Regional Extension Centers
Required Content for Preliminary Application
First Wave: Due September 8, 2009 for ARRA 2009
Health Information Technology Extension Program:
Regional Centers Cooperative Agreement Program
Below is an excerpt;  please go to ONC’s HIT Extension Program: Regional Centers Cooperative Agreement Program site for complete information.

I.  Geographic Catchment Area
Proposed Catchment Area
Sub-State Region:
          Specify State(s) by 2-letter USPS abbreviation(s)*
          Specify Counties
Metropolitan Service Area:
          Specify MSA Name
          Specify Code
Proposed Number of Practices
          (providers) receiving direct technical assistance

Hospitals:
          # of hospitals, # of sites, # providers
Community Health Centers
          # CHC, # sites, # providers
Large practices (>10)
          # practices, # sites , # providers
Small practices (= or <10)
         # practices, # sites, # providers

Prior quality improvement/ practice redesign experience
Hospitals
          # hospitals,  # sites,  # providers
Community Health Centers
          #CHC, # sites, # providers
Small practices (= or <10)
          # practices, # sites,  # providers

VA Hospital(s) in catchment area?
          Yes (Specify #), No
Department of Defense Military Treatment Facility in catchment area?
          Yes (Specify #), No
Tribal health facility in catchment area?
          Yes (Specify #), No
Health information exchange capability in catchment area?
          Yes (Specify  name and operational stage for each), No

II. Proposed Service Offerings
Group purchasing of EHR software
          Yes, No
Onsite technical assistance
         Yes, No
Local workforce support
        Yes, No
Implementation-related project management
         Yes, No
Practice and workflow redesign
         Yes, No

III. Organizational Mission, Capability, Experience
Organizational Tax Status
501 (c) (3)
          Yes, No
Other (specify)

Annual Budget
          Budget $

Staffing (# FTE Staff in each category)
          Outreach/ communications _#_
          HIT implementation _#_
          Quality improvement_#_
          Other_#_
          Interfaces and information exchange _#_
          Hardware and network infrastructure _#_
          Quality improvement_#_

Prior EHR implementation experience (must include clinical documentation)
          # Different EHR Systems (Name)
          # Active EHR vendor contracts
          Hospitals
                    # hospitals, # sites,  # providers
          Community Health Centers
                    #CHC, # sites,  # providers
          Large practices (>10)
                    # practices, # sites, # providers
          Small practices (= or <10)
                    # practices, # sites, # providers

Prior quality improvement/practice redesign experience
          Hospitals
                    # hospitals, # sites,  # providers
          Community Health Centers
                    #CHC, # sites,  # providers
          Small practices (= or <10)
                    # practices, # sites, # providers

IV. Multi-Stakeholder Community and Provider Support
Health Plans          0, 1, 2+
Hospital Systems          0, 1, 2+
Medical Professional Societies          0, 1, 2+
Community Colleges          0, 1, 2+
State/ Local/ Tribal Public Health Agency 0, 1, 2+
State Primary Care Association          0, 1, 2+
Medicare Quality Improvement  Org.          0, 1, 2+
State Medicaid Director (if applicable)          0, 1, 2+
Local Quality Improvement Org.          0, 1, 2+

Above is an excerpt;  please go to ONC’s HIT Extension Program: Regional Centers Cooperative Agreement Program site for complete information.

See previous e-Healthcare Marketing post about Regional Extension Centers Grant Program FAQs.