Health Care

Auditor: Millions of dollars later, VITL’s impact not measurable

A nonprofit organization has spent $38 million in state and federal money setting up a statewide system of electronic medical records, but officials can’t determine whether the project has been successful.
Outside the Vermont Information Technology Leaders in Montpelier. VTD/Josh Larkin
Outside the Vermont Information Technology Leaders office in Montpelier. File photo by Josh Larkin/VTDigger
That was the main finding of an audit from the office of Doug Hoffer, the Democrat-Progressive state auditor, who said the Department of Vermont Health Access and the Agency of Administration had been lax in their oversight of the electronic health records system.

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.

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Erin Mansfield

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  • stephen whitaker

    …not to mention the facts that VITL is supposed to be building the Health Information Exchange in accordance with the Vermont Health Information Technology Plan, which has not been completed and adopted since 2010 when statute requires annual updates; that VITL failed to address the core issue of who owns what, both in regards to an individual’s medical records and in all the “interfaces” they have developed; that VITL claims to have signed away to a for profit subsidiary of Aetna Insurance, all of the intellectual property developed with public funds and requires all health care providers to do the same as a condition of connecting, and that they claim to not be subject to Vermont’s Access To Public Records laws, an issue currently pending in Superior Court.

  • Eric Davis

    “The Department of Vermont Health Access and the Agency of Administration had been lax in their oversight of the electronic health records system.”

    EB-5, Vermont Health Connect, electronic health records – the story starts to repeat itself with some frequency.

    Hopefully, the next governor will pay more attention to the administrative and managerial competence of the people he/she appoints as secretaries, commissioners, etc., and will establish clear and transparent criteria by which the Legislature, the public, and the press, as well as the auditor, can evaluate their performance in office and the quality of the services they are charged with developing, overseeing, and delivering.

    • Dave Bellini

      “… managerial competence of the people he/she appoints as secretaries, commissioners,…”
      Thank-you Eric. A point that can’t be stressed enough. The past 6 years has been a “ship of fools.”

    • Jim Manahan

      Let’s hope Gov. Scott starts by closing the revolving door that has the same people moving from one department to another like a big game of musical chairs.

  • Steve McKenzie

    “…and almost never had appropriate measurements that would allow the Department of Vermont Health Access to measure success, the audit says.”

    “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.”

    I’m reminded of something I (fortunately) learned early in my career:
    No standards + no measurements + no penalties = no direction.

    $38m has been spent for what? In order to be able for “someone” to say “something” has been done done, presumably in an effort to address health care cost containment?

    As with numerous other issues with the current administration, this scenario begs many basic managerial questions, in this case beginning with “who wrote a RFP with no demonstrable metrics and deliverables, who approved it and who signed it?”

  • Quite frustrating to go to CVH for medical treatment and then go to Gifford and find out that CVH medical records are not accessible on-line and testing/ recording have to be duplicated to get to the point a second opinion was sought in the first place. Then there is the issue of the cost to the patient. I kept asking “You’re kidding me, right?” Equally frustrating was to find that the physician at Gifford left mid-stream and Gifford had nothing in place to guarantee continuity of care–never even advised of the physician’s departure. One contender for Governor says we should stick with this and that it will get better. ???

  • Tom Koch

    This is an ongoing story–nobody in this administration seems to know how to write a contract.

    • Kurt Levin

      News alert… The Douglas Administration did not set a high bar when it comes to knowing how to write a contract.

      • Jim Manahan

        This has nothing to do with the Douglas administration, but that’s a valid attempt at deflecting the blame from Governor Shumlin who owns this entire mess from the days when he was an obstructionist in the Vermont Senate.

        • Doug Hoffer

          For the record, VITL was created during the Douglas administration (2005).

    • tom burke

      or even oversee a badly written one.

  • Mary Daly

    This is absolutely disgusting. One more example of the poor management and results of the Shumlin Administration. As a taxpayer I am highly perturbed and, yes, angry that this kind of things keeps popping up. Thank you Doug Hoffer for bringing to light the latest debacle.

