As Vermont Medical Records Go Digital, Providers Build Shared Repository

Dec 8, 2015

If you’ve had a medical appointment lately, you’ve probably seen your provider peering at your medical history on a computer. Many doctors and patients are happy that paper records are giving way to digital information. But there are concerns that electronic health records can be hacked, and that physicians are now spending too much time with computers and not enough with patients. 

At Northern Vermont Regional Hospital’s mammography department, lab tech Debbie Hazelton hands patients a clipboard holding a questionnaire. It is the same form they’ve had for nearly two decades. But these days, Hazelton doesn't just slip that paper work into a file folder. She scans it into a computer. 

Some medical offices even give patients portable devices to type in information, which, along with test results, can be accessed by more than one doctor.

Patients can also log into their own heath information portals.

But the transition to a paperless medical system is far from complete. For example, records kept by NVRH cannot be directly accessed by doctors at the University of Vermont Medical Center, because the two hospitals have incompatible systems. 

NVRH CEO Paul Bengtson says that's a problem.

“Right at the moment we’ve built what I would consider a tower of Babel,” Bengtson explains, “And we just need to retrofit that into something that’s a tower of power, so to speak.”

The “tower of power” Bengston is talking about is one way to describe the central repository being built by a non-profit, publicly funded organization called Vermont Information Technology Leaders, or VITL

"As we change the way health care is delivered, things have to be done differently. And these companies that are developing these cutting edge electronic medical records systems, who are they learning from? They are learning from us." - Paul Bengtson, CEO of Northern Vermont Regional Hospital

At first, VITL’s mission was to facilitate the direct exchange of electronic records by medical practices. But when it became clear that those systems could not all talk to each other, VITL asked providers to send patient records to its own data bank, located in a private cloud in cyberspace.

Rob Gibson is VITL’s vice president for marketing and business development.

He hopes all patients will provide the written consent necessary to have their electronic records retrieved by any provider in Vermont who needs to see them in order to deliver care.

“I think [a patient] should care … because I think we should expect that our doctors would have the most recent, the most up to date, the most timely information about us,” says Gibson. “None of us want to undergo another test if it’s not necessary, I mean even if it’s as simple as another blood test, who likes to be stuck twice?”

Gibson says VITL's data sharing network, called The Vermont Health Information Exchange, now includes all of Vermont's 14 hospitals, Dartmouth Hitchcock Medical Center, most primary care providers, and five agencies of the Vermont Visiting Nurse Association.  But he says there are more senders than retrievers of the medical information in the exchange, because it's taking time to train and convince medical workers to use the system.

"We should expect that our doctors would have the most recent, the most up to date, the most timely information about us." - Rob Gibson, VITL's vice president for marketing and business development

At Northern Vermont Regional Hospital, CEO Paul Bengtson says clinicians are gradually adapting to electronic records, even as they keep up with the changes made to the network.

“As we change the way health care is delivered, things have to be done differently,” says Bengtson. “And these companies that are developing these cutting edge electronic medical records systems, who are they learning from? They are learning from us.”

NVRH even hires computer hackers to see how secure its system is. 

Allen Gilbert directs the Vermont chapter of the American Civil Liberties Union. Gilbert says privacy is a concern. He thinks it's too easy to gain access to confidential health information.

“No unique key is needed to unlock a patient’s records. There’s no PIN, there’s no ATM card,” Gilbert explains. “Access is granted simply by the provider pressing an online check box that says he or she is authorized to see the patient’s records.”

Gilbert does not oppose the shift to electronic records, but he is lobbying for a statute that would give patients the right to bring legal action if their files are breached.

This piece is part of VPR’s series, Digital Diagnosis, looking at the way information technology is changing how health care is delivered.