Do RECs Deserve Respect?

When I learned that HITECH included funds setting up the regional extension center system to support small medical practices in implementing EHRs, I thought, well, that sounds OK.

I wasn’t thrilled, mind you, as I wasn’t optimistic that a government-sponsored organization would produce the quick EHR adoption process HITECH demands, but it wasn’t a bad thing.

Since then, I’ve gone from mildly interested to downright irritated.  While I wasn’t expecting the RECs to blaze a path to glory, I thought it would be nice if they produced great educational materials and sessions, made themselves highly accessible to physicians and offered clear guidance on vendor selection. As far as I can tell, we’re largely zero for three.

Yes, as a recent a recent study notes, the RECs are doing better at some of these things of late. According to a recent study by the eHealth Initiative, they’ve now reached most of the 100,000 PCPs they’d hoped to enroll, and they’ve developed better vendor specifications.

That being said, they really don’t seem to be that focused. Hey, if a privately-funded organization took this long just to begin to get started with their work, they’d already be out of business.

Not only that, when I made one completely unscientific mystery-shopper call to a REC, the staff member I spoke to didn’t seem to have much on the ball. He didn’t have anywhere to direct me for further information, didn’t have any informational meetings pending, couldn’t define clearly what his group could do for me and didn’t even bother to get my contact information.

Of course, that may have been a freak instance, but I’m beginning to doubt it. The buzz I hear is that the RECs have barely a clue as to how to reach their target population, and don’t really speak their language. Some of my EMR-savvy buddies think they’re just about useless.

I do truly hope that the RECs get their act together — maybe all they need is better marketers — but I’m not holding my breath.  My advice to doctors: Keep pushing on your local medical society, your IPA, your hospital partners and your practice management consultants to shed some light on the EMR adoption process. You’ll get further, faster.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

21 Comments

  • You write an article on respect and the RECs. Your trashing of all of the 62 entities comes from your “EMR savvy” buddies and a mystery shopping phone call. Is this your professional advice to the THOUSANDS of Eligible Professionals trying to navigate this extremely important initiative? Maybe a mystery phone call to a practice that has received help and attested to the incentive payment would help give some respect? And isn’t that “government sponsored organization” can’t do anything argument old, lame, and without substance? I have spent time on ALL 62 websites of the RECs. There are some that are directionally challenged but there are MANY that are doing the right thing. And many of them are being led by EHR (not EMR) savvy people that are industry leaders in their own right. Your irritation and holding your breath are symbols of someone very naive. I am a craps player in Vegas and I play the pass line. You should try it some time, it is much more fun.

  • Wow Roberta, I never would have guessed that you’d be such a proponent of the RECs. I’m personally somewhere in between you and Katherine.

    I must admit that I think it’s impressive that the RECs have signed up the 100,000 providers. Although, I’d love to have a deep dive into those numbers. Stats can always be manipulated if someone wants to do it.

    Personally I advise practices to consider their RECs, but to go in with eyes wide open. Some really have done some good work and provided a good service, but some of them are really terrible and I believe will do some harm to the industry. Not usually on purpose, but through poor strategy and approach.

    All in all, I see the RECs as basically a wash. Haven’t been a resounding success, but haven’t been a resounding failure either.

    As a side note, I’m sure that you and I will never agree on the EMR/EHR debate. In fact, I like to occasionally throw EMR in my posts so the EHR purists will get their pantyhose in a knot. I think I’ve learned that in Vegas as well;-)

  • As a vendor, I see the creation of the RECs as a response by the ONC to the skepticism and distrust by doctors of vendors, and unfortunately there is some validity to that. The government created the concept of the RECs and taxpayers are funding them, so I do not hold the RECs responsible for flaws in the concept.

    Working with an REC creates an incredible amount of effort and expense on the part of a vendor and places a middle man between the vendor and the doctor. The REC participation agreements I have reviewed thus far have requested money from the doctors to obtain their services in the form of membership fees (didn’t they receive taxpayer money already), and a requirement of discounts and uniform pricing from the vendor as a member benefit along with many other vendor commitments.

    The RECs seem to be working with very few vendors, most of which offer what I would consider to be very expensive solutions. Being only somewhat familiar with so few vendors, how can they actually offer a balanced recommendation to a PCP?

    Some RECs are asking for the vendor (at its expense) to train the REC to be its sales, training and implementation force. How is the vendor to maintain its own professional sales, training and implementation force, dedicated and knowledgeable on it’s products? How is it possible for an individual in a REC to be competent on so many competing products, even if they only work with a handful? Do they divulge to their members how few of the many vendors they are familiar with? Do they divulge that their criteria for working with a vendor is that the vendor has agreed to the REC’s demands within the REC’s timeline? Do they tell their members that there are many, many solutions that will not even be considered by them in their recommendation?

