The chairman of the Green Mountain Care Board says he wants to see “meaningful changes” in “staff and operations” at the private organization creating electronic medical records for the Vermont health care system.
Kevin Mullin, head of the five-person regulatory panel that oversees almost every facet of the state’s medical industry, says Vermont Information Technology Leaders hasn’t developed the electronic records system as quickly or efficiently as it should have. And he says hospital administrators he’s spoken with have expressed “very little praise for VITL.”
“I question where we’re at today, and sadly we need good IT in the state,” Mullin says. “If we’re going to have an effective health care system that brings down costs, we have to be able to have an interchange of data.”
Mullin says that interchange of data is critical to system-wide health care reforms that Vermont is relying on to slow the growth of medical costs in the state. And he says that interchange can’t happen unless doctors have electronic access to patients’ medical records.
“My personal opinion is that there’s room for a lot of improvement,” Mullin says.
Mullin’s criticism comes at a critical juncture for VITL specifically, and the development of electronic medical record technology more broadly. The state uses what's known as a "claims tax" used to pay for the effort. It’s a small assessment on health insurance claims, and it's scheduled to expire at the end of the fiscal year. When lawmakers reconvene next January, they’ll have to decide not only whether to extend the tax, but also whether the money should continue flowing to VITL.
John Evans, president and CEO of VITL, says the organization is proud of its track record.
“We’re doing really important work in a very nascent area of health care,” Evans says.
Evans says VITL has now made nearly two-thirds of health care providers’ data electronically accessible. And he says fiscal year 2017 was especially productive.
“VITL completed 100 percent of its deliverables under all of its agreements, both public and private, so we take performance extremely seriously,” Evans says.
Much of VITL's work is devoted to helping electronic records systems at one hospital communicate records systems at others, since many of them aren't technologically compatible. Evans says the organization's efforts have already driven improvements in patient care. And he says the organization is playing a key role in the state’s broader health care reform efforts.
“As providers become increasingly at risk for managing a population’s health, then data is important to performing analytics,” Evans says. “And VITL has developed technology to support those needs as well.”
Earlier this year, lawmakers asked the Agency of Administration to scrutinize VITL’s work. A report is due in November.
“We want to be sure that we’re actually getting good value for the money we’re raising,” says Calais Rep. Janet Ancel, the Democratic chairwoman of the House Committee on Ways and Means.
Ancel says the report will help lawmakers decide whether the claims tax is the right funding mechanism for the job, “and frankly, what we’re getting for the money.”
And it is a significant amount of money. The claims tax has generated more than $20 million since 2009, and the federal government has pumped another $90 million into the initiative. Not all of the money goes to VITL - much of it goes directly to providers, to institute electronic medical records systems.
But Mullin says he’s not convinced the public dollars that do go to VITL are being well spent.
“You may be sitting down with one of VITL’s harshest critics, because I have history on this,” Mullin says.
That history dates back to 2008, when VITL first sought a more permanent public funding mechanism for its work. Mullin was a state senator at the time, serving on the Senate Committee on Health and Welfare.
“I helped sell that proposal on the Senate floor, and I can tell you that VITL was oversold to legislators,” Mullin says. “I regret ever selling the claims tax.”
Mullin says if the claims tax is going to be extended, then lawmakers should attach tighter strings to state funding. The tax has been set to sunset twice before; lawmakers extended it both times.
“I don’t think that just continuing the claims tax makes any sense unless there are some specific outcome measurements that are tied to it,” Mullin says.
And Mullin says even more rigorous contractual obligations for VITL might not be enough.
“What really has to sink in is there has to be some meaningful changes in the actual staff and operations,” Mullin says.
Evans says he welcomes legislative attention to VITL’s work.