Despite $70 million investment, health IT systems a long way from prime time

Sen. Kevin Mullin, R-Rutland

Sen. Kevin Mullin, R-Rutland

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.

Andrew NemethyAndrew Nemethy

Comments

  1. Bob Zeliff :

    While i fully support the basic premise, need and infact the inevitability of an automated and fully integrate health information system, I find this report to be disturbing. Hunt Blair statement, of bleeding edge, if true, is a RED flag.

    VErmont can NOT afford the effort and expense, of developing new technology, being the leader of hardware/software interface design. If true it will be a black hole to sink money.

    Vermont IT must use existing technology, developed elsewhere, proven and well debugged. Developing an integrated data base system is challenge enough.

    It sounds like some one in program leadership should be, if they are not already, taking a critical look at what tasks have least risk, give most bang for the buck and focus on those. Set the higher risk, money sink holes, tasks aside. Time ofter has a way of mitigating these risk and efforts.

    One should also separate, at least conceptually, the normal human resistance to change, the important efforts to educate the users and consumers and these costs from the direct technology.

    Design and scope change management is extremely important.

    It is important that Vermont succeed in this, but consider a crawl, walk, run progression. Trying to run too early is expensive and often you will find you will have run in the wrong direction. The magic is great leadership that finds the right mix of solutions.

    My best wishes

  2. I consult to healthcare IT companies, among other organizations. Vermont’s experience is no different than what’s happening across the U.S. But it’s a necessary stage as healthcare finally digitizes and enters the 21st century a decade behind most other industries. The cost savings will come and this investment will pay off. Many individual medical practices and health systems are already seeing the savings, and patients are beginning to benefit from more coordinated care and more readily available medical information.

  3. Lee Stirling :

    In September 2011 I attended the annual Vermont Information Technology Leaders (VITL) summit, held in Burlington. This group is supposed to be in charge of the VT Health Information Exchange (VHIE)the goal of which is supposedly to allow easy sharing of patient health information. This means easy doctor access statewide to patient information such that if I go the the ER in Brattleboro, those doctors should be able to see my medical chart information at my Primary Care office in Burlington. It should speed up treatment, cut down on duplicate work, unneeded tests, procedures, and cost. This wonderful capability has yet to come to fruition. Because they could not or would not provide an answer during their forum, I continued to push the VITL VP of Operations for when they think this information sharing might be operational. After much hemming and hawing, he finally stated that it may take another 18 months to begin to see this implemented. I think the healthcare professionals across who are deeply frustrated with the customer service of their expensive electronic health record vendors and those who bought into VITL’s vision of easy, seamless data sharing should hold VITL to this 18 month estimate. I hope VITL can start to deliver.

  4. Dan McCauliffe :

    These problems stem from the federal government’s decision to prematurely force computerized health care record system integration via government financial subsides for early adaptation and penalties for those providers that don’t meet the deadline for implementation. It appears that speed is of the essence, even if there are still a lot of wrinkles to be ironed out. We might learn something from the UK’s $18 billion dollar computerized health care record system failure that had it’s plug pulled last year.

    From a December 2010 Huffington Post article: “Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.

    But the United Kingdom has spent the last 6 years working on the same idea, and it’s proven to be a colossal failure — so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own? In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money — in fact in some cases, they may have led to patient harm.

    Britain’s government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:”

    Read more at:
    http://www.huffingtonpost.com/stephen-soumerai/dont-repeat-the-uks-elect_b_790470.html

  5. walter carpenter :

    “However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting.”

    The program should have been started a long time ago. It is strange that other countries with single-payer type systems have had integrated technologies (in many nations the person just swipes a debit card and all the info is there) for decades and we are still as disorganized with it as our health care system. I sympathize with Mr. Blair in how he is trying to organize and make sense of it all across the board so that all the technology is communicating with each other. He has quite a job, not only with the technical aspect but also with the human part of it as well:) Like just about everything with our chaotic health care system, it is always far more extraordinarily complicated than it should be. I’m sure that Mr. Blair will get it done, though.