    We have been developing and providing practice management and EMR/EHR solutions to doctors for nearly 30 years, and we have found it a continuous challenge to keep our dedicated sales and training resources current with our products. I think every vendor who offers consultative on site sales as well as on site training and implementation would concur. If our sales and implementation teams were working with even 5 different companies with competing products at the same time, it would be virtually impossible, and the RECs should be familiar with many more than that to honestly say they offer comprehensive consulting and implementation services to PCPs.

    Doctors and RECs and HIEs are being funded by taxpayer money. Vendor expenses for certification and additional complications created by RECs and HIEs are their own to assume. Many vendors have increased their prices to cover their increased expenses. Unfortunately working with RECs instead of working directly with a PCP represents additional expense and in many cases may represent a loss of revenue and control of its business to a vendor as well.

    I am hopeful and interested to see how it pans out as time goes by, but these are my reflections at this time on RECs.

    Mark Hollis
    MacPractice, Inc. President

  • You certainly got my attention with this one. It’s hard for me to gauge what kind of “quality” bar I should be using when reading something like this.

    For me, I wish this was written with more research to support the statements being made given the tone of the article.

    You may have gotten to the same conclusions but the subject does deserve more.

    Bottom line for me is that there’s much more complexity to REC program and RECs themselves.

    Simply put, they are 62 independent startups — some will excel and some will falter along the way.

    I don’t usually give respect until they’ve earned it but do believe in giving them a chance.

  • The experience I’ve had with RECs is inline with this post.

    If anyone should have a clue…shouldn’t it be the RECs?
    Shouldn’t they be the leading edge of knowledge on this?

    The challenge is as mentioned above, 62 startups…government startups. Each has a board, each is (probably) undermanned, on and on.

    The entire REC concept has baffled me from the beginning.

    So I don’t draw the wrath of Roberta, I’m not painting a broad brush of 62 entities, I’m giving actual real life experience from about half a dozen RECs.

  • I think Bobby Lee has a good point. There is a need to know what approach the RECs are making. For example, how many have endorsed one or multiple products?Exactly what services do they provide and at what cost?

  • Endorse?

    Why should a REC endorse?

    That should be the last thing they are doing.

    Isn’t that why an EHR has to get CCHIT certified MU?

    RECs should not endorse or give the impression of endorsement.

    They should be there to help navigate the maze that has been created by the government.

    A REC endorsing an EHR would be like the President going on Twitter…oh…wait…

  • There is an implied endorsement by the REC of the handful of vendors who have decided to conform to their business models and requirements. Unfortunately there are many doctors (not all) who are looking for someone else to take responsibility for their investigation, vetting and decision-making.

    The irony is that the vendors may have been in business for many years. Their business model has succeeded in spite of the lack of any government incentives for their clients, and they have invested an extraordinary amount of their own money for their software to become certified. Yet they are being required by 62 newly created, taxpayer funded organizations to conform to how each of them want them to do business.

  • -There is never very much value in a middle man broker inserted between vendors and customers.

    -There is absolutely no value in a middle man broker who is unschooled in the business they have been dropped into or with limited expertise in what they are pushing.

    Consider CALHIPSO who released an RFP and ran two vendor selection rounds picking 7 Jaba the Hut EMR companies using CCHIT criteria before ONC named the first MU certifying body.

    The 62 independantly operating RECs create a minefield of differing business rules affecting how EMR vendors will engage the clients in their region that the RECs coerced into signing up.

    RECs create a cost to the market paid for by the taxpayers, the client EPs, service partners, and vendors.

    RECs add ZERO value … and will hinder adoption and implementation.

    The sole reason the RECs were created using stimulus money was to create jobs for those understaffed and undertrained people the RECs hired.

    The only good news is that ONC has only $18bil to blow on this jobs program.

  • The irony is as a jobs program it stinks.

    Our local REC has 1 tech person, 1 secretary, and assistant and a board of directors of around 8.

    What private business would form like this?

    As I’ve said before, the government does not build businesses well.

    I still have not been shown a government business that is successful.

  • I’ve really enjoyed the interesting discussion about RECs. Lots of different viewpoints. I imagine a lot of that is probably due to the large number of RECs that are acting so independently. I guess if only about 10% of venture backed “startup” companies succeed. Should we expect government backed “startup” companies to do better?

    I also am surprised we haven’t had and discussion of the perverse incentives that RECs have. Their funding is very much number of provider driven. So, while we could certainly blame the RECs for many of the things they do, I think it’s worth also noting that the funding plan often encourages “bad behavior” on the part of RECs.

    I’ll be interested to see how many REC organizations survive past the government funding period.

  • Interesting there haven’t been any comments from anyone with a REC. Maybe ONC doesn’t permit open conversation.

    “I think it’s worth also noting that the funding plan often encourages “bad behavior” on the part of RECs.”

    In my opinion … your perspective reflects the majority opinion and probably the opinion of many REC leaders. Poorly designed, disparate revenue/funding streams would sentence 100% of privately held entrepreneurial startups to failure inside three years so it should not be surprising that RECs are suffering the same potenial results.

