A health information exchange can be connecting lots of practices and hospitals but still not gathering the data pertinent to member organizations as they move to value-based care. Realizing this, the 10-year old Vermont Information Technology Leaders (VITL), which operates the Vermont HIE, has made a concerted effort to improve data quality and to be a more valuable source of analytics data for the state’s three accountable care organizations.
Last week I interviewed Rob Gibson, VITL’s vice president of marketing and business development, about some of the highlights of its recently released 2015 annual report.
One milestone in 2015 was fully interfacing with Southwestern Vermont Medical Center, which completed VITL's goal of connecting all 14 Vermont hospitals to the VHIE. “All the hospitals have been marginally connected for a while,” Gibson said. Now we have a complete suite of interfaces with Southwest. That is a milestone VITL has been working towards for 10 years.”
Another key accomplishment of 2015 was the development of a clinical data warehouse to allow VITL to create data marts for ACOs.
VITL has been working with all three ACOs in the state. With OneCare Vermont, the largest, it initially sent the ACO HL7 messages directly. “Their data analytics vendor was collecting that information and doing analytics for them,” Gibson said. When OneCare switched to a different analytics provider, they switched course. “We were building a clinical data warehouse and found that the easiest thing for us to do was create a data mart for them, and their analytics vendor can have access to it,” he added. The other ACOs, Community Health Accountable Care and Health First, will follow suit.
VITL has vastly increased the amount of data about ACO participants it is collecting. At the beginning of 2015, VITL was only getting data into the HIE that covered 17 percent of the population of OneCare. “We may have had an interface to the source organizations, but if we were not getting CCDs (Continuity of Care Documents) from them, we were not able to capture the measures that the ACO needs,” Gibson explained. “So we went back and put 50 CCD interfaces online so we could get the care summaries they need, and then the data warehouse parses the information out from the CCD. We pull out the blood pressure or A1C they need.”
In one year, VITL went from gathering only 17 percent of the data the ACOs need about beneficiaries to 64 percent, in large part by bringing in CCD interfaces from the largest hospital in Vermont, the University of Vermont Medical Center. “We have been connected to UVM Medical Center for quite a while, but we didn’t have CCD interfaces,” Gibson said, “so while we were getting a lot of data from them, we weren’t getting the pieces that the ACO needs for their clinical measures.”
VITL executives also realized the importance of improving data quality at the grass roots. “When you do data quality improvement at the source system, you benefit everyone down the road,” Gibson said. As an example, Blueprint for Health, which manages patient-centered medical homes in the state, is creating practice profiles based on claims data and data in their clinical registry. Twice a year they create a practice profile for certain chronic conditions. “As they were developing the capability to do those profiles, they realized that if they are not getting the data they need, those reports aren’t going to be very meaningful,” he added. “We worked hand in hand to help providers understand why they need to collect data in a consistent manner, why they shouldn’t write ‘F’ one time and ‘Female’ the next. We call that hand-to-hand combat, but we do it for Blueprint and for the ACOs.”
Similarly, as VITL was bringing in the CCD interfaces to create the data mart, they noticed that the blood pressure measures were only present in a small percentage of the CCDs. “We had to go back and say, why aren’t we getting all of them? Is it something in the reporting system from the EHR? Something in the way the staff is entering the data?”
As it builds up the data marts for ACOs in 2016, Gibson said, VITL also plans to explore offering reporting capabilities to hospitals and practice groups. “This year is about expanding that clinical data management capacity we have built around the warehouse,” he said.
Another big piece for 2016 is enhancing the point-of-care query service called VITLAccess. “We have more than 2,000 providers signed up to use it, but we have to remind them of the value and get them using it more often for more scenarios. They want to work with the hospitals to make access available through single sign on through the EHR. Another aspect involves consent. Vermont has opt-in consent. Currently that consent is registered within VITLAccess. “We want to work with EHR vendors to say why can’t we flag that in the EHR when the providers are documenting everything else about the patient and have it come through as an HL7 message? So automated consent and single sign on are both big projects for us.”
Finally, Vermont is a progressive state, and several years ago the legislature agreed to pay for the HIE services through the creation of an HIT Fund paid for by a small tax on insurance transactions. That funding is still in place but under current law it will expire June 30 of 2017. “There is currently discussion within the legislature this session and at the Green Mountain Care Board, which has oversight for health reform, on the best way to move that forward,” Gibson said.
After considering a single-payer system, Vermont is moving toward an all-payer waiver from CMS to move toward a global budget structure for healthcare like Maryland has done.
“I think there is consensus that most of what VITL does benefits the entire population,” Gibson said. “So funding those core activities through a sustainable funding mechanism is important. After that you get into the details of how we are going to do it and how much it costs, but I think the fact that Vermont sees that is important makes it different from many other states. Stay tuned.”