[S]tate regulators have approved a $151.7 million project aimed at modernizing and streamlining electronic medical records systems at four University of Vermont Health Network hospitals.
The Green Mountain Care Board found that the upgrade – in which a new unified system will replace a patchwork of older systems – will simplify patient record-keeping, decrease the chance of medical errors and reduce security risks.
The board’s Jan. 5 decision also says the project won’t hurt UVM Health Network’s services or finances. The board hired its own financial adviser to evaluate the health network’s proposal.
“Our consultant has confirmed that the applicant is financially strong and has sufficient capacity to pay for the project, even if it does not realize all of its projected financial targets,” board members wrote.
The health network plans to pay for the project in part through employment reductions and efficiencies.
Dr. John Brumsted, the health network’s president and chief executive officer, said the new system’s benefits will be evident for staff and patients alike.
“It’s really going to not only provide a much higher quality of care … it’s really going to be a heck of a lot more convenient for patients,” he said.
UVM Health Network “currently utilizes a variety of (record systems) across its member hospitals, some more than 20 years old, no longer supported by their vendors or not fully compliant with federal security requirements,” Green Mountain Care Board members wrote.
About a year ago, the health network proposed a major record system upgrade at four of its six member hospitals: University of Vermont Medical Center in Burlington, Central Vermont Medical Center in Berlin, Porter Medical Center in Middlebury and Champlain Valley Physicians Hospital in Plattsburgh, New York.
Those hospitals – which saw a combined 1.7 million patient visits in fiscal year 2016 – will adopt a unified record platform from Wisconsin-based Epic Systems Corp. Epic is widely used, state documents say, and has expanded into “several large New England health care systems” including Dartmouth-Hitchcock based in Lebanon, New Hampshire.
“Epic is now the vendor in the majority of academic medical systems in the country,” Brumsted said.
What that means, hospital administrators say, is that electronic records will be more easily shared not only among UVM network hospitals but also with other providers that use Epic. For patients, that “allows us to be so much more prepared for your visit,” Brumsted said.
Brumsted believes that will curtail a common complaint he hears from patients: “Why do people have to ask me the same information over and over and over again?”
The Epic system – which administrators expect to eventually install at all UVM Health Network facilities – also has enhanced interactivity features. For example, patients will be able to schedule appointments online, send secure messages to providers and check test results.
The Green Mountain Care Board found that the system also will have benefits for doctors and nurses. In addition to reducing the risk of medical errors, the board wrote, the Epic system’s “simplified sharing process should reduce administrative burdens and leave more time for face-to-face patient care.”
That statewide information system has issues of its own, according to a recent report that found it is “at a crossroads” due to a lack of patient data and pervasive administrative problems.
Implementation of the Epic system at the four UVM network facilities is expected to take six years, with $109.3 million in capital costs and $42.4 million in operating expenses spread out over that period.
The $151.7 million total is “substantial,” care board officials said, but it’s still less than the $200 million it could cost to update, maintain and replace the network’s current health records systems over the next six years.
Brumsted said the hospital is “not borrowing money specifically to do the (Epic) implementation” and instead will rely on current cash reserves and future revenues.
UVM administrators plan to make the records project “priority No. 1,” state documents say – meaning that other capital projects and spending could be reduced if necessary to cover the Epic upgrade.
The hospital also is realigning its finances. “To offset project costs, the applicant expects to implement approximately $110 million in cumulative annual budget adjustments over the next six years including expense and staffing reductions,” Green Mountain Care Board documents say.
“What we’re talking about is, to maintain the finances of the (medical records) program, we have to continue to do what we’ve already been doing for the last five or six years – and that’s to find every single opportunity to do things better and more efficiently,” Brumsted said.
There are some job reductions specific to the Epic project, however. State documents say the hospital plans to “eliminate 89 positions across the network related to its legacy systems and create 63 new positions to support the Epic system, filled mostly by employees whose jobs were eliminated.”
The project’s net reduction of 26 jobs over a 40-month period “is well within the range that we can deal with just within normal attrition,” Brumsted said.
The Green Mountain Care Board has signed off on the hospital’s financial plans for the records project. In addition to relying on the applicant’s data, the board hired Deloitte Transactions and Business Analytics to look at the financials of the project and the UVM Medical Center.
Deloitte found that the hospital “has adequate capacity to implement the project while maintaining an ‘A’ credit rating” even if the records system requires more money than expected.
As a result, the board ruled, “the applicant has sufficiently demonstrated that it can sustain any financial burden resulting from the project’s completion.”
However, the board also ordered UVM to file implementation reports at six-month intervals. In addition to detailed financial information, those reports are supposed to show whether the project has improved patient care while reducing “wasteful, harmful or unnecessary medical services.”
