[S]tate officials expect to continue funneling tax revenue into the Health Information Technology Fund, despite questions about the efficacy of one of the programs the fund supports.
The Health Information Technology Fund, started in 2008, brings in between $3.1 million and $3.3 million annually, according to Steve Costantino, the commissioner of the Department of Vermont Health Access, which oversees Medicaid.
The revenue comes from a 0.199 percent tax on all health care insurance claims in Vermont, and the fund is scheduled to sunset by July 2017 unless the Legislature acts to extend it.
More than half of the HIT money, or around $1.9 million in fiscal year 2015, goes to the Vermont Information Technology Leaders, or VITL, a publicly funded nonprofit organization that spent seven years building the technology infrastructure to help doctors and hospitals share electronic medical records.
VITL pays its top five executives six-figure salaries, and pays its chief executive more than the governor of Vermont, according to tax filings. A citizen is suing the publicly funded organization for more financial information under the state’s Public Records Act.
Despite the state’s annual investment in electronic record-keeping, doctors continue to say documentation processes such as electronic health records are getting in the way of treating patients. In a survey of the Vermont Medical Society, 90 percent of doctors said “documentation and administrative issues” interfere with their jobs, and 32 percent said they don’t have enough time with their patients.
Costantino said he expects the Legislature and administration to come to an agreement to maintain the Health Information Technology Fund.
“I think it’s still a priority for the state, and I think there will be continued movement to advocate for health information technology,” Costantino said. “Quite frankly, how that’s funded, I think that’s open for discussion.”
“I think any transition is difficult,” he said. But he said, as time goes on, “physicians and other practices are seeing the value in the sharing of this information in a way that’s user-friendly to the physician gives the kind of feedback immediately when it’s dealing with the care of patients.”
VITL budget
VITL’s total budget in fiscal year 2015 was about $7.5 million, including a $4.2 million from Medicaid money that the state has broad authority to spend, according to the Department of Vermont Health Access. This year, in fiscal year 2017, the organization expects its budget to go up by $1 million to $8.5 million. (VITL also gets money from the state innovation model grant, which is up for renewal this year.)
The organization’s budget has grown substantially over the years, according to annual reports. In 2009, VITL received $4.4 million in total revenue, including HIT funds and federal grants. In 2013, state and federal funding together were $5.8 million. By 2014, state and federal funding to VITL reached $6.5 million.
The most recent nonprofit tax filing that is available is for 2013, when the organization had four executives making between $130,000 and $150,000 per year. The chief executive officer made $215,000 that year, including benefits.
John Evans, the chief executive officer of VITL, said the organization has been compiling health data for 10 years and taking information from as many as 75 different technology systems — and paying skilled workers “in a cost-effective way.”
“While we certainly appreciate the financial support that we receive from the state and the feds and other sources, the state and federal agreements are not always signed in a timely manner,” Evans said. “We are not always paid as a result on a timely basis.”
He also said he expects the state to continue funding his organization because it has the potential to reduce costs in the health care system. “I’m working with the state and the Legislature,” he said. “VITL and the state will identify a different approach.”
“It took seven years for us to connect up all the systems, bring all the data together so it was robust enough to be of value,” Evans said. “I fully expect that the state and the Legislature will want to continue the returns on its investment.”
Evans said his organization has not yet quantified the financial return Vermont gets on its investment. But he said the biggest benefit of their technology is how it helps doctors in different regions access the same data about the same patients.
“It’s a difficult challenge to isolate that a specific test result actually resulted in a similar test result not needing to be ordered, but the provider population will tell you absolutely that there is a cost savings associated with that,” Evans said.
“The most important way is to inform care, and that will never stop in terms of the interaction between the patient and their treating clinician,” he said. “That will always exist.”
Evans used the example of someone who lives in Burlington but gets injured while visiting Newport and ends up in the emergency room. He said that when the person returns to her doctor in Burlington, she can give the doctor permission to view her records through its new program, VITL Access, so the doctor would be less likely to recommend a redundant test already done in Newport.
That may save the patient money because, otherwise, “you may have to take more time off from work to go get blood drawn” but “that isn’t needed because (your doctor now knows) the blood was drawn in Newport.”
VITL Access is designed to let providers access medical records for anyone who uses a Vermont doctor, even if they don’t live in the state. VITL Access has about 2,000 providers using the system right now, according to Evans, and around 45,000 Vermont patients have given consent for their providers to access their records through the system.
That’s a small fraction of the nearly 2 million people whose records are in the system. “We’re rolling it out,” Evans said. “It’s being used. But we need to roll it out faster and so we’re looking at some ways to do that.”
