Vermont Information Technology Leaders, Inc'

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Vermont Information Technology Leaders, Inc.
Vermonts HIE Experience
eHealthCT Presentation Monday, June 28, 2007
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VITLs Guiding Principle
Sharing health information is a critical tool
for improving the overall performance of the
health care system. VITL will work with the
health care community to achieve new efficiencies
through the use of information technology in
order to deliver better overall value and care to
our citizens.
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What Is VITL?

• A non-profit public-private partnership located
  in Montpelier, VT
• Started by Vermont Hospital Association
• Incorporated on July 22, 2005
• It exists to serve multiple stakeholders,
  including patients, health care providers,
  payers, employers, and state agencies.

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Who Runs VITL?

• An 18-member board of directors that represents
• Physicians
• State Government (BISCHA, OVHA, VDH, VDII)
• Insurers
• Hospitals
• Patients/Consumers
• Business
• An executive committee of six board members meets
  weekly as a steering committee.

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VITL Staff and Committees
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2007 Session Legislation

• H.229 designates VITL to operate the exclusive
  statewide health information exchange network for
  this state
• H.229 gives Dept. of Information and Innovation
  oversight over VITL (previously Banking Insurance
  Securities and Healthcare Administration)

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VITL Products

• Community Utility
• Neutral convener of health care organizations
• Participant and data source agreements
• Clinical and Administrative Data Services
• Build secure interfaces to data sources / sites
• Provide data / App hosting, storage and messaging
• Data normalization and matching services
• Provider EMR Adoption Assistance

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VITL Funding

• Vermont General Assembly
• 1.4 million received FY06-FY07
• 726,664 appropriated for FY08
• Non-State Grants
• 335,000 RTI privacy and security
• 500,000 Vermont Hospital Association
• Hosting and Data Services FY07
• 600,000 VDH
• 39,000 Medication History

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VITL Initiatives
RTI Privacy Security Project
Medication History Pilot
Vermont HIT Plan
Build Exchange Infrastructure
Provide Services to Blueprint
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Medication History Pilot

• With patient consent, data is retrieved from
  pharmacy benefit managers on paid medications.
• A list of medications is printed out, verified
  with the patient, and placed in the medical
  record.
• Operating in emergency departments of
• Rutland Regional Medical Center April 07
• Northeast Vermont Regional Hospital - May 07

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Phase1 Medication History (RxHx)
GE-BVT
GOAL Pilot HIE in Vermont by providing
Medication History data to the ED setting (for
Medication Reconciliation)
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VITL
Medication History Pilot
Sea
rch Criteria Results
Data Name MOUSE, MICKEY A. lt gt
MOUSE, MICKEY Address 1200 N. ELM STREET
1200 N. ELM STREET
GREENSBORO, NC 27401-1020 GREENSBORO, NC
27401-1020 DOB 06/15/1961 Gender M
06/15/1961 Gender M WARNING Result
patient differs from query patient on marked
lines
DISCLAIMER THE
PROVIDER SHOULD INDEPENDENTLY VERIFY MEDICATION
HISTORY WITH THE PATIENT. THIS REPORT IS NOT
GUARANTEED TO BE COMPLETE OR ERROR FREE. CERTAIN
INFORMATION MAY NOT BE AVAILABLE INCLUDING
OVER-THE-COUNTER MEDICATIONS, LOW-COST
PRESCRIPTIONS, MEDICATIONS PURCHASED IN CANADA,
PRESCRIPTIONS PAID MORE THAN 6 MONTHS AGO,
PRESCRIPTIONS PAID FOR BY THE PATIENT, OR
NON-PARTICIPATING SOURCES OR ERRORS IN INSURANCE
CLAIMS INFORMATION.
Date
Range 08/01/2005 - 08/01/2006 Data
Source(s) Caremark, ReStat
Most Recent Drug Name
Description Fill Date Fills
Verified HYDROCHLOROTHIAZIDE 50 MG
08/01/2006 1 ????? INSULIN 100 U/ML
08/01/2006 13
????? GLUCOVANCE 2.5/500
07/15/2006 8 ????? GLUCOTROL XL 10 MG
07/25/2006 12
????? PREVACID 30 MG
07/20/2006 7 ????? PREVACID 15 MG
06/30/2006 1
????? AMPICILLIN 125 MG/5ML
01/29/2006 1 ????? AMOXICILLIN 500 MG
CAPSULE 11/30/2005 1
????? HYDROCODONE/APAP 7.5/500 TB
10/20/2005 10 ?????
END REPORT
The
information disclosed to you may include
information re-disclosed from records protected
by Federal confidentiality rules (42 CFR, Part
2) The Federal rules prohibit you from making any
further disclosure of this information unless
further disclosure is expressly permitted by
the written consent of the person to whom it
pertains or as otherwise permitted by 42 CFR
Part 2. A general authorization for the release
of medical or other information is not sufficient
for this purpose. The Federal rules restrict any
use of the information to criminally investigate
or prosecute any alcohol or drug abuse
patient.
Page 1/1
2/1/2007 1430 Transaction ID 45716 (VITL
use only)
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Preliminary Medication History Pilot Results
(RRMC)

