In some states, early healthcare reform efforts are not yet tightly integrated with programs to boost health information technology infrastructure, such as statewide health information exchanges. In part that’s because in many states, health information exchanges (HIEs) are still in the formative stage.

But executives in the state of Vermont say their IT efforts have gained acceptance precisely because they are seen as underpinning clear health outcome objectives. David Cochran, M.D., president and CEO of Vermont Information Technology Leaders Inc., the nonprofit organization funded by the state to oversee HIE development, says his mission is to support improvements such as the patient-centered medical home and accountable care organizations. “This is about care improvement and reimbursement improvement,” he stresses. “Don’t focus on the technology itself. Focus on what you are trying to fix that IT can assist.”

Vermont’s four-year-old health reform effort is actually made up of more than 60 separate initiatives designed to increase coverage, improve care, and contain cost growth.

In one example, the Vermont state HIE gathers data from electronic medical records of physicians participating in the state’s Blueprint for Health medical home pilot initiative and delivers it to a state-licensed registry for care tracking and quality analysis. It also provides a medication history service that is used in hospital emergency departments.

Vermont has always envisioned IT as an enabler of reform, says Hunt Blair, director of the Division of Health Care Reform and the state health information technology coordinator in the Department of Vermont Health Access. “The policy vision coming out of Washington is consistent with the direction we were already going, so it is a validation,” he says. That has political significance, Blair adds, because there are people in Vermont who are not convinced that this investment in health IT is the right way to go. “So as much as we were out ahead of other states, this provides some reassurance that we are on the right path.”

In 2008, Vermont created a dedicated health IT fund. Set to expire in 2015, the fund is derived from a small (0.199 of 1 percent) quarterly fee on health-care insurance claims and is expected to raise $32 million overall.

Vermont is also focused on how existing state government IT systems can be part of the solution. It doesn’t hurt that Blair’s health IT policy office is physically located inside the state Medicaid agency. The state is anticipating Centers for Medicare & Medicaid Services (CMS) matching funds to support interoperability between the Medicaid Management Information System (MMIS) and the state HIE. “We are in a process of procuring a new MMIS system that should be online by June 2013,” he says. The system will be based on a service-oriented architecture and include a new eligibility system to support a state insurance exchange. “It will replace any remnants of old legacy systems that were islands unto themselves,” Blair says, “and not just for clinical data but for financial transactions as well.”

The most exciting piece of what CMS is doing from the state’s perspective is that it will enable Vermont to move at a much faster clip on health IT than its leaders thought possible a few years ago.

Although he sees many challenges ahead, Blair is bullish on the national effort to transform health IT. “CMS is all in on this,” he says. “This is one of the first things I can think of where Medicare and Medicaid are working together toward the same goal. That is very encouraging.”