Dr. Karen DeSalvo, National Coordinator for Health IT, said Tuesday that Vermont is building a model she hopes can be leveraged in other states.
Vermont’s efforts to bring broadband to its rural pockets has helped increase the use of online patient access portals and electronic health records, she said. That experience could be useful to other rural states like Alabama that are struggling with rural broadband and the adoption of electronic health records, she said.
One of her goals is to create opportunities for states to help each other, she said.
DeSalvo, a former New Orleans health commissioner, was the keynote speaker at the annual Vermont Information Technology Leadership summit Tuesday. VITL is a public-private partnership to support health IT development in the state.
DeSalvo, who was appointed in January, struck a tone of support for state and local efforts to adopt health IT systems, describing the Office of the National Coordinator for Health IT as a facilitator for progress.
She said making health IT systems interoperable is her top priority. That statement drew an ovation from the crowd of several hundred people health care industry people gathered at the Sheraton Burlington Hotel and Conference Center.
Interoperability of health IT systems is not only crucial so that medical information can be accessed when and where patients seek care, but also to improve data sharing that will drive population-based health initiatives across providers and government programs, DeSalvo said.
The lack of standardization for electronic health records software recently led one Vermont hospital executive to compare the array of IT systems that can’t share information to the biblical Tower of Babel.
VITL’s primary role since its inception nearly a decade ago has been to develop the Vermont Health Information Exchange, which is designed to bridge the gaps created by the disparate systems used by the state’s hospitals, doctor’s offices and other health care providers.
Virtually all of Vermont’s hospitals and community health centers are connected to the health information exchange, according to figures in VITL’s annual report, along with the Department of Health, according to a September report from the organization.
The state has made less progress bringing primary care practices into the fold, which may be because the practices have less resources and fewer staff to focus on IT. Only 64 precent of primary care practices are in the exchange.
In addition, only 55 percent of home health providers and 25 percent of designated agencies — organizations with state contracts to provide mental and behavioral health as well as substance abuse services — are connected to the health information exchange.
VITL will begin to bring other mental health providers, specialists and long-term care providers into the system soon.
That will do things like cut down on redundant tests and allow ER doctors to see what medications an unconscious patient is taking, he said.
It will also create a rich data set for Vermont’s health care reform initiatives, said VITL CEO John Evans. VITL has participated in the development Vermont’s Accountable Care Organizations and other payment reforms that rely on measuring outcomes and establishing baselines from people’s health data.
Part of the organization’s $10.3 million budget comes from the federal state innovation model (SIM) grant, which is meant to support payment reform. The rest of VITL’s funding comes through the claims assessment, a tax on all medical claims filed in the state.
Harrington called VITL a “public utility” and asked DeSalvo what the federal government might do, beyond funding, to ensure its sustainability.
DeSalvo didn’t give a direct answer, but said sustainability should be a focus for her office’s regional partners in health IT development. Her primary focus is creating health IT infrastructure that’s national, she said.
Providers around the U.S. are ready to share information across the “discrete lines” of tax ID numbers, state borders and IT products, but there hasn’t been an expectation of “standardizing standards.”
“The timing is different than I believe it was when we were just beginning to take off and develop these new multitudes of systems,” DeSalvo said.
Her job as national coordinator is to set the table for that to occur across the U.S., she said, but that states shouldn’t just wait for the “long arch” of federal rulemaking to run its course before they start working toward greater integration.
Harrington said he was encouraged to hear DeSalvo’s qualified support for standardization at the federal level, because it would be hard for Vermont to compel the health IT giants to promote interoperability.
DeSalvo recently wrote at 10-year plan for making health IT systems interoperable and has had representatives from several states, including Vermont, come to Washington to discuss how that can be achieved.
Another top federal priority for health IT is to “set some expectations about governance,” meaning who will be entrusted with health data and how, and what will happen if that trust is violated.
A related concern is how to keep health data secure, DeSalvo said. That struggle was thrown into sharp relief recently when 1,100 Vermonters social security numbers were potentially compromised by alleged Chinese hackers in a massive data breach involving one of the largest health data management companies in the U.S.
DeSalvo will continue to work with leaders at the state and local level to address consumer engagement, interoperability and data security, she said.
