Congratulations to the Massachusetts Regional Extension Center , which leads the nation in reaching its recruitment goal. 

The Regional Extension Centers (RECs) are charged with bringing 100,000 providers to “meaningful use” of certified electronic health records (EHRs) by 2012 to 2014. Recruitment, which consists of a provider enrolling with the REC, is the first of three key milestones of the REC program. It is followed by going live with its EHRs (with e-prescribing and quality reporting capabilities) and, ultimately, achievement of meaningful use. Providers who enroll with the REC commit to using REC technical assistance to achieve meaningful use.

Each REC set its own goal based on the number of primary care providers that fit the description of a priority primary care provider (PPCP). These are solo and small group practices, community and rural health centers, public and critical access hospitals, and other practices serving uninsured, underinsured, and medically underserved patients.

When the Massachusetts eHealth Institute (MeHI), a division of the Massachusetts Technology Collaborative, became the Massachusetts REC for the Office of the National Coordinator for Health Information Technology (ONC) in April 2010, it set a goal of recruiting 2,500 PPCPs to adopt and become meaningful users of EHRs. Within just a year—and with two years left to go in the grant cycle—the REC has started more than 2,500 PPCPs on the road to meaningful use of certified EHR.

“Thanks to the leadership of Massachusetts Governor Deval Patrick and Secretary of Health and Human Services Dr. JudyAnn Bigby, Massachusetts is leading the nation in the advancement of health technologies that reduce costs and enhance the quality of health care for our residents,” said Bethany Gilboard, director of health technologies for MeHI.

Gilboard also credits the experience of the staff and organization for reaching the goal so quickly.

“Teamwork made this accomplishment possible,” says Gilboard. “We have three clinical relationship managers who are exceptional in working with the small physician practice.”

A Trusted Partner in Health IT

The key to the Massachusetts REC’s successful approach is its ability to demonstrate success and build upon that success to become a trusted advisor and partner to providers.

MeHI is a division of the Massachusetts Technology Collaborative (MTC), which has been working to speed the adoption of e-health technologies such as Computerized Physician Order Entry (CPOE) since 2003. MTC developed and funded an unprecedented review of 4,200 medical charts at six community hospitals in the Commonwealth. The CPOE program found that Massachusetts hospitals could prevent 55,000 dangerous medication errors and save $170 million annually.

As a result of these efforts to implement CPOE, MTC and MeHI already had established relationships with chief information officers (CIOs) in hospitals and physician practices across the state. The Massachusetts REC staff have continued to build on those relationships to help PPCPs transition from paper to EHRs.

“We are a trusted third party,” explains Gilboard. “We understand the needs of small physician practices. We understand how overwhelming this can be to figure out.”

Prescriptive Roadmap to Meaningful Use

While it’s exciting that the Massachusetts REC has recruited more than 2,500 providers, it’s only the first step. The ultimate goal is to help all of these providers achieve meaningful use. Physicians embarking on the journey from paper to EHRs have a lot of questions:

• How do I determine which EHR vendor is right for my practice?
• I already have an EHR system. How do I make sure it’s certified? How should I improve my processes to best utilize the EHR?
• What questions do I ask?
• How do I select a consultant?

The Massachusetts REC provides answers to those questions.

Participating vendors must go through a rigorous qualification procedure and guarantee “most favored pricing” to REC members. Consultants also must show their knowledge and expertise in EHR implementation to become Implementation and Optimization Organizations (IOO) that augment, complement, and supplement the training and advice from the vendor. For example, the IOO may perform a workflow analysis of the practice to determine what type of EHR is most likely to meet their needs and how to use technology to improve workflow at the practice.

Massachusetts REC staff members have put together a prescriptive roadmap that lays out the steps and expectations of physicians, consultants, and vendors in order to meet meaningful use requirements. If all parties follow this roadmap, the REC guarantees that they’ll qualify as meaningful users, with some even being eligible for Medicare or Medicaid incentives administered by the Centers for Medicare & Medicaid Services (CMS).

“We take a lot of the guesswork out for the small provider who has no one to turn to. That’s the beauty and value of the Regional Extension Center,” Gilboard says. This is the message that the Massachusetts REC has successfully communicated to physicians across the state.

Getting the Message Out

Another important strategy for success was the Massachusetts REC staff’s systematic canvassing of the state, putting extra emphasis on community hospitals with less capital resources to support their physicians in the transition to EHR technology. Staff contacted CIOs at all 72 hospitals in the state and found out if they had a strategy for EHR implementation. They then asked about the number of employed and independent primary care providers associated with the hospital. For those hospitals with a physician hospital organization or an independent practice association, the REC offered the opportunity for a wholesale approach to membership—where the PHO/IPA signed up for memberships for all primary care physicians. Alternatively, they supplied a draft letter that explained the benefits of the REC and encouraged individual physicians to join.

REC staff also visited different areas of the state to meet with local providers at hospitals or medical society meetings. This outreach included more than 25 educational summits and presentations to health care providers and other key stakeholders. Once physicians join the REC, they’re invited to local meetings to share stories and hear about the experiences of local physicians known as MUVers (Meaningful Use Vanguards, provider champions who have already made the transition to EHRs).

All members also get access to a special member portal to the REC website. There physicians can ask questions of their colleagues and learn from each other. REC members include providers in small practices (45%), community health centers (29%), small practice consortia (16%), and public hospitals (10%). That diversity ensures that physicians will find others in similar practices who have experiences to share.

Recruitment Continues

Although the Massachusetts REC has met its goal of enrolling 2,500 PPCPs, it’s still out there encouraging other primary care physicians and specialists to join and take advantage of the many services it has to offer. REC staff are reaching out to specialists across the state through the Massachusetts Medical Society’s Committee on Interspecialty.

“It’s not enough for primary care providers to have EHRs,” says Gilboard. “Specialists also need EHRs to work with primary care providers.” They also need access to a health information exchange (HIE) in order to get referrals and share information about patients. “If they go through the REC” to help them with the transition, “they know they’ll be configured properly” to connect to the HIE, she said.

The Massachusetts REC is clearly on a roll and eager to rack up more accomplishments. It expects to have a number of physician members ready to attest to meaningful use—and qualify for CMS incentives. We applaud Massachusetts’ early success and look forward to continue to celebrate the success of RECs around the country.