  6. Kristin Sohlstrom :

    Those of us who understood the Blueprint Quality Care Initiative which required such connectivity was a spending bill not a money-saving bill aren’t surprised by this information at all.

  7. Bruce Shields :

    Many countries in which there is an integrated health data system also have virtually no private practice physicians; in turn, medical students do not pay from their own pocket to get their medical education. If we expect to squeeze payments to physicians, but still require them to put several hundred thousand dollars into acquiring their medical degree, you may very soon find it hard to graduate any new doctors. We already loot medical schools from around the world for our doctors — how long will the rest of the world put up with that? The methods and objectives of Vermont’s march to single payer are very poorly thought through — it sounds like the educator’s fad of “Open Classroom” which was such a disaster 40 years ago.

  8. Craig Powers :

    Why doesn’t the Green Mountain Care board step up and offer some of their expertise on how to design a generic IT records system that all providers can use? Aren’t they experts or is the “pea soup fog” too thick today?

    Wasting $70 million, with very little progress, is pathetic and provides concrete proof of governments’s lack of ability to accomplish anything without screwing it up first.

    Where is the outrage from the proponents now?

  9. Carol Thomss :

    Indeed pathetic. Finally, reality is setting. One reason why these devices are not ready for prime time is that they have not been vetted by the FDA for safety, efficacy, and usability, as requird by the Federal Food Drug and Cosmetic Act.

    There is zero premarket scrutiny and an equal amount of post market surveillance. The vendors have backed up the truck and you are loading them up with cash, for crap.

    Outcomes and costs will not improve, and may worsen under these circumstances. These EMR and HIT devices are impediments to the doctors workflows of medical care.

  10. Janice Gee, MD :

    Is anyone in Vermont tracking the deaths in your wired hospitals that have occurred as a result of the toxic impact that these EMR and CPOE systems have had on care?

    Is anyone tracking the crashes and “unplanned down time” of these computerized care devices durng whichtime the patients’ records all vanish in one fell swoop and the doctors can not even find their patients, let alone find lab results or MARs?

    Just wondering, Vermont.

    J. Gee, MD

  11. sandy brady, rn :

    For the life of me, I do not understand why doctors would purchase electronic care record systems that have the reputation of reducing efficiency and disrupting work flow, in addition to facilitating new errors as reported in the medical journal, JAMA, in 2005, by a U Penn professor.

    My doctors would not do that even if they an incentive.

    And did they read about the 2.4x increase in baby deaths in Pittsburgh’s UPMC Children’s Hospital after a CPOE was activated, as reported by Han et al in the medical journal, Pediatrics, in December 2005?

  12. Mari Cordes, :

    Sandy – this is 2012; your evidence is quite outdated – especially when you consider that both medicine and IT are rapidly evolving fields. Were these studies high level studies – large sample sizes, meta-analysis of high level studies, or just articles from one or a few experts?

  13. Christina Bolan :

    What I wonder about the most is why new systems are still being started here that are not compatible with systems already in place…we already have incompatible systems but going forward that should no longer happen…that is a big waste of dollars that can be avoided.

  14. Marla Temple, PhD :

    I found the comment about evidence of more than passing interest. There is not any evidence that the devices that are the subject of the report provide any meaningful benefit in outcomes, costs, or medical care efficiency, yet $ billions are being spent. To boot, there is not any surveillance.

    Did anyone happen to read about the FDA recall of an interface engine manufactured by Philips that was sending incomplete data to EMR storage devices?

    Did anyone happen to be affected by the crash of the Surescripts e-Rx devices last week?

    Tell us more. Marla

  15. Donni Baloe :

    This is hilarious… they are bringing StarTrek’s effluence to Appalachia.

    This should really help with tracking family trees, and genetic diseases but will do nothing to put shoes on the feet of children. Oh, I forgot; reading , writing and arithmetic- so where will they get the local talent to keep the thing running? They’re too busy moonshinin’ and growing green gold to bothered with this stuff.

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