1. HIE:
The Vermont Version
David Cochran, MD
President and CEO
Vermont Information Technology Leaders, Inc.

2. Topics
• VITL Overview
• Vermont Health Reform
• Blueprint for Health
• Health Information Exchange

3. Snapshot of Vermont
637,000 population
9615 square miles
13 Health Service Areas
Few large employers (IBM,
State Government, University
of Vermont)
Little industry
Dairy and Tourism

4. VITL Background
• Started as a project within the Vermont Association of
Hospitals and Health Systems
• Spun off as independent entity in July 2005
• Received 501(c)(3) non-profit status in March 2009
• A public-private partnership with participation from
health care providers, government, employers,
consumers, and health plans
• Shared public investment supporting IT requirements
of Vermont’s health care reform efforts
4

5. VITL
Programs
Vermont REC
Statewide HIE
Blueprint Support
ePrescribing
5

6. Support Based on Practice’s
Technology Maturity
Meaningful Advanced
Paper EHR Labs Blueprint HIE
Use
Paper EHR Lab Patient Clinical, Clinical
(clinical) installed results demo- structured data
practice Standard update graphics data sharing
May have workflows EHR and captured with
a PMS Data May also clinical Quality consent
entry is have summary measures
manual immun- sent to are
ization Registry automatic
6

7. Vermont Health Care Reform
60+ Discrete, Active Initiatives which combine to…
Improve Quality
• Provider Access, Transparency
Increase Coverage • Promote Wellness / Prevention
• New Coverage Options • Blueprint for Health
• Premium Assistance integrated Medical Home &
• H202 – Roadmap to Single Payer Community Health Team
• Health Information Technology
• Accountable Care Organizations
Contain Cost Growth
All of Above PLUS
• Cost Transparency
• Statewide Health Resource Planning and Review
• Prescription Drug Cost Containment
• Administrative Simplification
7

8. HIT & HIE Fully Integrated in
Health Care Reform from start
• In 2005, VT authorized and funded a single statewide
Health Information Exchange
• VITL (Vermont Information Technology Leaders), a
501(c)3 public/private partnership, developed
standards based architecture for statewide HIE and
began operations.
• Investment in EHR adoption and deployment
included in HCR legislation, starting with a primary
care EHR pilot, expanded through creation of HIT
Fund (fee of 0.199 of 1% on each health care claim)
in 2008
8

9. Blueprint for Health
Advanced Primary Care Practices
Community Health Teams
Payment Reforms
Health Information Infrastructure
Expansion & Quality Improvement Program
(EQuIP)

10. Advanced Primary Care
Practice
Doc Site
Centralized Registry
Community Health Team
Medical Home

11. NCQA Score & Payment
$3.00
$2.50
$ PPPM per provider
$2.00
$1.50
$1.00
$0.50
$0.00
0 10 20 30 40 50 60 70 80 90 100
NCQA PCMH Score

12. Continuum of Health Services - General
Specialized & Targeted
Services
Higher Community Health • Specialty Care
Acuity &
Teams • Advanced Assessments
Complexity
• Advanced Treatments
• Support Patients & Families • Advanced Case Management
• Support Practices • Social Services
Level of Need
Advanced Primary • Coordinate Care • Economic Services
• Coordinate Services • Community Programs
Care Practice • Referrals & Transitions • Self Management Support
• Health Maintenance • Case Management • Public Health Programs
o DVHA Care Coordinators
• Prevention o SASH Coordinators
• Access • Self Management Support
• Communication • Counseling
• Self Management Support • Population Management
• Guideline Based Care
Lower • Coordinate Referrals
Acuity & • Coordinate Assessments
Complexity • Panel Management
6/15/2011 12
Level of Service & Support

