By Ken Frantz and Mark Newman

Physicians and other healthcare providers are more concerned than ever about how they will implement electronic health record (EHR) systems in their practices by 2011 to qualify for the first phase of American Recovery and Reinvestment Act (ARRA) funds and ultimately be eligible for the maximum reimbursement. The systems can be complex, the reporting requirements and processes for demonstrating meaningful use are not yet clear, and the resources to help are still emerging. With the recent release of the Final Rule for “meaningful use” requirements for electronic health record systems (July 12, 2010) and the first of several deadlines rapidly approaching in 2011, the need to find help and implement EHR systems is at an all time high. Failure to meet the deadlines means missed opportunities for financial incentives. Failure to start now may also mean missed opportunities for federally supported implementation assistance. The Health Information Technology for Economic and Clinical Health Act (HITECH Act) within ARRA provides incentives in the form of higher Medicare and Medicaid reimbursements for physicians and other medical care providers who implement certified EHR systems (up to $44,000 per provider from Medicare or $63,750 from Medicaid). The incentives require providers to use the systems in a meaningful way as defined by the government guidelines just released.  This article will discuss various options that providers can chose for assistance in the selection and implementation of an EHR.  These options include Regional Extension Centers, EHR software vendors, and consultants. Regional Extension Centers ARRA provides funding to support implementation assistance organizations known as Regional Extension Centers (commonly RECs). In eastern Pennsylvania, the REC is known as Pennsylvania REACH East. REACH stands for the Regional Extension & Assistance Center for Healthcare IT. PA REACH East has a counterpart in the western part of the state as well, PA REACH West. The Pennsylvania centers are supported with a grant to Quality Insights of Pennsylvania and the services will be delivered through several contracted healthcare technology organizations. The New Jersey counterpart to PA REACH is the New Jersey Health Information Technology Extension Center (NJ-HITEC), which is supported with a grant to the New Jersey Institute of Technology. HITECH subsidizes PA REACH East, NJ-HITEC, and other RECs to provide a set of assistance services to primary care physicians, nurse practitioners, physician assistants, and others who provide ambulatory healthcare services. Primary care practices can include internal medicine, family practice, OBGYN, pediatric, and gerontology practices. The RECs are not subsidized to provide services to specialists and larger practices (greater than 10 providers); however, many will be offering membership in their programs for a fee. PA REACH East is gearing up to provide the following services:

• Selecting a certified EHR product
• Achieving effective implementation of a certified EHR product
• Enhancing clinical and administrative workflows to leverage an EHR system’s potential to improve quality and value of care.
• Guidance and training on achieving “meaningful use”

• Support for participation in health information exchanges
• Group purchasing opportunities

