CMIO Summit: Cochran discusses Vermont HIE's sustainability challenges
 |
If there’s one take-away from Vermont’s program, Cochran said, it's that its success to date is because the program is a clinical program, not necessarily a technology program.
He noted that Vermont is relatively small and rural compared to some other HIE players’ indigenous geography. The state has 13 health services, a population of 637,000 and few large employers (which includes IBM and the University of Vermont). In addition, there are 14 hospitals, eight of which are critical access hospitals with 25 beds or less, Cochran added.
VITL started as part of the Vermont Association of Hospitals and Health Systems but spun off as an independent entity in July 2005. VITL, the state-designated HIE, is unique in that it is funded by state health IT legislation where two-tenths of 1 percent of every medical claim goes into a state health IT fund, which supports the deployment of EHRs through the state and the HIE. The funding law will sunset in 2015.
“We do have challenges associated with sustainability, but that fund has allowed us to do some federal matching,” said Cochran.
VITL, which is also the state-designed regional extension center (REC), boasts that 75 percent of the state's physicians have signed on to the REC, which tightly aligns to the HIE. Most practice participants are small, with one to three physicians, according to Cochran, who anticipates that all primary care practices will be participating by 2013.
“Over time, the vision for the care system is [that it is a] care system, not simply physicians and simply the hospitals; it’s all the folks in the community and in the broader community who are participating and in parallel to what we’re doing with the exchange for the medical community. The state is recasting how it does its information architecture both so [it] can communicate from program to program within the state, but also so that architecture can communicate directly to the exchange so we can share information across some of the state-based programs with the clinical programs that are out in the community,” Cochran said.
By connecting a horde of small practices, thereby building community health teams, VITL hopes to create a supportive statewide network at a community level that mirrors a larger support network.
Currently, nine hospitals are connected into the exchange as well as 54 practices and one commercial lab.
Looking toward the future, Cochran admitted he does not have an answer to the sustainability question. “Our public utility model has provided a good ramp for us, but the question will be whether we can convert that into a recurring revenue model going into the new world once the public utility goes away, in an environment where [projects like DIRECT and companies are gathering the low-hanging fruit],” Cochran concluded. “It’s an interesting challenge and I’m not sure we have an answer yet.”