- Regional Extension Centers (RECs) are an effective tool for facilitating EHR adoption and helping to solve the technical and business challenges along the way, according to a study published in Medical Care and co-authored by former ONC chief Farzad Mostashari. Fifty-five RECs reported on more than 19,000 issues affecting 43,000 unique providers, including administrative problems, workflow adjustments, vendor selection questions, and struggles to meet the requirements of Stage 1 of Meaningful Use.
Providers who work with their local REC are more than twice as likely as independent providers to successfully receive payment under the EHR Incentive Programs, the study says. By using the ONC’s Customer Relationship Manager (CRM) tool, the research team was able to examine what specific issues may prevent providers from being among those successful attestations and how healthcare organizations are overcoming the barriers to meaningful use. “The data reported by RECs includes a description of the problem faced by the practice site,” the report explains. “The challenge section also captures when the problem is resolved and when the site is on track to meeting its MU goal.”
In 2012, 14,424 unique sites reported a total of 19,209 problems. Twenty-two percent of sites had multiple issues in the database. The top issue reported to the ONC for those sites not let live on an EHR was provider engagement. Administrative practice issues and the problem of selecting an EHR product also appeared frequently.
“Challenges to EHR adoption, implementation, and MU achievement are widely known, but this is the first nationwide assessment of these challenges,” the study says. “This work has identified and categorized those challenges so best practices, tools, and resources can be developed and targeted to groups who need the most assistance.”
Delays in implementation and installation, practice workflow adoption, and financial issues stemming from vendor fees, incentive eligibility, and available capital were reported frequently, as well. Providers in California, Texas, Florida, and New Jersey were among the most vocal, volunteering more than a thousand complaints in each state. Struggles with individual meaningful use measures made up only 14% of complaints, although the clinical quality measures (CQMs) figured largely. Practice staffing and training rounded out the list of top internal challenges.
Vendors seemed to cause many of the headaches associated with EHR adoption. Questions over certifications and upgrades were often reported, as was a lack of support from EHR developers. Many providers complained that vendor reports and data were inaccurate, slow, or not available, and that training materials were insufficient.
“New challenges emerge as providers progress toward MU, creating opportunities to preempt large-scale issues with timely interventions,” the study concludes. “These interventions must take into account organizational and cultural dynamics, increasing the need to identify multiple, often setting-specific solutions. If identified quickly and a time response is provided, problems may be halted before becoming widespread or impeding progress. RECs collective organized and addressed these by building tools and processes that were proactively shared with providers, ultimately leading to more timely attestation and payment.”