NJ-HITEC will offer a similar set of services, though they are behind PA REACH in setting up their programs. Getting help from a REC to adopt an EHR system will be the right choice for many practices.  They offer services, for free or for a modest fee, that traditionally were only available to large hospital systems with internal information technology departments, or from experienced consultants.  Smaller primary care practices, especially in underserved and poorer communities, are the main targets for help through the RECs, as they have not had many options for assistance. Extension centers are required to be software vendor agnostic. They will provide services that support the implementation of any certified EHR system. They are likely, however, for practical and logistical reasons, to select a subset of available certified EHRs for consideration.  While a cross section of available EHRs will be on the preferred list, be aware that these systems may not fit some providers’ needs or work with all practice management software, such as registration and billing systems.  This could lead to the practice switching practice management software, creating additional interfaces for the new EHR, or working with a software package the REC is less familiar with. To be sure, the Extension Centers will make a great effort to provide working solutions that will assist practices in achieving meaningful use. However, because there are so many diverse practices to work with, the RECs will concentrate on processes and configurations that lean towards common denominators and quick wins. PA REACH East will be conducting a series of information sessions throughout the month of August for practices and providers across the eastern region of Pennsylvania to answer questions and more fully explain the program. Registration, location and dates for these events, requesting Extension Center assistance, and more information on PA REACH can be found at http://www.pareacheast.org/. NJ-HITEC, at press time, is in the process of setting up their services. According to Bill O’Byrne, the Executive Director of NJ-HITEC, their Web site should be operational by the end of August, with plans to conduct information sessions throughout New Jersey in October. For the moment, any New Jersey provider who has questions about the Regional Extension Center should email him directly at obyrne@njhitec.org. Vendors Most vendors of EHR systems have implementation services that can be purchased separately from the software. It is best to negotiate these services when you buy the software, because negotiation leverage is at its greatest. Vendor implementation teams have a great deal of experience in implementing their product. They are experts of their systems. However, they are not usually experts of medical practices. Software vendors will know WHAT needs to be configured within the system to make it work, but they will expect the practice to tell them HOW it should be configured. Regional Extension Centers and experienced consultants are great resources to help determine HOW these systems should be configured and HOW workflows can be optimized. Without such services, there is a greater risk of dissatisfaction and future re-works to the system, which can lead to lost productivity and delays in achieving meaningful use. Experienced Consultants Specialties, large practices, multi-specialty practices, and other providers who have unique needs may want to work with consultants who have had experience in their fields of expertise. In addition, there may be unique needs in terms of integrating or interfacing with existing systems and medical devices, which will require an expertise in those areas. Specialized consultants can provide additional services that will be helpful in these situations. Seasoned consultants have in-depth knowledge of practice types, practice workflows, and processes for implementing solutions effectively. Good consultants work as advocates for individual practices, helping them meet their specific needs. EHR, practice management, and medical device systems are becoming more complex. Consultants should have a good understanding of how these systems fit together and can help practices get the greatest value out of these systems by supporting integration. Practices should expect to pay more up front for focused and specialized consulting services. However, these services should cost less in the long run by helping practices get up to speed faster, capture charges more completely, and create more efficient workflows. They can also help practices develop solutions like patient access to online functions for bill paying, appointment scheduling, requests for patients’ basic health information, and renewing prescriptions. Experienced consultants can be found on lists from professional medical and healthcare IT organizations (see the section on Other Resources, below for details), on the Web, and from recommendations from other practices.  Going forward, many of the RECs plan to also develop a preferred service provider list, including consultants. Internal Resources Whatever type of help is chosen -- Regional Extension Center, experienced consultants, software vendors, or other outside assistance -- providers will get the most out of their systems if they make the investment in time to learn how these systems work. These systems can help providers maintain records and see trends over time. By tracking patients’ allergies and medications, the systems can help providers avoid dangerous or contraindicated prescriptions. These safety mechanisms are only effective if providers adapt their practice processes to utilize them effectively. Care providers must plan how they will adopt the new systems and effectively incorporate them into the patient care experience. Planning time to learn the systems will make adoption smoother and practices gain efficiencies faster. Failure to plan and practice can result in awkward and frustrating patient experiences. Without proper planning, the computer terminal can become an unwanted third party in the room distracting the provider from the patients’ needs rather than making the provider more informed and enhancing the patient experience. Other Resources Many medical specialty societies make available free or discounted EHR system selection tools, implementation field guides, and advice for their membership. Some examples include the American College of Physicians, American Gastroenterological Association, and American College of Cardiology. The advice is designed to help their members decide which systems fit best with their practice types. Professional organizations such as the Healthcare Information and Management Systems Society (HIMSS) and the Medical Group Management Association (MGMA) also have a wealth of information through their websites. They have tools and advice concerning the selection and implementation of EHRs, as well as information on HITECH, stimulus funds, and meaningful use. Other good sources of advice are colleagues who have successfully implemented EHR systems, though bear in mind that every practice is different and a rigorous analysis of what is right for your practice is still required. What to look for in EHR assistance Regardless of the source of help, there are a several factors to consider with any EHR consultant. With over $30 billion from the stimulus package slated to help physicians adopt EHRs, there will be individuals who claim expertise in healthcare information technology, but without the right experience. It is important to ask the right questions before you enter into a contract. Any group that is under consideration to help select and implement an EHR should:

• Provide reference clients and the EHRs they’ve worked with
• Have experience with your type of practice or specialty
• Understand EHR contracts to assist in negotiation
• Provide a list of deliverables for the engagement
• Disclose biases and financial incentives in the EHR selection process

Going Forward Selecting and implementing an EHR system is a major undertaking for a practice.  However, thousands of providers have successfully adopted this exciting technology.  The key is finding the right partner to help you take advantage of what has worked for others, and avoid what has not.  Experienced consultants, Regional Extension Centers, and vendors are all good choices.  Which you choose (or in which combination) will depend on the specifics of your practice, your goals, and available resources.  The ultimate success of any implementation is determined by your commitment and ability to understand how the system can best work for you. Ken Frantz and Mark Newman are partners at EHR Associates; a consulting firm dedicated to helping physician practices adopt information technology. They can be reached at 215.690.4133 or info@ehr-associates.com.