    Roberta may wish it were true that a ” ‘government sponsored organization’ can’t do anything argument (is) old, lame, and without substance” … but the reality proof is in the poor results.

    Might be interesting for each state MGMA to report how many of its member PCPs adopted an EHR/EMR on their own versus those who employed or who are employing a REC middle man … along with feedback on the processes used.

    There is no visibility of the ONC/REC process … so they don’t have to defend themselves. Their silence is the most telling validation of why most RECs haven’t earned any respect from the practice or vendor communities.

  • While I cannot defend or even describe the other 61 REC’s I can offer some insight into the performance and service of the DC Regional Extension Center http://www.ehealthdc.org

    We are charged with supporting 1000 primary care providers within the District of Columbia. That audience is primary individual practices, small practices, and the “safety net” health system in DC. We are “vendor neutral”. Our “list” is the list of certified vendors. We respond personally to any inquiry made by phone, email, web site, or referral. Our technical assistance team, experienced EHR/practice management experts, responds within 24 hrs of receipt of a participation agreement. Services provided by the technical assistance team include in house practice assessment, review of existing software/hardware resources, contract review, matching vendor services to practice needs, implementation support, and ultimately achieving meaningful use. We do not replace vendor services and intentionally do not play go between roles. We do however ensure that practices clearly understand what their resource allocation will be over the coming year as they implement and use an EHR. We provide significant online and inhouse training, web based community learning, and “over the shoulder” assistance.

    To date the entire safety net health system (8 clinics, 250 providers) in DC is utilizing an EHR. Another 150 (+/-) providers are enrolled and receiving technical assistance services. Although not specifically part of our charge we are also working to connect participants to the HIE and supporting the development of PCMH and ACO, all outcomes requiring a well functioning EHR system. We are agressively “marketing” through our Education & Outreach team to locate, contact, and serve primary care providers throughout the District. We get paid for performance not just activity – registration, EHR implementation, and meaningful use. If we don’t perform we don’t get paid.

    I can’t argue for or against the REC model as it seems that boat has sailed. I can however describe the extent to which we are, at least at DC REC, working hard to ensure the primary care provider community is supported, connected, and using their EHR in a meaningful manner. If you are a PCP in DC call us. We will answer the phone, we will return your call, we will work with you to achieve meaningful use. For free…

  • Hi John Dudte,
    Thanks for sharing your perspective on the DC REC services. Sounds like you’ve taken a reasonable and appropriate approach to how a REC should provide service. I especially love the part where you said “Our “list” is the list of certified vendors.” Nicely done.

    I’d love to hear more about your experience. First, how have the doctors received the services that you describe? Are they open and grateful for the services, or are they skeptical about what you’re really providing?

    Also, I’d love to have you walk through an example client and what services they can get through the REC and what services they’d need to get elsewhere. Use a real life example with the names hidden to protect the guilty. I and I think many others would find it interesting. I’d be happy to post it as a guest post if you just want to submit it on the contact us page of the site: https://www.healthcareittoday.com/contact-us/

    Thanks!

  • John and DonB,

    Without naming names, here’s our real-world REC experience so far in a nutshell.

    REC: We love your system, etc., etc. This is really a “better mouse trap”.
    AXEO: Thanks

    REC: Send us a list of many 1000’s of truly happy and satisfied customers that have been using your system for more than 10 years.
    AXEO: This is a new system. New tools, technologies, approaches, platforms, etc.

    REC: We won’t/can’t recommend your system unless your company has a monster balance sheet. On the order of the publicly traded companies.
    AXEO: Thanks. Why didn’t you say so in the first place.

  • John Dudte,

    Your RECs approach is to be commended. I wish I could say that it was common in my experience and not an anomoly.

    Mark Hollis
    MacPractice, Inc.

  • It’s too bad that so many are putting all these REC eggs into one basket. The two that I have dealt with are:
    – 1 – Vendor agnostic and utilize the certified EMR/EHR listings
    – 2 – Have been very responsive – via phone and email as well as in person visits.
    – 3 – Have assisted in several attestations
    Honestly – I have seen our tax dollars wasted in worse ways…anyone want to buy a bridge to nowhere? RECs have assisted several CAHS in my two states that I hover between – sorry that one apple or two have spoiled the whole bunch in some of your eyes.
    Jane S
    Clinical Informatics Specialist

  • Jane … great to hear your commendation. I second AXEO’s request for names. If they are as good as you say they are … given the broad generalization of disappointments … you ought to be shouting these folks names at every opportunity.

    Kind of a backhand compliment saying “[you] have seen our tax dollars wasted in worse ways” … but then I wonder what the value is being “less worse” wasted over “moderately worse wasted” … or highly worse wasted”.

    It would be helpful knowing who these RECs are. Thanks.

  • Jane…I would love to know who the 2 RECs are as well. Sounds like MacPractice should be working with them to fulfill their mission.

    Mark Hollis
    MacPractice, Inc.

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