A recent evaluation of the Vermont Health Information Exchange found governance and data quality issues and low usage rates. For instance, only 19 percent of Vermont patients’ records are currently accessible in VHIE, and statistics show providers generally use VHIE for limited purposes.
Vermont Information Technology Leaders (VITL), the nonprofit organization that runs the HIE, responded that it agrees with the assessment and believes the state should undertake a comprehensive realignment of the governance and delivery of its health information technology and exchange initiatives statewide.
The evaluation, presented to the Green Mountain Care Board in December by consultancy HealthTech Solutions, highlighted several shortcomings and made recommendations for improvement for the HIE, which has received a total of $44.3 million in state and federal funding.
In a survey of 89 Vermont stakeholders, only 19 percent said the VHIE is meeting the needs of their organization. However, when asked if the health IT fund — created through a small tax on insurance claims — should continue to fund the HIE, 58 percent said yes, and only 2 percent said no, with the rest undecided. Ninety-one percent said the VHIE was critical for the state to have.
Other weak points the report noted:
• Accountability is difficult when state-sponsored HIT efforts are segregated and spread across multiple state entities with no alignment.
• Lack of HIT Plan hinders coordinated view of HIT/HIE efforts in Vermont. The last approved plan was in 2010 (in part, because the state focused on federal HIT reporting requirements).
• Most HIEs use an opt-out policy vs. Vermont’s opt-in policy. VHIE’s consent management process is cumbersome (users log into different system).
• Patients must provide written consent to have data viewable. Of those asked, 96 percent consented—patients want their data to be accessible in VHIE.
• There are gaps in matching patients with records, and records are incomplete and/or not consistently accurate. Stakeholders expressed consistent concern about data quality.
• Providers do not use the HIE because patient numbers are low and there are issues with data quality.
• Most users have view-only access. They cannot exchange (share) health records.
• In many cases, users must log in to a different system to get access to VHIE.
• Providers do not get high-value information for the amount of time needed to access and find data.
• Statistics show providers generally use VHIE for limited purposes.
The evaluation suggested that Vermont needs to develop effective HIT/HIE governance, create and execute an HIT planning process, link financial investment to performance, and better leverage the state’s relationship with VITL. It also recommended transforming VITL board membership to include users or potential users of VHIE, or people who have specific expertise. It should also emphasize that the role of the VITL Board is to focus on operations, and the board should use the priorities established in an HIT Plan to drive technical decision-making.
For the State/VITL contract between July 1, 2018 and June 30, 2019, the evaluation recommends continuing to involve state entity counsel throughout negotiations and adding more delivery-based terms for core services with financial and legal consequences.
In a written response, Bruce Bullock, M.D., VITL board chair, said the board wholeheartedly agrees with its recommendations that “Vermont undertake a careful and comprehensive realignment of the governance and delivery of its health information technology and exchange initiatives statewide, including VITL, to better serve providers and patients.”
In addition, John Evans, John Evans, VITL president and CEO, retired on Jan. 1, and VITL said it would use the period of transition to lay the groundwork for increasing the impact of its technology and tools in support of better healthcare at lower overall cost to Vermonters.
