The effort to get Vermonters health records computerized and on line has hit some technological roadblocks.
Despite years of work and millions of dollars spent, officials say the systems are not fully compatible and the information they produce is not always accurate.
The Legislature’s Health Access Oversight Committee is asking some tough questions, because information technology is a key piece of health care reform. Electronic health records are supposed to improve patient care, and provide valuable data to measure hospital and physician performance.
But the promise that technology would provide the great leap forward has not yet been fully realized. Hunt Blair, the state’s health information technology coordinator, told the oversight committee that Vermont was an early adopter of electronic medical records.
"We are on the bleeding edge," he says. "The bleeding edge. We are paying the price for being out in front and trying to move this forward."
Blair says some of the computer systems that were put in place in the early years have encountered technological bugs, including the inability to exchange data across different platforms. Blair faults the federal government for not coming up with strong standards to ensure that the various programs that hospitals and physicians use can actually talk to each other.
"For instance, in a simple a thing as recording blood pressure some systems record it as a text, some as numbers," he says. "That’s where the problems begin, when you have one system that keeps something as an integer and another as text it gets very hard to merge that data together without lots of translation steps."
Blair didn’t cite any specific patient care issues. But the problems are frustrating to Rutland Senator Kevin Mullin, a member of the Health Access Oversight Committee.
"Providers are frustrated. They’re looking at health records that are not accurate or complete," he says. "So they’re not useful. And it’s just a mess, and this needs to be cleaned up."
Mullin says that many of these problems were anticipated in 2006 when the systems were first designed.
"And here we are six years later and now fingers are being pointed at the feds, although the feds try to point to Vermont as being leaders in technology," Mullin says. "Well if we’re the leaders why aren’t we having the conversations with the feds and saying: ‘look these systems have to be inter-operable; they have to communicate with each other.’"
State officials say they are pushing back to the federal government with exactly those kinds of concerns.
Mark Larson is a former lawmaker and now commissioner of health access in the Shumlin Administration. He told the oversight panel that he sees progress in the fact that the state can now identify the problems in health IT.
"In the past we had no systems and therefore they didn’t talk to each other. Now we actually have systems and we find they’re not sharing the information as effectively as we want them to," he says. "That is a sign of progress from where we started. It’s an unfortunate step along the way that we get to this point and we have to figure out now that we have these things why the hell aren’t they working the way we want."
The stakes for the taxpayer are huge. The state and federal government are investing about $79 million in fiscal years 2012 and 2013 to improve health information technology.