[F]acing increased scrutiny from the state, Vermont Information Technology Leaders has cut $500,000 from its budget for next fiscal year.
The Burlington-based organization — which operates a statewide electronic network of medical records — also is working to increase and consolidate its patient data while making that data more accessible for health care providers.
The changes come as VITL is under tight deadlines to improve after years of sub-par performance and significant state investment. Mike Smith, the organization’s new president and chief executive officer, said the themes of the coming fiscal year are “regain confidence” and “regain credibility.”
“We are transitioning to a leaner and more focused organization,” Smith told the Green Mountain Care Board Wednesday.
VITL manages a secure system that pulls together a variety of patient information such as lab results, discharge summaries and medication histories. That data is supposed to be available to care providers regardless of where the patient seeks treatment.
The idea is “one patient, one record,” with the result being a more efficient and safer health care system.
But VITL has run into administrative and financial problems that were summed up in a report by an outside consultant last year. That document said most users had “lost confidence” in the health information exchange, and it found that less than 20 percent of Vermonters had consented to allowing their information to be included in the system.
A bill now moving through the state Legislature, H.901, is a response to that report.
The legislation requires that VITL and the Department of Vermont Health Access submit a work plan for improving the health information exchange, with regular updates due afterward. It also requires, by Sept. 1, a “contingency plan” detailing how the state would transition away from VITL if the organization can’t meet its goals.
The bill also says the improvement goals in last year’s report are “essential.” And if those goals aren’t met, “it is the intent of the General Assembly to eliminate the designation of Vermont Information Technology Leaders Inc. to operate the exclusive statewide health information exchange network.”
Sen. Ann Cummings, D-Washington, pointed out there have been “issues for years” with the information exchange. In H.901, she said, the Legislature is giving VITL a limited amount of time “to get their act together.”
“This is the, ‘This time we really mean it,’ bill for VITL,” Cummings said.
The Senate on Wednesday amended and approved H.901, and it will now go to the House for further consideration.
Even though the bill has not yet passed, both the state and VITL have gotten to work.
“There is a lot to do in a very short time frame,” said Michael Costa, deputy commissioner for the Department of Vermont Health Access. “So there is not a lot of room for error on the side of (the department) or VITL or the contractors who are involved in this.”
Two new groups have been convened to work through short- and long-term issues: There’s a Health Information Technology Advisory Group to support VITL’s transition, and a steering committee that is focused on the Nov. 1 completion of a new health information plan for the state.
That plan is critical for answering two key questions, Costa said: “What do we want, and can VITL deliver it?”
Additionally, the state has revised VITL’s contract to require more accountability in return for funding. It’s currently only a six-month contract, officials said, to allow for revision after the state has a new health information plan.
“It’s just really important that we’re all on the same page for what our goals are,” Costa said.
The state has hired an outside contractor to develop the contingency plan called for in H.901. And the legislation’s requirement for a state/VITL work plan already has been fulfilled, with officials presenting it to the care board on Wednesday.
In addition to requiring accountability from VITL, Costa said state officials also are holding themselves accountable for the future of the information exchange.
“I think it’s just been a good process of trying to demand more of ourselves if we’re going to continue to spend and invest taxpayer money,” he said.
For their part, VITL administrators are pledging to spend less of that money.
The organization’s proposed fiscal 2019 budget, featuring $5.9 million in expenses, decreases VITL’s reliance on state funding by $500,000. The fiscal 2020 budget is expected to cut state funding by another $500,000, administrators said.
A big cut has come in personnel spending: VITL now has 23.6 full-time-equivalent staff positions, eight fewer positions than in fiscal 2016.
“These reductions have been across the board, but the largest has been in administration,” said Bob Turnau, VITL’s chief financial officer.
At the same time, Turnau said the organization’s financial health is strong. VITL projects that it will have more than $1.2 million in cash on hand by the end of fiscal 2019 – about 78 days’ worth.
“For us, this represents really a good place to be,” he said.
That’s in sharp contrast with VITL’s past troubles: In late 2016, administrators told the care board that they had only four days of cash on hand and might have to borrow to make payroll.
Green Mountain Care Board staffers recommended on Wednesday that the board approve VITL’s submitted budget. The board may vote on the matter May 30.
Financial issues aside, VITL also is working to improve the quality and accessibility of its product — patient information.
That includes steps already taken to boost the number of Vermonters included in the database. That figure that now stands at 32.5 percent, representing a big boost from last summer.
Additionally, administrators are seeking to better match records with patients and to make those records easier for doctors to access.
“Health care providers — they’re extremely dedicated to providing quality care for their patients, but they also have enormous time pressures on them,” said Frank Harris, VITL’s interim chief technology officer. “We may have have great data … but if it’s hard to use, they’re not going to use it.”
There is one other change that could boost the fortunes of VITL and the health information exchange. But no one can move forward with it yet.
Currently, Vermont’s exchange is an “opt-in” system, meaning residents must consent to allow their patient records to be included. Other states are “opt out,” so records are included unless a patient says they shouldn’t be.
H.901 currently includes a provision requiring VITL, the Department of Vermont Health Access, the state Health Care Advocate and others to provide recommendations by Jan. 15 on whether the state should switch to an opt-out setup.
Without making that change, Smith said the exchange may “plateau” at around 50 percent participation no matter what VITL does.
“So this is a very important question as we go forward,” Smith said.