13. Blueprint for Health:
Practice Transformation Engine
Blueprint for Health’s integrated platform:
– web-based registry,
– clinical data repository,
– population-based management tool
Populated through the HIE for bi-directional feeds from practice and
hospital EHR systems, labs, public health registries, other sources to
support:
– clinical messaging,
– care coordination,
– patient and panel management functions
13

14. Hospitals
Medical
Self-Help Recovery Home
Communities
Medical
Social, Economic, & Community Health Team Home
Community Services Nurse Coordinator
Social Workers
Nutrition Specialists
SASH Coordinator Medical
Mental Health & MCAID Care Coordinators Home
Substance Abuse
Programs
Medical
Home
Long Term Care
Public Health
Programs & Services
Health IT Framework
Evaluation Framework
6/15/2011 14

15. Federal HIT/HIE Policy, Oversight, & Standards - Office of the National Coordinator (ONC)
State HIT/HIE Policy, Oversight, & Standards – OVHA/HCR
State Government & Public Health Vermont Health Care Providers & Institutions
NHIN Connectivity
Public Health surveillance, Tertiary and Community Hospitals
registries, & other public
health functions
Primary Care & Specialty Providers
Health Information
Medicaid health programs
case management Exchange “Cloud” Federally Qualified Health Centers
& Rural Health Clinics
functionality and connectivity for secure, privacy protected
interchange of health records, Free Clinics
Other Medicaid & AHS case
management functionality
demographic data, image files,
Mental Health/BH/SA Providers
and connectivity clinical messaging, & other
digitized health information Long Term Care Providers
Other state agency & dept. Statewide HIE Operated by VITL
case management Home Health & Hospice Providers
functionality and connectivity
Community Human Service
Law Enforcement, Agencies (Family Centers, Area
Corrections, & Court System Individual Vermonters: connectivity to EHR Agencies on Aging, etc.)
Portals, Personal Health Records (PHR), Health
2.0 applications and Ix Services
15

16. Blueprint Integrated Pilots
Health Information Infrastructure
Medical
Home
• Visit planners for individual patients
• Reporting for panel management & outreach (Medical Homes, CHTs)
Medical Hospital data warehouse • Clinical information for care coordination (CHTs, OVHA CCs)
Home (hosted EMR) • Tracking for public health services (e.g. cessation counselors)
• Reporting for public health planning
• Reporting & comparative benchmarks to support program evaluation
Medical Core data elements
Home
Medical VITL
Home
HIE
Core data elements Core data elements Central
Medical FQHC
Home (hosted EMR) Registry
Medical
Home
Medical
Home
EMR
Core data
Medical elements
Home
EMR
Access
Medical Community
Access
Web
Web
Home Health Team
No EMR

17. Blueprint Integrated Pilots
Health Information Infrastructure
Medical
Home
• Visit planners for individual patients
• Reporting for panel management & outreach (PCMHs, CHTs)
Medical Hospital data warehouse • Clinical information for care coordination (CHTs, OVHA CCs)
Home (hosted EMR) • Tracking for public health services (e.g. cessation counselors)
• Reporting for public health planning
• Reporting & comparative benchmarks to support program evaluation
Medical
Home
Medical VITL
Home
HIE
Medical FQHC Central
Home (hosted EMR) Registry
Medical
Home
Medical
Home
EMR
Medical
Home
EMR
Access
Community
Access
Web
Web
Medical
Health Team
Home

18. Blueprint Integrated Pilots
Evidence Based Quality Improvement
Data Data Data Data
Source Processing & Storage Analysis Reports & Uses
EMRs used for EMR Databases Data transmission & EMR Clinical Individual Patient
Individual Patient transformation Reporting Tool or Process Care & Support
Care VITL / GE Analyst Measures Services
DocSite used for DocSite Database DocSite Health Population
Individual Patient Reporting Status Management
Care Tool Measures
Contracted Healthcare Quality Quality
Analysis Measures & Standards Improvement
Services
Medical Claims from BISCHA BISCHA Healthcare Provider Payment
Commercial Insurers Multipayer Reports Patterns & Resource for Quality
& Medicaid Database Utilization
VCHIP VCHIP VCHIP Healthcare Program
Chart Review & Databases Analysis & Report Expenditures & Evaluation &
NCQA Scoring Generation Financial Impact Sustainability
Public Health Surveys Public Health VDH Health VDH Health Population Indicators Community
& Data Collection Registries & Surveillance Analytic Surveillance Analyst & Prevention
Databases Database Risk Factors Planning

