A few months after receiving a scathing report about Vermont’s health information exchange network, state officials have begun taking steps to improve the system.
The Department of Vermont Health Access and Vermont Information Technology Leaders (VITL), the network’s Burlington-based operator, are working together on short- and long-term fixes designed to make the patient record database more usable and sustainable.
Those efforts are already showing some success, as officials are reporting an uptick in the number of patient records in the system.
But those same officials say they cannot be sure their actions will solve problems that have been festering for years. In fact, the department is formulating a “contingency plan” for the network if VITL can no longer operate it.
“We will be transparent and we will try our best,” said Michael Costa, the department’s deputy commissioner. “It’s not clear yet whether we’re going to be successful.”
VITL manages a secure system that collects patient data such as lab results, discharge summaries, radiology reports and medication histories. That data is accessible to care providers regardless of where a patient seeks treatment. The goal is to offer “one patient, one record,” making health care more efficient and safer.
But VITL has not been able to fulfill the system’s promise due to administrative and financial problems.
A 2016 state audit cited issues with oversight and performance. Soon afterward, VITL administrators admitted that they were having trouble making payroll.
Last year, the state Legislature called for a comprehensive review of the health information exchange. The resulting report showed that medical providers had “lost confidence” in a system that contained only about 19 percent of Vermonters’ patient records.
The consultant hired by the state also found that the system had a fragmented governmental oversight, no long-term plan and a much higher dependence on public funding than similar exchanges in other states.
On Wednesday, Costa told House Health Care Committee members that a lack of clear direction from the Department of Vermont Health Access has contributed to VITL’s problems.
“It’s very hard to reach a goal if nobody will articulate what the goal is,” he said.
Committee members were focused, however, on what can be done to fix the system. And those who testified had some positive news on that front.
From an accountability perspective, Costa said the state has “moved from a grant to a deliverables-based contract” with VITL. “We are trying on all fronts to put much more rigor into this relationship,” he said.
There also are two new committees meeting regularly to address issues raised by last year’s report.
One is a 10-member health information exchange steering committee. “They’ll support us in developing a strategic plan that represents statewide health information exchange needs,” said Emily Richards, health information exchange program director at the Department of Vermont Health Access.
While that goal may sound arcane, officials said it’s critical to figuring out where the state’s needs, and how to get there. “There is no doubt that the lack of a current plan is a material weakness in all of this work,” Costa said.
The other committee is a partnership between the state and VITL leadership. “This is not high-level abstract thinking,” Costa said of those discussions. “This is very concrete, tactical steps to try to improve the program and work toward success.”
VITL itself has had changes at the top. The former president and chief executive officer retired at the end of 2017, and Mike Smith — a one-time senior state official and former head of FairPoint Communications – has been tapped to take over as VITL’s top administrator.
Kristina Choquette, who has been serving as the organization’s acting president and CEO, told the Health Care Committee that VITL is focused on “making significant improvements” even as officials ponder the network’s future.
As an example, she said VITL has worked with University of Vermont Medical Center to tweak the network’s login and patient consent procedures. As a result, the percentage of Vermonters in the health information exchange has risen from 19 percent to 30 percent.
Going forward, department officials have proposed submitting a work plan to the Legislature by May. It would define specific goals for the state and for VITL “as a requirement for continued work and funding.”
There also would be a contingency plan in case those goals aren’t met. That plan, Richards said, will include “an assessment of what it would take to move current assets to a new operator or operators, and what that transitional impact would be on our health reform efforts, health care system (and) Vermont state government.”
The department’s proposals, however, do not include a more controversial potential fix for VITL.
Currently, Vermont is an “opt-in” state, meaning patients must agree to allow their records to be included the health information exchange. The consultant that prepared last year’s report said most states that operate successful exchanges automatically include health records unless a patient opts out.
“One way we could get more providers to use (Vermont’s system) is if we have more data in it,” said Rep. Lori Houghton, D-Essex. “I feel like we’re not going to get more people using it unless we change the opt-in, opt-out (policy).”
But that could be a contentious discussion.
Rep. Anne Donahue, R-Northfield, said she was involved as a mental health advocate in the state’s initial debate about whether patients would be opting into or out of the health information exchange. The exchange was successfully “sold to the public,” she said, partly on the basis of the freedom to opt in.
Donahue recalls thinking at that time that “we were misleading the public, because we’re eventually going to have to change it.”
“Now I’m feeling like, yeah, we misled the public,” she said.
Costa said his department is open to discussing reconsideration of the opt-in policy.
“There is a reason to restart that conversation,” he said. “But I want to be respectful of the fact that that’s a difficult, charged conversation to have.”
