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- Realizing the Promise of Health Information Exchange
Regional health IT extension centers have signed up more than 100,000 physicians, or one third of all primary care providers in the nation, to help them deploy electronic health records, reaching its goal slightly ahead of its yearend schedule.
And 70 percent of all primary care providers in small practices in rural areas around the country are working with the extension centers, and in some states, it’s practically 100 percent, said Dr. Farzad Mostashari, the national health IT coordinator.
[Editor's Desk: This Week in Government Health IT.]
Those are among the efforts through which the Office of the National Coordinator for Health IT’s toolbox has established a beachhead, he said at a Nov. 17 summit spotlighting the progress of the extension centers, health information exchange, and beacon or model health IT communities to help to transform health care.
“Our challenge to extension centers is that every Medicaid provider that you’re working with must get $22,000 in the next six months, not because of the money but because it’s a concrete indicator of our commitment to them that this is real. Then take those who have adopted and keep moving toward meaningful use,” Mostashari said, referring to the incentive for Medicaid EHR adopters.
The 62 extension centers created by ONC offer hands-on assistance to providers in getting over the hurdles of establishing EHRs, such as vendor selection and project management.
The trained health IT workforce also has expanded through 81 community colleges offering health and IT training. The community colleges in the ONC program have enrolled 20,000 professionals in the past year, 5,000 more than the goal, and produced 5,000 graduates.
[Commentary: Developing REC 'MUVers'.]
Despite the tremendous need for these positions in hospitals, health plans and clinics and vendors, it is still difficult to link the demand with the supply, he said.
For health information exchange, the conversation has changed from “gauzy vision to real-life how-to,” he said. The Direct Project is a version of secure messaging for simple and direct exchanges between providers, or providers and labs or providers and patients. It is a streamlined version of the Nationwide Health Information Network (NwHIN) Exchange for securely sharing patient information via the Internet.
Providers can move messages now but next must figure out how to integrate exchanges into their workflow. ONC and public and private organizations working together are considering an implementation guide, how best to communicate information and the critical data that needs to be exchanged.
Dr. David Blumenthal, the previous national health IT coordinator, recounted the progress in EHR adoption and health information exchange based on the difference upon his return earlier this year to Partners Health System in Boston.
“Meaningful use has become a fact of life. Two years ago it was a distant possibility. Today there is a sense of urgency attached to it,” he said.
He also discovered unanticipated secondary gains. The requirement for sharing a care summary with patients at the end of their visits revealed that some physicians had not been writing much in the way of notes or recording medications, vital signs or care plans, and so didn’t have anything to show their patients.
“I never could have anticipated that the actual fear of embarrassment of handing your patients something that is below the standard of what you would expect from your physician and they expect from you would be a major motivator in terms of upgrading the quality of information that is available in our healthcare system. But you can never anticipate what’s going to change professional behavior,” he said.
To encapsulate the progress that is occurring, Mostashari related a visit with a solo practitioner in San Francisco serving mostly Medicaid patients. The physician used an extension center to help implement an EHR, which is remotely hosted, and meet security requirements. He began sharing information with 50 other providers who are served by the same independent physicians’ association (IPA), when it asked its providers open their notes to their colleague members to advance care coordination.
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These doctors knew each other, and their financial future is tied together. California paid them 180 percent of Medicaid fee for service because as a group they have lowered unnecessary hospital admissions.
They are now indexing data like a Google search of their EHRs to be able to synthesize all the information and doing predictive modeling. His IPA has applied to be an accountable care organization.
“He said the critical switch for him was when he realized that it’s not my record anymore; it’s the patient’s record,” Mostashari said.