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Review Reveals Problems with Vermont Health Information Exchange

A review determined most users have lost confidence in Vermont’s $44.3 million health information exchange.

Source: Thinkstock

By Kate Monica

- Vermont’s health information exchange (HIE) is suffering from consistent and significant financial and administrative problems, according to a recent review by HealthTech solutions.

The exchange is operated by Vermont Information Technology Leaders (VITL) and has received a total of $44.3 million in state and federal funding since its establishment. Following the review, state officials and VITL administrators told VT Digger they plan to implement a multi-year strategy to ensure the HIE runs more efficiently, effectively, and accountably.

“This is the right work to get us all back on track,” Department of Vermont Health Access Deputy Commissioner Michael Costa told VT Digger.

The HIE currently facilitates the collection, maintenance, and exchange of patient EHRs, patient demographic information, lab results, radiology reports, medication histories, and other health data. The comprehensive HIE review came after legislators approved an act requiring a review of the state’s HIE, health information technology plan, and VITL.

HealthTech consultant Dawn Gallagher reported problems with the HIE to the Green Mountain Care Board. As part of her report, she and others at HealthTech interviewed 89 parties, reviewed hundreds of records, and assessed the HIE’s management structure.

While 91 percent of interview respondents agreed it is critical to have an HIE in Vermont, only 19 percent stated the exchange has met their needs or the needs of the state.

Furthermore, less than one-quarter of respondents agreed VITL’s current organizational structure has been successful in managing the exchange. Additionally, only 9 percent of respondents agreed the state has provided guidance and planning for the HIE.

“Many stakeholders said they’d lost confidence in VITL as the organization to operate the (exchange), and many people also said the state isn’t providing enough focus,” said Gallagher.

Gallagher stated the fact that three government agencies and the Green Mountain Care Board are involved in running the HIE makes accountability a challenge. The firm also took issue with the state’s health information technology plan, which they found has not been officially updated for five years.

Moreover, HealthTech consultants determined the HIE has not succeeded in fulfilling its core mission of enabling patient health data access.

 “We have a very low percentage of patients whose data are accessible, and there are quality issues,” Gallagher said.

Gallagher stated the low volume of accessible data may be partially attributable to the state’s opt-in policy. The nine successful HIEs HealthTech has assessed have each been opt-out exchanges, meaning that patient health data is automatically incorporated into the exchange unless a patient explicitly opts out.

 “In addition to that, the consent process (in Vermont) is very cumbersome,” stated Gallagher.

While most patients agree to make their health data accessible through the exchange when asked, only 19.5 percent of the state’s residents have been asked to provide consent.

In an effort to improve the HIE’s value in the future, Gallagher recommended the administration establish a governance committee including leaders from the private and nonprofit sector. The governance committee should also be attached to the Department of Vermont Health Access, she advised.

Additionally, Gallagher suggested VITL’s board be modified to focus on operations and core services. Gallagher recommended the nonprofit find ways to increase the amount of patient health data available in the exchange, improve patient EHR matching methods, and simplify health data access.

Gallagher also pushed for better financial reporting and transparency, stating Vermont should conduct an operational audit of VITL operations. She added that these suggested changes may take about three or four years to implement.

So far, VITL has demonstrated its commitment to improving operations by working with state officials on a transition plan. Additionally, VITL plans to strengthen its partnership with the state after VITL President and CEO John Evans retires on January 1, 2018.

VITL Chairman of the Board Bruce Bullock, MD stated he intends to align as much as possible with HealthTech’s recommendations.

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