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Laying the foundation for health information highway By Nancy Remsen Free Press Staff Writer July 30, 2007 MONTPELIER — Car dealerships have long been able to generate letters reminding customers that based on past mileage and service records their vehicles are due for tune-ups. It is also standard practice for veterinarians to advise pet owners when their dogs and cats need another round of shots. Medicine, however, has been slower to harness computer technology to routine clinical data to enhance the way doctors care for their patients. One of the biggest roadblocks: Most medical records are still paper documents stuffed in file folders. “There is very little universal sharing of electronic health information because the infrastructure to do that doesn’t exist,” said Paul Forlenza, chief operating officer for Vermont Information Technology Leaders Inc. VITL, a nonprofit, public/private partnership, which was formed in 2005 to build a health information network that would play an important role in improving the performance of the state’s health care system. “We aren’t building this all at once,” Forlenza said. Instead VITL and others have begun taking small steps to demonstrate the feasibility and benefits of electronic exchanges of health information. Since May, for example, the emergency department staff at two Vermont hospitals have been able to tap into patients’ prescription medication histories — critical information when quick decisions must be made. Earlier this month, VITL released a five-year plan intended to guide all the small steps in the development of a �statewide health information exchange. "That's the whole vision, that this will get bigger and bigger," said Andrea Lott, chief information officer at Northeastern Vermont Regional Hospital in St. Johnsbury and a member of the VITL board. Her hospital and Rutland Regional Medical Center are the sites for the VITL-sponsored medication information project. "Eventually someone would be able to have their medical record follow them where they are," Lott said. "We have a long way to go," said Rep. Steve Maier, D-Middlebury, chairman of both the House Health Committee and the Health Care Reform Commission. Still, he sees momentum building toward an operational health information highway in Vermont. "At some point, as people start to understand and see the power of it, and want it," Maier said, "then I think it is going to happen pretty quickly." GETTING STARTED "What we are building is an interstate," said Dr. Cyrus Jordan, chairman of the VITL board of directors. He said the small projects, such as patient medication project, represent the interchanges and feeder roads along the highway. Although there is broad support for building a health information network among politicians and in the health care industry, VITL officials note there are thorny issues to tackle -- such as funding, security and privacy. In planning the pilot project to make available prescription drug histories, VITL officials said they made sure to address security and privacy. Hospital staff explain the new option to patients then ask them for permission before tapping into their drug records. "If they give their consent, we have the means for pulling up their last year of medications, the prescription medications that have been paid for by insurance," Forlenza said. "In Rutland, we are getting a 99 percent opt-in rate," said Steve Larose, communications director for VITL. Jordan said electronic records give patients more control over their medical information because limits can be placed on who has access to sensitive data. Now, he said, "whoever can physically get their hands on a paper record can see everything." TRANSFORMING RECORDS One of the biggest hurdles standing in the way of a statewide health information exchange sits in doctor's offices: reams of paper records. "People refer to this as the last mile in digitizing health care," Jordan said of the challenge of transforming paper recording-keeping to electronic. "Private practices can't afford to do this. There is no financial return," he said. "It goes elsewhere in the system." Studies cited in VITL's plan suggest the switch could cost $44,000 per physician, plus annual expenses per doctor of $8,500. Only 11 percent of any savings from the switch end up in the physician's pocket, according to citations in the report. Insurance companies benefit most. Lawmakers recognized the financial barriers and directed VITL to raise up to $1 million from sources such as insurance companies and hospitals to pay to help some small primary care practices make the jump to electronic medical records. VITL estimates that with $1 million, it could assist 12 providers. To bring electronic medical records to all the non-hospital affiliated medical practices still using paper would require $25 million. The organization must recommend to the Legislature in January how to find that money. INDEPENDENT INITIATIVES Many other health information technology initiatives are under way, independent of VITL. A medical team at the University of Vermont, for example, developed a niche service to help diabetic patients and their doctors keep current with the many tests critical to managing this chronic, debilitating and costly disease. Drs. Ben Littenberg and Charles MacLean and technology expert Michael Gagnon set up an electronic database -- the Vermont Diabetes Information System -- that collects and stores patients' laboratory results and provides overnight reports that interpret test results for doctors based on standard care guidelines. The system also alerts doctors and patients when follow-up tests should be scheduled. It provides individual doctors with quarterly analyses of the lab results for their diabetic patients compared to those of other doctors in the system and to best-practice results. "This has really improved the efficiency in my practice," Littenberg said. With diabetic patients, he said, "lab results are the linchpin of all the medical actions, but it is difficult to keep track -- for the doctor and the patient." The trio tested the "real world" feasibility of the system in medical practices in Vermont and New York in a study funded by a National Institute for Health grant. UVM has obtained a patent for the system and spun off a company -- Vermedx -- to distribute the service. Littenberg said the Fletcher Allen Medical Group was among the first to buy into the Vermont service. The New York City Department of Health bought the software, so it could set up a similar system. At $4 per patient per month, the cost of the service is modest -- less than $4,000 a year for a doctor with 80 diabetic patients. Littenberg noted that doctors don't have to make any technology investments. Reports can be faxed to offices that don't have electronic capabilities. The UVM team sees this diabetic information service as a tool allowing physicians to step toward the information highway while addressing another broadly supported goal of better managing a significant chronic disease. As the state's health information network grows, Littenberg added, "our work can be folded in." |
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