Building a national health IT infrastructure will rely, in large part, on the success of a military style "boots on the ground" initiative aimed at helping doctors to part with paper files and embrace electronic health records.

"The core has got to be the 70 regional extension centers that will be deployed over the next year or so," said Dr. David Hunt, chief medical officer of the Office of the National Coordinator for Health IT, speaking yesterday during an eHealth Initiative Webinar. "The expectation is that we'll be able to train and provide technical assistance to more than 100,000 primary care providers across the country."

Changing the mindsets of doctors who have been averse to using health IT won't be easy, panelists conceded. The $600-million program anticipates sending multidisciplinary teams of consultants, techies and others to work with practices for up to an estimated 40 hours each. Staffing those teams in states without a surplus of IT experts, such as Oklahoma, could be a challenge.

In support of the massive effort, a central health IT research center will compare and assess approaches and share the results of those inquiries with people in the field.

"They will disseminate best practices from around the country with the expectation of continually improving the quality of service the regional extension centers give," Hunt said. "The whole focus of this work is the expectation that as many providers as possible will become meaningful users of electronic health records."

The hope is that the extension centers "will work seamlessly" with a $564 million program of state grants for building systems of secure health information exchanges across the health care system. The program will disburse planning grants to states that don't have much experience in setting up HIEs and development grants to states that are further along in developing exchanges.

"We have a way to go in terms of developing a robust nationwide infrastructure around the exchange of information," Hunt said.

The various initiatives are focused on making health-care providers meaningful users of health information technology. The ultimate goal, however, "is all about improving the quality of care," Hunt said. Rules defining meaningful use and ONC's rules about certified electronic health records should be out in December, he said.

Work continues, as well, on determining how to distribute $1.1 billion to advance comparative-effectiveness research. The monies include $300 million allocated to Agency for Health Research and Quality, $400 million to the National Institutes of Health, and $400 million for allocation at the discretion of the Secretary.

"One large piece of the allocation expected from the secretary's portion of the funds will be around the idea of data infrastructure, things that will allow and facilitate use of huge amounts of data available in the federal system for comparative-effectiveness research," Hunt said. "That is one of the most exciting pieces."