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Where Healthcare Reform Meets HIE

August 27, 2010
by Mark Hagland
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Interview: David Cochran, M.D., President and CEO, Vermont Information Technology Leaders
David Cochran, M.D.
David Cochran, M.D.

David Cochran, M.D., who has spent decades in patient care and healthcare management, became president and CEO of Montpelier-based Vermont Information Technology Leaders (VITL) in July 2009. The organization's mission is responsible for supporting the deployment of electronic health records throughout Vermont in support of the state's ambitious healthcare reform and population health initiatives. Further, VITL manages Vermont's statewide health information exchange (HIE). Cochran spoke recently with HCI Editor-in-Chief Mark Hagland about his work at VITL. Below are excerpts from that interview.

Healthcare Informatics: Your organization seems to be focused on several different, important objectives.

David Cochran, M.D.: The main thing to recognize about our HIE is that it's about our overall health reform initiative. And what brought me up here last year was the understanding that the HIE and technology are really there to improve care. We have a statewide medical home initiative called the Blueprint for Health. When [U.S. Health and Human Services] Secretary [Kathleen] Sebelius announced that she was going to work at the state level, Gov. [Jim] Douglas was at her side. So we've established a statewide program that involves community-wide patient registries. And one of the major functions of the HIE is to provide the data infrastructure for that initiative, which was initiated in 2006, and built around the Wagner Chronic Care Model, and was focused around chronic care. In 2008, the concept was broadened to include preventive measures and wellness and disease measures, per the medical home. And it was done in three communities that get certified by the NCQA [the Washington, D.C.-based National Committee for Quality Assurance] for their medical home initiatives, and which get incremental fees from Medicaid and private payers for their medical home work. Those three communities are St. Johnsbury, Burlington, and the Berlin-Barre area.

HCI: So, it began by facilitating work in those three communities?

Cochran: Yes, the state legislature approved pilot projects in those three communities, and then extended the medical home-based program statewide.

HCI: So VITL was first established to provide IT support for Blueprint for Health?

Cochran: That's right. We're a 501c3 public-private partnership, with active participation from the hospital association, state medical society, and other stakeholders; and we were initially identified in 2006 to support Blueprint. One of the learnings early on with the exchange was that not enough physicians had EMRs, so VITL did some initial work using funds from the state to help physician practices implement. In addition, we were designated as the regional extension center for Vermont.

HCI: What are the sources of your funding?

Cochran: We are primarily funded by federal and state grants. There is a very interesting state program here in Vermont, in which 0.2 percent of state claims levied on private insurers, go to fund programs like ours (and Medicaid makes a separate contribution), and that ends up being about $2 million per year; and we have other grants from the state as well. And then we are also the recipient of a regional extension center grant, and that's about $5 million, out of federal healthcare reform, and that's spread out over four years. We're also the prime subcontractor for the state's health information technology/health information exchange grant from the ARRA-HITECH [American Recovery and Reinvestment Act of 2009/Health Information Technology for Economic and Clinical Health Act] program, and we're one of the prime contractors for that, and that's $4.8 million over four years.

HCI: Do you have a staff?

Cochran: We have a board of directors that is our primary governing body, and includes private stakeholders, the medical society, etc., as well as a staff. We have a staff of 14 to oversee and deploy the HIE work, as well as the regional extension center, helping practices get up on EHRs. GE Healthcare [based in Waukesha, Wis.] is our vendor.

HCI: How many physician practices have you interacted with, in regard to EMR implementation?