  • Mary Alice Bisbee

    As a consumer, I would think that I have access and own my records, but that is not the case. As a former VITL consumer oversight member a few years ago, this was the one thing consumers were fighting for and now we still have no access to our own health records. Call it paranoia if you wish, but I like to know what the docs are saying, first hand.

  • Page Guertin

    My medical practitioners are mostly part of the UVM Health Center, which includes Central VT Hospital, Montpelier Integrative Health, etc – the largest provider in the state. Medical records are maintained in a system from a company called Eclinicalworks. Why has the state been paying $38 million since 2005 for a system its largest providers aren’t even using?

  • What is it? Is it the two year election cycle? The lack of strategic planning? Who wants to pay for planning ahead!

  • You have to laugh, or we’d cry. I’m waiting for the VITL to say something like “We’ve spent far less for nothing then other States have spent for nothing…..
    Hey, It’s only $38,000,000. But lets add that to the DCF Fraud Hoffer reported on last month, No Bid Contracts, Health(dis)Connector and pretty soon any rational person can see why Vermont is always in the bottom of Economic Outlook.
    Will someone, anyone be FIRED! No, they’ll just slide over to another taxpayer funded job.

  • William Hays

    To have a Democrat-Progressive state auditor put out this information is scary. Could this be the new “”EB-5, Lite”?

  • Steve Beck

    Opening paragraph: “A nonprofit organization has spent $38 million in state and federal money setting up a statewide system of electronic medical records, but officials can’t determine whether the project has been successful.”
    My head exploded. No wonder I have become so cynical. The wonders never cease!

  • stephen waite
  • stephen waite

    so it could be argued that they own the data warehouse? could they be in better position to capitalize on the all payer transition?

    if they find the right vendor,

    and the conference call:

  • Anne Dickerson

    Then there is poor little old me. So I have a broken arm. Does everyone in the whole wide world need to know this. I’m all better now. No big deal.. No complications. It will never bother me again. All that really happened was I went to the ER at UVMMC. They took an xray, said it was broken. Gave me a sling and told me to make an appointment with an orthopedic specialist. Anyone convenient to me but suggested the one on Tilly Dr who is part of UVMMC. I went there. They had all my electronic records. YEA! They took more xrays to see how I was doing. I was still doing OK and they told me to get PT. Of course I couldn’t drive my car. I was able to a PT where I could walk. Fortunately they too could get a copy of my xray. How they managed to do that I don’t know as they are NOT part of UVMMC. Maybe they have a contract with somebody to be able to get UVMMC’s records. COULD IT POSSIBLY BE THIS STATE OF VERMONT DATA WAREHOUSE? How did the Govt get permission to have all my health records?

  • Anne Dickerson

    What ever happened to HIPPA laws Below is what I found when I Googled it.

    What does HIPAA mean? The Health Insurance Portability and Accountability Act (HIPPA) protects patient privacy and ensures privacy of all accumulated health information that belongs to the patient. … It means that your private health information is protected by federal law.

    If Vermont has this Giant warehouse of health information did everyone’s information in this warehouse somehow give the Vermont Health Access or whoever permission to “warehouse” every single bit of information they have collected. I don’t remember doing this. Maybe I did but I don’t remember doing it.

    Does this warehouse need to keep track of stuff like if I have a cold and go to my primary doctor? Hum! Is this a waste of taxpayer’s dollars? Is this the stuff in the warehouse? What IS in there?

  • Doug Hoffer

    For the record: Our report on the State’s oversight of VITL found a number of problems. I’m concerned that some of our findings have been misunderstood. In particular,

    1. The $38 million cited are costs incurred over an 11-year period.

    2. These costs were for a wide variety of activities, only some of which relate to licensing or developing software.

    3. Health information exchanges are being implemented nationwide and there are national barriers and challenges to these implementations (see the observation section in our report).

    I don’t want to downplay our findings because they are serious and need to be addressed. My office has been a strong advocate for the need to measure the performance of contractors and state functions and our work on the State’s oversight of VITL illustrates this need again.

    I was encouraged by the DVHA Commissioner’s response to our report, but my team will follow-up to ensure that the commitments made were followed through.