19. Blueprint Integrated Pilots
Evidence Based Quality Improvement
Data Data Data Data
Source Processing & Storage Analysis Reports & Uses
EMRs used for EMR Databases Data transmission & EMR Clinical Individual Patient
Individual Patient transformation Reporting Tool or Process Care & Support
Care VITL / GE Analyst Measures Services
DocSite used for DocSite Database DocSite Health Population
Individual Patient Reporting Status Management
Care Tool Measures
Contracted Healthcare Quality Quality
Analysis Measures & Standards Improvement
Services
Medical Claims from BISCHA BISCHA Healthcare Provider Payment
Commercial Insurers Multipayer Reports Patterns & Resource for Quality
& Medicaid Database Utilization
VCHIP VCHIP VCHIP Healthcare Program
Chart Review & Databases Analysis & Report Expenditures & Evaluation &
NCQA Scoring Generation Financial Impact Sustainability
Public Health Surveys Public Health VDH Health VDH Health Population Indicators Community
& Data Collection Registries & Surveillance Analytic Surveillance Analyst & Prevention
Databases Database Risk Factors Planning

20. Blueprint Integrated Pilots
Evidence Based Quality Improvement
Data Data Data Data
Source Processing & Storage Analysis Reports & Uses
EMRs used for EMR Databases Data transmission & EMR Clinical Individual Patient
Individual Patient transformation Reporting Tool or Process Care & Support
Care VITL / GE Analyst Measures Services
DocSite used for DocSite Database DocSite Health Population
Individual Patient Reporting Status Management
Care Tool Measures
UVM CCTS Healthcare Quality Quality
Health Informatics Measures & Standards Improvement
Platform
Medical Claims from BISCHA BISCHA Healthcare Provider Payment
Commercial Insurers Multipayer Reports Patterns & Resource for Quality
& Medicaid Database Utilization
VCHIP VCHIP VCHIP Healthcare Program
Chart Review & Databases Analysis & Report Expenditures & Evaluation &
NCQA Scoring Generation Financial Impact Sustainability
Public Health Surveys Public Health VDH Health VDH Health Population Indicators Community
& Data Collection Registries & Surveillance Analytic Surveillance Analyst & Prevention
Databases Database Risk Factors Planning

21. Intermittent Academic Analyses
•Outcomes & Effectiveness Reporting
& Studies
•Guide Health Reform Policies & Programs
Advanced analysis
New analytic models
Routine Analytic data sets Supportive reporting
HIPAA Compliant
DocSite
Environment
Clinical Data Analytic models
Central
Multipayor Repository
High Performance
Claims Data Computing Center
De-
 Storage
Identified
Public Health Normalization
Data Processing
Data De-identification
Re-identification Query for experiments
Analytics (Routine)
Other Data Analytics (Exploratory)
Sources Workbench
Reporting
Data Sources UVM CCTS Health Informatics Platform

22. HIE Current State
• Infrastructure
• Connectivity
– Nine hospitals
– 54 practices
– 1 commercial lab
• Blueprint -- 34 practices
• Meaningful Use

23. Learnings and Issues
• Vendor Challenges
– Capabilities
– Business model
– Focus
• “Interoperability”
– State of the standards
• Sustainability
– Beyond the public utility model
– Preparing for reimbursement reform

24. Questions?
David Cochran, MD
Vermont Information Technology Leaders, Inc. (VITL)
dcochran@vitl.net
802.839.1935