VITLs Projects, Present and Future

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VITLs Projects, Present and Future
VITL Summit 07 October 19, 2007
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Agenda

• VITLs Successes in the Past Year
• The Year Ahead
• Strategy Moving Forward
• Considering Future Projects and Policy

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VITLs Successes in the Past Year
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Vermont HIT Plan Completed

• Sent to Legislature and Administration on July 17
• 1,157 views of VHITP page on VITL website
• Model for other RHIOs
• Positive comments from legislators, stakeholders,
  federal officials

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The Vermont Health Information Technology Plan
is among the best plans for health information
exchanges around the country. Likewise, Vermont
Information Technology Leaders, Inc., is taking a
leadership role among the nations health
information exchanges. -- Robert M. Kolodner,
M.D. National Coordinator Office of the National
Coordinator for Health Information Technology
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Building Infrastructure

• One year ago this week, GE Healthcare won a
  competitive bid to build VITLs standards-based
  HIE infrastructure
• Vermont Dept. of Health became VITLs first
  customer with a five-year contract worth 7.5
  million

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Chronic Care Information System (CCIS) Data
Service

• First project under VDH contract is development
  of chronic care information system
• More than 1,000 pages of requirements
• Design process completed, build/implementation
  underway

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Awarded Federal Contract for Security and Privacy
Work

• Initial engagement ended in April
• VITL awarded extended contract for six-month
  implementation project
• Educational efforts
• Project selection strategy
• Technology requirements
• Emergency access
• Funding in 2008 to multi-state collaboratives

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Legislation Passed

• VITL designated to operate Vermonts health
  information exchange network
• HIT Interim Fund and
  EHR pilot program
  established
• Appropriated funds for VITL operations
  through 2008

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Office and Staffing

• Expanded office space, added equipment
• Hired five new staff members
• VITL now has seven professionals
• Financial systems in place

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Communications

• Launched new website
• More than 20 news stories
  generated
• Outreach to practitioners and
  consumer group representatives
• VITL newsletter, 2 issues published
• National exposure
• First video completed

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Medication History Pilot

• Northeastern Vermont Regional Hospital
  Rutland Regional Medical Center

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Please see www.vitl.net to view the Medication
History video
Electronic Medication History Service Video
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Purpose of the Program

• Save time
• Improve patient safety
• Reduce medication errors
• Decrease costs
• Demonstrate accuracy of retrieved data

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Improving Accuracy

• The VITL Med Record is a list of all medications
  paid for in the last 12 months, which is then
  used for medication reconciliation.
• Lists medications the patient may not remember
• Lists medications the patient has recently been
  on that may help diagnosis
• Prompts dialogue with patient regarding adherence

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Saving Time

• Reduces amount of time spent calling pharmacies
  and physician offices to inquire about a
  patients medication list
• Eliminates need for patient to carry pill bottles
  into ED where they may be lost
• Indicates how long patient has been on that med
• Indicates most recent fill date

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Improving Patient Safety

• Enables physician to see a complete 12 month
  medication history
• May catch incompatibilities
• Makes it easier to identify polypharmacy ()
• Can identify inappropriate fills ()
• Can lead to earlier adoption of more appropriate
  medication choices or other therapies

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Controlling Costs

• Can potentially prevent unnecessary admissions
• Can shorten consultation time for providers
• Can prevent prolonged ED observation, thus
  increasing ED throughput
• Can potentially prevent unnecessary procedures,
  treatments, and transfers
• Can catch duplicate medications

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Pilot Goal

• Demonstrate these goals on a small scale

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How Does It Work?
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Lets Do the Numbers

• Go Live
• late April at RRMC
• Late May at NVRH
• Both sites showing opt in rates gt90
• Records found for 70 of patients
• Records not found are
• Self-pay
• Some private commercial insurers
• Some Medicare D
• About 10 of the retrieved records capture a
  medication that a patient forgot (chart review
  n100)

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Success Stories

• A male presented to ED complaining of chest pain
• Patient reported a past medical history of
• Intracoronary stent
• CABG
• VITL Record did not show clopidigrel
• ED physician questioned patient about taking
  clopidigrel after his stent procedure
• Patient states he never filled the Rx

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Success Stories

• Patient was immediately started on heparin and
  sent to referral hospital for cardiac
  catheterization
• In this case, the VITL Record
• Enabled earlier diagnosis leading to earlier
  treatment
• Potentially saved the patients life (time is
  heart muscle!)
• Saved money by preventing unnecessary diagnostic
  procedures
• Potentially prevented complications during the
  catheterization related to prolonged time before
  treatment

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Improving quality Improving patient safety

• Medication reconciliation
• Adherence to guidelines of care
• More complete medication history
• Accurate information in real-time

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The Year Ahead
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Expanding Medication History Project

• Revising current product based on user feedback
  evaluation results
• Adding more data
• Interfacing with ED EMR
• Marketing to other hospitals
• Contracts with new customers
• Roll out to other EDs

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Expanding Medication History Project

• Audience Feedback on Medication History?

