Today I'm in Vermont, meeting with the stakeholders of Vermont Information Technology Leaders (VITL), the federally designated Regional Extension Center and Health Information Exchange for Vermont.

I feel a close affinity to VITL as one of our New England collaborators (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut) but more importantly because of my longstanding relationship with VITL's CEO, Dr. David Cochran, MD who was senior vice president for strategic development at Harvard Pilgrim Health Care and an influential driving force in the rollout of electronic health records in Massachusetts.

On a personal level, Vermont is one of my favorite places with remarkable countryside, a strong willed people, and a can do attitude. Hurricane Irene has deeply affected the state but everyone is pitching in to accelerate the recovery.

My keynote will reflect on the journey from EHR implementation to true quality improvement using decision support, advanced analytics, and novel care management tools.  

For the first time in my career, I am seeing a cultural transformation such that the majority of clinicians believe an EHR is a necessary part of their practice. Emerging accountable care organizations are stressing the need for health information exchange and financial/clinical analytics as a foundation for the healthcare reform work ahead.  

Meaningful Use Stage 1 sets the stage for quality measurement by moving clinician offices from paper to structured data entry. Stage 2 will require more data exchanges and increasing use of controlled vocabularies that will make quality measurement easier. Stage 3 will include new levels of decision support and data mining to prospectively and retrospectively help clinicians manage population health.

BIDMC's strategy to prepare for future stages of meaningful use and healthcare reform includes

• Embracing health information exchange by serving as a pilot site for government, academic, industry, payer, and patient engagement experiments
• Capturing the value of unstructured data by testing novel Natural Language Processing software
• Empowering users with new analytics using new business intelligence platforms
• Embracing novel sources of information including data from home care devices and patients themselves
• Exploring the implications of gathering and using genomic data for clinical care and clinical trials

I'll share examples of each of these with my colleagues in Vermont and in upcoming blog posts.

One of the most exciting developments is that we now are sending HL7 CDA document summaries from every patient visit to a community-wide registry which generates our meaningful use quality measures, submits our PQRI measures and supports ad hoc clinical queries. By requiring every EHR vendor to send a CDA document over the New England Healthcare Exchange Network (NEHEN) to the Massachusetts eHealth Collaborative Quality Data Center, we have created the technical foundation for our emerging ACO that is in production now. I'll post a more complete technical overview next week.

I look forward to exchanging lessons learned with Vermont.

John Halamka, MD, blogs regularly at Life as a Healthcare CIO.