MONTPELIER — Vermont's health information exchange network is supposed to make treating patients easier, safer and less redundant.
But a new report says the exchange — operated by Vermont Information Technology Leaders, or VITL — suffers from serious, long-term financial and administrative problems that have greatly diminished its usefulness.
As a result, a consultant found that most users have "lost confidence" in the exchange despite federal and state investments totaling $44.3 million.
State officials and VITL administrators say they're not giving up on the system. They've begun implementing a multiyear plan that they believe will make the exchange more efficient, effective and accountable.
"This is the right work to get us all back on track," said Michael Costa, deputy commissioner with the Department of Vermont Health Access.
The information exchange is a collection of data designed to allow multiple care providers to access and share important facts about a given patient. The idea is "one patient, one record," regardless of where that patient is seeking treatment.
Burlington-based VITL is the operator of that system in Vermont. The nonprofit says it collects and manages a secure system featuring information like demographics, lab results, discharge summaries, radiology reports and medication histories.
But the system has been plagued by problems. An audit last year cited oversight and performance issues in concluding that "the state is unable to adequately assess the performance of VITL and to demonstrate the value" of the health information exchange.
On the heels of that audit, VITL administrators told the Green Mountain Care Board in late 2016 that they were having trouble meeting payroll.
Earlier this year, the Legislature approved Act 73, which called for a "comprehensive review" of the state's Health Information Technology Fund; a plan associated with that fund; the health information exchange; and VITL.
The state picked Kentucky-based HealthTech Solutions to undertake that review. And HealthTech's Dawn Gallagher was the bearer of mostly bad news when she reported back to the Green Mountain Care Board at a recent meeting.
Gallagher said health information exchanges have common origins - states received federal funding to set them up - and common challenges. It's been difficult for state exchanges to become financially self-sustaining, for example, and it's still hard to ensure the quality and accessibility of patient data given the variety of electronic health record systems in use.
But Vermont's problems go well beyond that, according to Gallagher's report.
Interviews with 89 "stakeholders" showed that 91 percent agreed it is "critical" to have a health information exchange in Vermont. But just 19 percent of those respondents thought that the exchange has been meeting their needs or the needs of the state.
Twenty-one percent thought VITL's current organizational structure allows for successful management of the exchange. And only 9 percent believed the state has "provided guidance and planning" for the exchange.
"Many stakeholders said they'd lost confidence in VITL as the organization to operate the (exchange), and many people also said the state isn't providing enough focus," Gallagher said.
The consulting firm also took a close look at hundreds of records and examined the exchange's management structure.
From the state's perspective, Gallagher pointed out that three governmental agencies and the care board all have a hand in health information technology and the exchange. This mix "makes accountability difficult," she said.
Also, the state's health information technology plan hasn't been officially updated for five years.
At the same time, the consultant found that VITL itself doesn't have a long-term plan and has a much-higher dependance on public funding than health information exchanges in other states.
Management issues aside, Vermont's exchange seems to be failing in its core mission - making patient information available. "We have a very low percentage of patients whose data are accessible, and there are quality issues," Gallagher said.
She attributed this in part to the state's "opt-in" policy, wherein patients must agree to allow their information to be included in the exchange. In comparison, all of the nine "successful" exchanges examined by HealthTech Solutions in other states automatically incorporate information related to physical health unless a patient opts out.
"In addition to that, the consent process (in Vermont) is very cumbersome," Gallagher added.
While most patients agree to make their information available to the exchange when they're asked, VITL told the consultant that only 19.5 percent of the state's residents have been asked to provide that consent.
As a result, "if I'm a provider, I have less than a one-in-five chance that my patient's data are going to be accessible" in the exchange, Gallagher said.
The consultant offered a variety of potential solutions.
Those included establishing "an across-the-board governance committee" for Vermont's health information exchange. This should include leaders from the private and nonprofit sectors, and it should be attached to the Department of Vermont Health Access, Gallagher said.
She also recommended revamping revamping VITL's board to "focus on operations and core services." The nonprofit needs to develop mechanisms to increase the amount of patient information in the exchange; to better match patients with records; and to find easier ways to access that data.
Additionally, Gallagher urged better "financial reporting and transparency," and she said the state should conduct an operational audit of VITL's operations.
While some at VITL think such changes can happen in two years, Gallagher told the care board that it might take three or four.
Whatever the time frame, "you're really at a crossroads," she said. "The one thing you can't do is not do anything."
Costa said the state already has changed its relationship with VITL by requiring more accountability in exchange for funding. Also, he said state officials "fully intend" to develop an updated health information technology plan.
VITL also appears to be on board with making big changes.
President and Chief Executive Officer John Evans is set to retire Jan. 1, according to information submitted to the care board. The nonprofit is working with state officials on a transition plan and also expects to develop a stronger overall partnership with the state, administrators said.
Dr. Bruce Bullock, chairman of VITL's board, said he wants to "align as much as possible" with the consultant's recommendations. That includes making VITL more sustainable and focusing on a "back-to-basics" administrative approach.
"As a clinician, I feel strongly about this issue," Bullock told the care board. "I'm passionate about it. How can we help you help us succeed?"
Mike Faher can be contacted at firstname.lastname@example.org.