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EHR Pilot Act 70 of VT 2005 Legislature

• Establish Pilot for Deployment of EHRs
• Encourage and facilitate use of EHRs
• Promote sharing of EHRs using states health
  information exchange (HIE)
• Primary care practices serving low income
  Vermonters
• Set goal of 1m to be raised by administration
  and VITL from voluntary contributions
• VAHHS Community Foundation 250k
• Office of VT Health Access (OVHA) 250k
• We are continuing to seek contributions from
  other stakeholders

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EHR Pilot 3-prong approach

• Request for Information (RFI) to develop list of
  pre-screened EHR products meeting certification
  criteria. List is for use by all VT providers -
  available 12/2007.
• Competitive process for selection of practice
  sites. Request for Applications process will be
  used. Sites selected by 12/2007.
• Then, pilot practices will provide input into
  Request for Proposal (RFP)
• Vendors/Resellers offering Pre-screened EHRs
  invited to bid on RFP for selected practices
• Awards made 3/2008

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Eligibility for EHR Pilot

• Independent primary care practice with preference
  given to small practices
• Primarily serve a population of low-income
  Vermonters
• Ready to implement an EHR within the next 6-12
  months and to commit practice resources including
  a single point of contact
• Ready to undergo a clinical transformation using
  the concepts of Clinical Microsystems for the
  purpose of improving the quality and efficiency
  of health care delivery (http//www.ClinicalMicros
  ystem.org)

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Eligibility for EHR Pilot

• Willing to participate in the states health
  information exchange (HIE), for purposes of
  improving the delivery of health care.
• HIE will provide security safeguards
• Patient consent will be necessary
• Have need for financial assistance
• Have access to high speed Internet at the
  practice site

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Considerations

• Learning Curve for one doctor
• 40-80 Hours to Learn
• 3 Months to Proficiency
• 9-12 Months to Master
• Quality of vendor support critical to success
• Estimates of cost per provider
• 1st Year costs 32,000 one time
• On-going costs 10,000 per year

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EHR PilotTime for your feedback

• Pilot Structure three prong approach
• Eligibility Criteria
• Additional considerations

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Strategy Moving Forward
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Vermont HIT Plan Four Core Objectives

• EHR Deployment Encourage and enable the
  deployment and use of electronic health record
  systems within the state to increase the amount
  of health information that exists in electronic
  form.

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Vermont HIT Plan Four Core Objectives

• HIEN Infrastructure Establish and operate the
  infrastructure necessary to promote secure
  electronic health information exchange to achieve
  the plan's vision.

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Vermont HIT Plan Four Core Objectives

• Consumer Empowerment Empower consumers to take
  an active role in electronic health information
  initiatives in Vermont.

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Vermont HIT Plan Four Core Objectives

• Public Health Enable public health agencies to
  leverage HIT/HIE investments to monitor and
  ensure the public's health more transparently and
  quickly.

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VITL Implementation Plan
VHITP Core Objective 3 Consumer Empowerment
VHITP Core Objective 2 HIEN Infrastructure
VHITP Core Objective 1 EHR Deployment
VHITP Core Objective 4 Public Health
VITL Sustainability
Other Objectives
VITL Executive Committee / Board
Project Review Committee
Other VITL Committees
Policies, Projects, Other Opportunities
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Project Review Committee

• Formalizing the informal process
• Proposed in the Plan
• Implement project selection strategy
• Make recommendations to Executive Committee/Board
  on projects, RFPs, partnership opportunities
• Continuing to solicit members

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Considering Future Projects and Policy
Initiatives
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• Potential service offerings
• Data sources
• Stakeholder needs
• VHITP Use Narratives
• Services offered by other HIEN/RHIOs

• VITL Projects
• Product development/deployment
• RFPs partnership opportunities

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Quick informal poll
Highly valuable
Not valuable
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Top 5

• Med History
• Labs
• Disease management
• Allergies
• Problem list

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Who are we talking to?
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When a patient presents, our physicians want
medications, allergies, problem list.
What are they saying?
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Concentrate on those things with well-defined
standards, such as E-prescribing, medication
history.
What are they saying?
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Also where regulations put demands on
providers.
What are they saying?
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Formalizing the informal process
VHITP Core Objective 3 Consumer Empowerment
VHITP Core Objective 2 HIEN Infrastructure
VHITP Core Objective 1 EHR Deployment
VHITP Core Objective 4 Public Health
VITL Sustainability
Other Objectives
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Step 1 Evaluate Outcomes
Outcomes

• Is this the right fit for health care reform and
  HIT in Vermont?
• Overcome significant barriers, i.e., practice
  transformation?

Broad use Quality improvement Increased
efficiency Patient centeredness Security and
privacy Public image of EHI
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Step 2 Evaluate Infrastructure Needs
Utilization Of Technical Infrastructure
Utilization Of Organizational Infrastructure
Clinical data repository Master patient
index Interfacing Security Data
aggregation Auditing
Provider agreements Privacy policies Governance Wo
rkflow Education and outreach Stakeholder
participation

• Steps 1 2 are about prioritizing in terms of
  HIT and health care reform in Vermont.

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Step 3 Business Analysis
Business Analysis

• Is this the right fit for the VITL?
• Financial sustainability remember the funding mix

Fulfills unmet need Technical feasibility Technica
l sustainability Financial sustainability Synergy
with other projects Reasonable timeframe Measurabl
e results