[M]ike Smith isn’t wasting any time in trying to turn around Vermont’s troubled health information exchange.
Less than a week after starting work as the interim president and CEO at Vermont Information Technology Leaders, Smith appeared before the Green Mountain Care Board on Monday to explain plans for improving the state’s underperforming patient-record network.
Smith said he’s working to temper tough new legislative language aimed at putting tighter controls on VITL. He also told care board members about a plan to restructure the organization’s board.
Ultimately, though, Smith said the key is giving VITL’s staff “the tools in order to succeed.”
“You have a staff of thoroughbreds that want to do the right thing,” Smith said. “They are committed to running hard to get to a productive end.”
The organization has a long way to go to get there.
Burlington-based VITL operates a system that collects a variety of patient records — such as lab reports, admissions/discharges, immunizations and care summaries — and puts them in a secure database. The idea is to create a single record for each patient that can be accessed by any health care provider, making medical treatment more efficient and safer.
But even though the health information exchange has received more than $44 million in state and federal funding, VITL has been plagued by difficulties. A 2016 state audit found oversight and performance issues, and VITL later that year had trouble making payroll.
Last year, a Legislature-commissioned report documented widespread administrative and financial problems with the database. Chief among them was the low number of patient records: Just 19 percent of Vermonters had records in the system.
The Department of Vermont Health Access has been working with VITL over the past few months to come up with a plan to right the ship, though state officials have made no guarantees that the effort will be successful.
“I know that it is a challenge,” care board Chairman Kevin Mullin told Smith on Monday. “It appears that you have some great people working with you … if anyone can figure this out, it will be you.”
Smith takes VITL’s reins from Kristina Choquette, who had been filling in as the organization’s top administrator since the retirement of former President and CEO John Evans at the end of last year.
Choquette will resume her role as VITL’s chief operating officer. On Monday, she told the care board that VITL continues to work with hospitals to increase the number of Vermonters who have agreed to allow their records into the health information exchange — only 33 percent have done that to date.
Choquette also said the number of patient queries — the amount of times providers are accessing patient data — increased from 1,988 in December to 2,529 in January. That 27 percent jump is partly the result of adding new health care organizations, but Choquette said it’s also due to VITL implementing a “beefed up” training regimen with providers who were already using the system.
It will fall to Smith — a former high-ranking state official, telecommunications executive and college president — to keep VITL moving in the right direction. Michael Costa, the Department of Vermont Health Access deputy commissioner, said his office has formed a better working relationship with VITL and is “very grateful to have Michael Smith come on board and play a leadership role.”
Smith said VITL is participating in frequent planning discussions with state officials while also seeking to rearrange its own board. The goal, VITL documents say, is to revamp the board “to ensure that end users are guiding VITL operations and overseeing prudent management of projects and funds.”
Smith and other VITL executives also are keeping close watch on a new bill approved last week by the House Health Care Committee.
The bill, H.901, seeks to boost accountability by requiring VITL and the Department of Vermont Health Access to submit a “work plan” for fixing the health information exchange. It also requires bimonthly progress reports and a contingency plan in case reform efforts aren’t working.
Additionally, the bill, as currently written, provides potentially powerful motivation for reform: It sunsets funding for VITL and eliminates the nonprofit company’s status as the health information exchange operator on July 1, 2019, unless the Legislature takes action.
That’s meant to “ensure successful implementation” of exchange reforms, the bill says.
But Smith said that language is too harsh, and he’ll be lobbying to change it. He believes it’s possible to hold VITL accountable without putting such a drastic step in the statute.
“Hold VITL’s feet to the fire, (but don’t) demoralize staff,” Smith said. “I think everybody wants to succeed. It’s just making sure that you don’t send this into a spiral where you can’t succeed.”
