The state, through the Department of Vermont Health Access, has paid Vermont Information Technology Leaders, or VITL, since 2005 to set up the system, called the Vermont Health Information Exchange. About one-third of the money — $12.3 million — was spent in 2015 and 2016, the audit says.
The money awarded to VITL came in the form of contracts that were often signed late and then backdated, and almost never had appropriate measurements that would allow the Department of Vermont Health Access to measure success, the audit says.
Additionally, the state has not been billed for all the tasks scheduled to be completed in 2015 and 2016. The audit warns that once the state receives the invoices, the total amount spent on the health records system could exceed $38 million.
“This system has to be much more mature before we can begin to measure it, and we’ve already spent $38 million, so I don’t know what it’s going to cost to get from here to there,” Hoffer said in an interview. “We don’t yet have the amount of information that you would hope given the amount of money we’ve spent.”
Steven Costantino, commissioner of the Department of Vermont Health Access, called the audit “a very, very valuable tool” and said his department has already started making improvements. Hoffer credited the administration for taking the results of the audit in stride and promising to fix the issues his team identified.
Criticism of the system goes back to its very beginning. As part of the health information exchange, VITL set up a large data warehouse that stores information from electronic health records and has gradually given different doctors’ offices access to the warehouse.
That means doctors’ offices that have installed the right software can access those records almost immediately if their patients give them permission. But it is not clear who owns the information in the database or whether the state can use the information for health care reform, according to the audit.
“The state never explicitly included the clinical data warehouse as a deliverable in the agreements with VITL and did not define expected functional and performance requirements,” the audit says. “Thus, the state is not in a position to know whether the clinical data warehouse is functioning as it intends.”
Costantino said of the audit finding: “I think that’s a fair assessment. I’m not going to disagree with it. But I certainly think it’s a lesson learned that, as we move forward into the future, we have to have very well defined deliverables and performance standards.”
John K. Evans, the CEO of VITL, said the organization met all the performance measures the state gave it. He said the organization still has a handful of outstanding deliverables out of about 420 total.
The audit credits the Department of Vermont Health Access and Agency of Administration for seeking monthly status reports from VITL and holding regular meetings. But the report adds: “The state did not sufficiently oversee a significant VITL activity, the building of a clinical data warehouse.”
Additionally, the audit says the state does not know how many doctors’ offices and other health care facilities are in Vermont. The audit says at least 276 were connected to VITL’s network as of June but cautions there could be more than 1,300 total throughout the state.
“VITL reports annually on the number of interfaces to the (information exchange) by health care organization type,” the audit says. “However, without targets to assess whether the usage of (the information exchange) by providers is at a level the state intended, the state does not have a way to effectively interpret VITL’s progress.”
The Department of Vermont Health Access wrote in response to the audit that it would work with VITL to determine how many health care facilities there are in Vermont by the end of November and update the list once a year.