Back in 2008, the Vermont state legislature assessed a fee on commercial payers based on reimbursement claims paid on behalf of residents in order to create the Vermont Health IT Fund. With a vision toward improving patient care, the state then awarded grants to be used exclusively for health information technology (HIT) and health information exchange (HIE). The assessment sunsets in 2015, but the state – through those grants – has seen tremendous gains in electronic health record (EHR) adoption and connectivity.
Most recently, eight of Vermont's Federally Qualified Health Centers (FQHCs) now have operational EHR systems, with the help of the Bi-State Primary Care Association and Vermont Information Technology Leaders (VITL), an independent nonprofit and a recipient of the health IT funding. VITL's board of directors represents various shareholder groups, including consumers, healthcare providers, payers, employers and state government. With the FQHCs on EHRs, they can now connect and share patient information for better care coordination.
VITL has used money from the health IT fund and federal dollars from the Office of the National Coordinator (ONC) to develop the statewide HIE, specifically in allowing healthcare providers to access the HIE network without having to pay any fees, which makes it more attractive to participate, according to Steve Larose, vice president of external affairs. "We've been careful to say, when we sign up healthcare providers, that while there is no subscription fee now it could happen depending upon what happens with the health IT funding," Larose said. "We may have to charge a subscription fee or other type of fee in the future."
Reaping the benefits of HIE
One thing is certain, future fee or no fee, participating healthcare providers are benefiting from the connectivity, he pointed out. Physicians are getting lab test results generated by hospitals and labs transmitted directly into their EHR systems in a timely manner, which eliminates faxing, filing and misfiling, scanning and manually inputting data into their EHRs. Physicians have reported that they no longer have to spend time searching for missing lab results or other paper-based patient information. They can now search the electronic records, as well as have multiple authorized clinicians and staff look at the same information at the same time, which was not possible with paper records. Donna Ransmeier, implementation specialist for VITL who works directly with physician offices, noted that practices – both clinician and administrative staff – are much more efficient and can now devote their time to patient care.
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Test results are received as discrete data values, so when they are accepted into the patient record, the discrete data values flow seamlessly into the correct data fields. "It's a faster turnaround," Larose said. "Providers have the data to use when they need it because the data flows into the EHR." For example, clinicians can more easily chart trends when they have timely access to various lab data and help educate their patients in self-management of their conditions.
First step to connectivity: Getting providers on EHRs
VITL is also the regional extension center (REC) for Vermont. RECs received 90 percent of their funding from an ONC grant but were required to raise the remaining 10 percent locally. While other states had to fundraise their 10 percent, Vermont jumpstarted its REC program by using part of the state health IT fund. As a result, Ransmeier and three other implementation specialists were able to get a quick start in working with primary care physicians (PCPs) in their offices to help with the transition from paper to electronic records and to achieve meaningful use of their EHR systems.
To date, nearly 900 PCPs have signed up to work with VITL through the REC, which comprises 90 percent of the approximately 1,000 PCPs in Vermont, according to Larose. More than 750 PCPs are currently using their EHR systems. Larose attributes the high adoption rate to the physicians' dedication to improving the quality of care for their patients. "They realize the value that it brings, not only to them, but more importantly to their patients," he said. Whereas other RECs have requested financial contributions from PCPs for their REC services, VITL made the decision not to charge any fees in order to eliminate a barrier to health IT adoption. "[Not charging fees] has helped a lot in bringing them in," he added.
Lastly, having implementation specialists such as Ransmeier work side by side with clinicians and their practice managers to ensure a smooth workflow transaction and the meeting of particular needs has provided invaluable support and education for physician offices. "You need to make sure that the systems work for them as much as they work around the systems," Ransmeier said. The hard data going into the EHRs need to be correct in order to be used in the HIE and interfaces need to be implemented. "All of these processes need to be worked through in a practice," she said.
The REC set up a list of preferred EHR vendors and federally certified systems, but did not require physician offices to use a particular system. One of the challenges VITL has encountered is dealing with multiple EHRs and EMRs that require their own interfaces to be built in order to connect with the statewide HIE. VITL has been working with the EHR vendors on these interfaces. On the HIE side, VITL has experienced good success with its HIE vendors and proven technologies. "We've made the right decisions in investing in the right technologies," Larose said.
Next steps: Provider portal, patient education and consent
VITL sponsors an annual conference, which draws some 300-plus attendees, and webinars to educate and inform stakeholders of the progress of the statewide HIE. While the providers are familiar with the statewide HIE efforts, awareness is needed in the community, Larose said. VITL will launch a provider portal in early 2013 to allow authorized physicians to conduct queries and view aggregated patient data generated from various healthcare providers, such as discharge summaries and problem and medication lists, within the HIE system. At that time, physician offices will help educate their patients, as patient consent will be required in order for their information to be viewed in the provider portal. Already, the statewide HIE is processing approximately one million transactions a month.
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While VITL will continue to try to get the remaining 10 percent on board with EHR adoption, the organization is especially vested in seeing all of the PCPs who have enrolled in the REC live on their EHRs. "We would like to see more of them achieve meaningful use and work with them daily to help them collect data and attest to meaningful use," he said. VITL will continue to build interfaces to the EHRs and help physician offices go live on the HIE. Thus far, 11 of 14 hospitals in the state are connected to the HIE, with HIE interfaces currently being developed for the remaining three hospitals.
HIE: Part of Vermont’s healthcare reform
Vermont has a progressive attitude, Ransmeier said. When the state released its Vermont Blueprint for Health, a state program administered by the Department of Vermont Health Access that focuses on patient-centered medical homes and other quality initiatives, physicians understood that in order to meet the standards, they needed EHRs. Once they adopted EHRs, "they saw how that improved patient care and helped them track and manage their panels of patients," she said. When you add HIE to EHRs, it makes it even easier for physicians to take care of their patients.
Vermont has had "terrific support" from state legislators and officials, hospitals and physician groups, the business community, payers and other healthcare organizations for the adoption of health IT and HIE. That support, which includes the health IT funding, is tied to the state’s mission to reform its healthcare system, Larose pointed out. "They have embraced the idea of working together on behalf of healthcare reform. They understand the important role healthcare information technology plays in healthcare reform," he said. "It sets us apart from other states in the country. It has helped us to get to where we are today."