a completely novel epitome or the much exulted iPhone proprietary model. Personally, I promise nosotros don’t devolve dorsum to days when a item software production was inextricably tied to a item slice of hardware, as well as for lack of a ameliorate term, telephone phone it innovation, but this is ameliorate left for some other twenty-four hours as well as some other post.
Full Disclosure: I guide maintain a fiscal involvement inwards EHRpathway, LLC which is currently providing consulting services to the Missouri State REC.
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