• 1 of patients opting out
• High degree of data accuracy
• With Vermont Medicaid and BCBSVT participating,
  data available on average for 72 of patients
• Data availability as high as 85 of patients,
  during some periods

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Medication History Pilot

• Benefits
• Saves time reconciling medications
• More complete and accurate data
• Gives practitioners better information to make
  clinical decisions on
• Less chance for adverse drug events
• Better quality care
• A more efficient system

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VITLs Services to VDHs Blueprint for Health

• Five-year contract signed in October
• VITL to provide comprehensive chronic disease
  data services to VDH
• GE Healthcare is prime contractor
• Orion Health is subcontractor

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Blueprint Chronic Care Information System (CCIS)

• Data on diabetes and other chronic conditions
  sent from physician EMRs and registries to GE
  Healthcare
• Data is processed and returned for physician
  analysis using Orion Healths disease management
  application
• Physicians use information to improve treatment

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Benefits of Blueprint CCIS

• More comprehensive data for clinical decisions
• A view of the whole patient, including care
  provided by other physicians and in other
  settings
• Identify and manage disease before it becomes
  chronic
• More effective and efficient care

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Blueprint CCIS Current Status

• Requirements phase generated more than 1,000
  pages of material to define what the system is
  required to do
• Requirements work pushed schedule back by about
  two months
• Design phase to be completed in July
• First user online by late fall

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Vermont Health Information Technology Plan

• Information from the RTI, medication history
  Blueprint projects will help shape the plan.
• Will contain recommendations for the General
  Assembly and Administration to encourage rapid
  HIT adoption.
• Being written by a workgroup of more than 30
  volunteers, due July 1

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Health Information Exchange

• Links hospitals, physicians, labs and other
  ancillary services, payers, consumers,
  government, and other stakeholders.
• Built to national standards
• Allows practitioners using different brands of
  electronic health records to share data

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VITL Connects All The Players
Facilities
Consumers
Labs Ancillary
Practitioners
Payers
Government
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Conceptual Model
EMPI
Patient Portal
Lab tests
Data Processing Integration
Clinical Data Repository
Security
Diagnostic Images
Auditing
Medications
EHR
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An Electronic Health Record Is Used to Capture
and Retrieve Patient Data
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VITL Links Different EHRs Together
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Potential Sources of ROI

• Time savings in daily operations
• Reduction of duplicate tests
• Reduction in adverse drug events
• Formulary compliance
• Better compliance with care plans
• Less administrative work
• Better disease management

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Public Values EHRs

• 51 of consumers are willing to pay for EHRs, if
  the price is reasonable
• 67 of consumers say EHRs are important in choice
  of physician
• More than 70 of consumers say EHRs (with patient
  portal) would help them ask more informed
  questions and understand choice of treatment
  options

Source Accenture survey 2/26/07
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Physicians Value EHRs

• 90 of physicians say EHRs allow for easier
  sharing and gathering of information
• 88 of physicians say EHRs provide access to more
  comprehensive patient information
• 80 of doctors say EHRs reduce clinical errors

Source Accenture survey 2/26/07
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Physicians Without EHRs

• There are 634 primary care physicians in Vermont
  and 978 specialists
• Estimates are 25 of physicians already have EHRs
• VITL is analyzing our physician EHR inventory to
  determine more precise adoption rate, and to
  identify practices ready to implement

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Reasons Why Physicians Lack EHRs

• Cost of software, hardware and implementation
  averages 50,000 per doctor
• Requires major adjustment to workflow
• Reduced patient volume while on learning curve
• Primary care physicians lack the capital to invest

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Interim Health Information Technology Fund

• Fund established under H.229, goal is to raise at
  least 1 million
• Voluntary contributions from insurers,
  self-insured employers, community foundations,
  and others
• VITL to work with Secretary of Administration on
  fundraising

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Interim Health Information Technology Fund

• Vendor RFP by Oct. 1
• VITL to establish criteria and award conditions
  for pilot sites by Nov. 1
• Licenses to be awarded by Jan. 1.
• VITLs annual report will provide assessment on
  interim funds progress, recommendations for
  additional funding and legislation

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Take-Aways

• There are many potential benefits to EHRs and
  health information exchange
• To realize those benefits, further discussion is
  needed on
• Balancing patient privacy with physician access
• Financing of EHRs and other physician assistance
• Investments in other core components

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Future CollaborationThis can be done, and we are
here to help!

• Some Ideas
• Meet regularly to share project ideas, lessons
  learned, etc
• Share application or support components as they
  are developed
• Figure out how to enable interstate
  interoperability
• Team on proposals to the Feds (e.g. CDC
  Biosurveillance)

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For More Information

• Please visit
• VITLs new
• website at
• www.vitl.net