The state’s efforts to digitize the world of health information, a costly multi-year endeavor that is approaching a $70 million pricetag, got a lousy diagnosis Tuesday.
Instead of creating cost efficiency and improving payment flow to doctors and treatment for patients, it’s creating stress and a lot of headaches for physicians, according to both lawmakers and state officials overseeing the effort.
But Health Information Technology (HIT) coordinator Hunt Blair said that’s to be expected considering the difficulty of the “incredibly challenging” task of getting such disparate groups as doctors, hospitals, other health care providers, insurance companies, the state and federal government on the same digital page.
“We’re talking about an extremely complex undertaking and I think it’s important to recognize the state of Vermont was way out in front,” Blair said.
“We’re on the bleeding edge,” he told a legislative Health Care Oversight Committee Tuesday at the Statehouse.
That prompted Sen. Claire Ayer, D-Addison, the panel’s chairwoman, to ask him to clarify if he meant “leading.”
He stuck with “bleeding.”
That doesn’t surprise Sen. Kevin Mullin, R-Rutland, who had tough questions about the state’s effort to oversee and promote use of electronic medical health records and a statewide health information exchange.
“I hear genuine frustration from providers who are spending time and resources trying to modernize and make their offices more efficient, and prepare for the future, and yet every one of them feels like they’ve been burned,” he said.
“Basically we’re not getting any results for these millions and millions of dollars that have been pumped into IT (information technology),” he said after the meeting.
“We should be a lot further along,” he said. “I just don’t think the leadership’s in place.”
He also said it was frustrating trying to track how much the state was spending and from what sources.
A sheet provided to the panel Tuesday tallied just under $70 million in cumulative spending through fiscal year 2013, though it was unclear how much of that had so far been spent. The vast majority of that is federal funds.
Mark Larson, commissioner of the Vermont Health Access Department and a former House representative from Burlington, oversees management of Vermont’s publicly funded health insurance programs and the effort on digital medical records and a new medical information exchange.
The goal of electronic medical records is cost efficiencies in the way patients are treated, as well as providing doctors and hospitals instantaneous access to vital records and information that will lead to better treatment and patient outcomes.
But Larson told lawmakers he hears the same message they do, that there’s “a lot of confusion in the field.” He said that is an inevitable part of the complex process.
“These are not systems where you just plug that in and they work perfectly on day one,” he said. “Problems are appropriate along the path to get where we want.”
“We just have to work through that,” he said.
According to Steve Maier, who works on integrating technology systems for the department, between 70 percent and 90 percent of all the physicians practices in each Vermont county are “actively involved” in implementing electronic medical records. He said $12 million was allocated in the just finished fiscal year in federal recovery act monies to enable physicians and hospitals to set up the expensive systems.
Based on testimony Tuesday, the issues that medical practitioners and the industry face in digitizing information are familiar ones for anyone who deals with technology: Software that is problematic, digital files that don’t translate and can’t be read by other systems, lost time spent on technological issues that detract from what doctors are paid to do, which is treat their patients.
Blair cited one example of the difficulties encountered as Vermont forges ahead with electronic health records: “As simple a thing as recording blood pressure.” He said some systems record that as a text file, others as a number.
“That’s where the problems begin,” he said. “It gets very hard to merge that data together.”
He noted Vermont has been holding back on “prematurely” spending some of its stash of funds until such issues can be resolved, noting the state is well ahead of the curve in implementing health information technology.
“We are paying the price here in Vermont and in the medical community writ large for trying to implement all these systems when they’re just barely ready for prime time,” he said.
Dr. David Cochran, president and CEO of Vermont Information Technology Leaders (VITL), a public-private partnership that is working with physicians, hospitals and the state as a consultant and problem solver, told the panel that while there are general guidelines for systems and consistency in some areas such as lab results, there is no rule or consensus on how to deal with data in other areas.
“It is a continuing struggle,” he said.
Mullin was incredulous that the state has been working on electronic medical records for more than half a dozen years and still is dealing with incompatible software and computers that can’t talk to each other. He said after the meeting that the state can’t keep blaming vendors and the federal government for not providing clear guidelines to make systems compatible.
“Someone needs to be stepping up,” he said, especially as the state hopes to move to a single-payer health care system where efficiencies are being counted to provide big cost savings.
According to Cochran, there are around 950-1000 medical providers in Vermont, and 859 are signed up and are using or intend to adopt use of electronic medical records. That is around an 85 percent to 90 percent adoption rate, the highest rate in the country, he said.
About three years ago it was around 20 percent. Cochran called the jump “a very substantial upgrade.”
Maier said it was important to understand that as more and more HIT systems are set up, the state gets more efficient at understanding and fixing problems and dealing with them, speeding up the process of implementation.
Larson reminded lawmakers that the transformation has been radical and remarkable for a medical community “where everybody worked on paper” not too long ago. There’s more work to be done to reach “full functionality,” he said, but overall insisted, “I believe we are still on track.”
Paul Harrington, executive vice president of the Vermont Medical Society who sat in on the hearing, said there is no disputing that adopting electronic medical record systems “for many physicians has been a time-consuming and costly effort” and that, in some cases, the focus on technology has hurt the physician-patient relationship.
But he said the Society overall supports the work that VITL is doing with physicians and the state as both implement digital medical record systems.
Harrington said more issues loom down the road with an overhaul of the extensive numerical diagnostic codes for digital systems that are also key to payment reimbursement, That will occur in 2014 and will increase the number of diagnostic codes by a factor of of 400-to 500 percent, he said.
“Having said that, I think at the end of the day, information technology is here to stay,” he said.