HITEC-LA Bridges Gap Between Physicians, Technology

by Stephanie Stephens, California Healthline Regional Correspondent

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LOS ANGELES -- HITEC-LA, a federally designated Health Information Technology Regional Extension Center in Los Angeles County, is almost finished with the first phase of its federally subsidized mission to get 3,000 health care providers to use electronic health records.

HITEC-LA is currently undergoing a biennial evaluation by its funder, the Office of the National Coordinator for Health IT. Hopes are high for funding to continue after April 2014.

"This is the first leg of a relay, and we've done everything we were supposed to do," said spokesperson Len Rosenthal. "Physicians are busy serving patients -- which should be their main focus. Yet, we've been able to reach providers, get them on board and get them 'live' with an EHR in a relatively short time."

The center is a project of L.A. Care Health Plan, the nation's largest public health plan serving almost 800,000 L.A. County residents. Operating under the administrative umbrella of L.A. Care, HITEC-LA is a distinct, independent, not-for-profit organization, according to Rosenthal.

HITEC-LA was a logical way for L.A. Care to support smaller providers, particularly those caring for the underserved, according to Elaine Batchlor, L.A. Care chief medical officer. "Our health plan has offered significant financial assistance to safety net providers and those who take care of the low-income. We're very committed to ensuring they're not left behind."

As of mid-February, HITEC-LA was working with 3,327 providers, was providing on-site assistance to more than 2,600 of them and counted 1,550 members using an EHR. Last week, there was "space" for 300 more providers to register with the REC.

"We're going to keep going and are working on a business plan to be sustainable," Rosenthal said. "We're seen as a trusted source, constantly relied upon to be impartial. Plus, this is a service that needs to be provided."

Complex Goal of Achieving 'Meaningful Use'

The creation of RECs came through the Health IT Economic and Clinical Health Act, part of the American Recovery and Reinvestment Act of 2009. The federal government awarded L.A. Care a $16.4 million grant in 2010 to establish HITEC-LA, which is one of 62 RECs in the U.S. and four in California. The original grant of $15.6 million was later adjusted to $16.4 million.

Approximately two-thirds of L.A. County's primary care providers -- most of them in solo practices -- contract with L.A. Care. HITEC-LA's mission is to offer customized technical assistance, guidance and information on best practices to support and accelerate providers' efforts to become "meaningful users" of EHRs.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicare and Medicaid incentive payments.

According to Rosenthal, 49 of the health care providers working with HITEC-LA have reached the meaningful use threshold and received incentive payments. So far in California, CMS has handed out more than $100 million in meaningful use incentive payments. Nationally, more than $2.5 billion in incentives has been paid.

Every Practice Is Different

"We help physicians implement as early as possible, with the least amount of practice disruption," Rosenthal said. "It's not like you buy an iPhone and everything is 'happy.' This is very intricate and every practice is different. And it's also not just about obtaining an EHR system and turning it on, but it's about really using it."

Meaningful use is "complicated," said Rosenthal, "and doctors are, as we know, very intelligent. Our job is to simplify this for them."

Batchlor said, "Health information technology is a tool, and it's really important for doctors to begin to recognize the value it can bring. HITEC-LA is here to help them."

Since 2007, L.A. Care has awarded more than $6 million in health IT grants to the L.A. County safety net and more than $2.4 million through its Health IT Provider Incentive Program.

"Our physicians serve Medicare and Medi-Cal patients," said Rosenthal. "So in terms of who's getting money, it's not plastic surgeons in Beverly Hills who may already have great systems in place -- for that can cause a fracture in health care delivery. We want to ensure that safety net providers have the same technology and that their care can be as good as the rest." Medi-Cal is California's Medicaid program.

Rosenthal said, "Doctors may not always enjoy the implementation process. Ironically, it's kind of like taking medicine. You might not like it, but it's good for you."

Some Doctors Heed REC Recommendations

Meaningful use is "where the rubber meets the road," said Dylan Roby, assistant professor of health services at the UCLA School of Public Health. "Sure, providers can buy any off-the-shelf IT system, or subscribe online, upload patient data and track progress. However, physicians in primary care who aren't part of a big medical group or health center with more resources really do need the type of on-ground support HITEC-LA provides."

Physician groups are generally very supportive of receiving incentives, Roby said, because they know they'll need to eventually adopt EHRs. "Plus, medical groups can pool incentives together."

RECs like HITEC-LA can teach all providers how to best use data to improve the quality of overall care for patients, Roby said. A key advantage will be the interface with other area providers to build a type of network that in turn, should reduce duplication of services. "Thirty-three percent of health care costs are waste, fraud and abuse," Roby said.

S. "Mike" Neskovic, the first HITEC-LA "graduate" to complete meaningful use, said moving to EHRs is the right thing to do for patients as well as providers.

"To those who say the government is taking control of us, I say this is an opportunity," Neskovic said. "I would do it without that check. It's the right thing to do. It's helping my patients, and I believe they get better care than before."

Neskovic, a family practice and geriatrics physician in Glendale, started his process in January 2011, attested to meaningful use in March and received his first Medicare incentive check in May.

Bipartisan Support for Health IT

Surprising to some, support for health IT remains bipartisan, Roby observed. "We don't see many attacks on that. I think a lot of people think it's a good use of funds -- the money was appropriated."

Bipartisan approval indicates a good chance of long-term support for health IT -- financial as well as legislative.

Health IT is "one of the extremely few areas where there still does appear to be consensus," said Dave Roberts, vice president for government relations at the Healthcare Information and Management Systems Society in an interview with Government Health IT. "I personally think one of the reasons is that you have people on both sides of the aisle who see its value," he said.

President Obama supports health IT, as did President George W. Bush, who created the Office of the National Coordinator for Health IT in 2004.


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