[V]ermont’s health information exchange network is supposed to make treating patients easier, safer and more efficient.
But a recent review found the exchange itself, which is operated by Vermont Information Technology Leaders, or VITL, suffering from serious financial and administrative maladies of its own.
As a result, most users have “lost confidence” in the exchange, according to the review by Kentucky-based HealthTech Solutions.
State officials and VITL administrators say they’re not giving up on the problem-plagued system, which has received a total of $44.3 million in state and federal funding. They have begun implementing a multiyear plan to make the exchange more efficient, effective and accountable.
“This is the right work to get us all back on track,” said Michael Costa, deputy commissioner with the Department of Vermont Health Access.
Electronic information exchanges increasingly have been employed as a way of allowing multiple care providers access to patient information, regardless of where the patient is seeking treatment.
An audit last year, citing oversight and performance issues, concluded “the state is unable to adequately assess the performance of VITL and to demonstrate the value” of the health information exchange.
Shortly after the results of the audit released in late 2016, VITL administrators told the Green Mountain Care Board they were having trouble meeting payroll.
Earlier this year, the Legislature approved Act 73, which called for a “comprehensive review” of Vermont’s Health Information Technology Fund, the state’s health information technology plan, the health information exchange, and VITL.
Dawn Gallagher, a consultant with HealthTech, which was chosen to conduct the review, was the bearer of mostly bad news when she reported back to the Green Mountain Care Board at a recent meeting.
Gallagher said health information exchanges have common origins, they were set up by states with federal funding, and common challenges. She said state exchanges have struggled to become financially self-sustaining, for example, and to ensure the quality and accessibility of patient data, particularly given the variety of electronic health record systems in use.
But Vermont’s problems go well beyond that, according to Gallagher’s report.
Interviews with 89 interested parties showed that 91 percent agreed it is “critical” to have a health information exchange in Vermont, but only 19 percent thought the exchange has been meeting their needs or the needs of the state.
Twenty-one percent regarded VITL’s current organizational structure as sufficient for successful management of the exchange. And only 9 percent believed the state has “provided guidance and planning” for the exchange.
“Many stakeholders said they’d lost confidence in VITL as the organization to operate the (exchange), and many people also said the state isn’t providing enough focus,” Gallagher said.
The consulting firm examined hundreds of records, as well as the exchange’s management structure. Gallagher said the fact that three governmental agencies and the care board are all involved in the exchange “makes accountability difficult.”
Also, the state’s health information technology plan hasn’t been officially updated for five years.
At the same time, the consultant found that VITL itself doesn’t have a long-term plan and has a much higher dependence on public funding than health information exchanges in other states.
Management issues aside, Vermont’s exchange seems to be failing in its core mission: making patient information available. “We have a very low percentage of patients whose data are accessible, and there are quality issues,” Gallagher said.
She attributed this in part to the state’s “opt-in” policy — patients must agree to allow their information to be included in the exchange. Every one of the nine “successful” exchanges examined by HealthTech Solutions in other states automatically incorporates information related to physical health unless a patient opts out.
“In addition to that, the consent process (in Vermont) is very cumbersome,” Gallagher added.
Gallagher offered a variety of potential solutions, including establishing “an across-the-board governance committee” for Vermont’s health information exchange. Members should include leaders from the private and nonprofit sectors, and it should be attached to the Department of Vermont Health Access, Gallagher said.
She also recommended changes to VITL’s board to “focus on operations and core services.” The nonprofit needs to develop mechanisms to increase the amount of patient information in the exchange; to better match patients with records; and to find easier ways to access that data.
Additionally, Gallagher urged better “financial reporting and transparency,” and she said the state should conduct an operational audit of VITL’s operations.
While some at VITL think such changes can happen in two years, Gallagher told the care board that it might take three or four.
Whatever the time frame, “you’re really at a crossroads,” she said. “The one thing you can’t do is not do anything.”
Costa said the state already has changed its relationship with VITL by requiring more accountability in exchange for funding. Also, he said state officials “fully intend” to develop an updated health information technology plan.
VITL also appears to be on board with making big changes.
President and Chief Executive Officer John Evans is set to retire Jan. 1, according to information submitted to the care board. The nonprofit is working with state officials on a transition plan and also expects to develop a stronger overall partnership with the state, administrators said.
Dr. Bruce Bullock, chairman of VITL’s board, said he wants to “align as much as possible” with the consultant’s recommendations. That includes making VITL more sustainable and focusing on a “back-to-basics” administrative approach.
“As a clinician, I feel strongly about this issue,” Bullock told the care board. “I’m passionate about it. How can we help you help us succeed?”
