Through a combination of financing, government support and the coordination of a nonprofit technology consultancy, Vermont is building an electronic medical records system that will have a profound impact on the quality of health care.

One of the driving forces behind this in Vermont is a nonprofit incorporated in 2005: Vermont Information Technology Leaders. Its immediate goal is to help medical practices and hospitals move from paper records to electronic record keeping, and then facilitate the sharing of those records between health providers.

“This is a transformational opportunity nationally, it's also a transformational opportunity in Vermont,” said VITL's President and CEO David Cochran. “The challenge is that some of the transformation is driven by federal timelines and funding cycles that are a challenge for the practices. Our challenge is to help them through it.”

As part of the 2009 American Recovery and Reinvestment Act (or, as it is commonly called, the “stimulus bill”), Congress included billions in funds to speed the adoption of electronic, rather than paper, record-keeping in the health-care system. Much of this funding is through incentives that are only paid out after practices and hospitals reach stages of “meaningful use,” a complex set of standards on Electronic Health Records.

And, there are penalties in Medicare and Medicaid payment reductions if those standards are not met by a certain time.

Rutland Regional Medical Center went live on March 1 with a EHR system, which cost about $15 million — $10 million of which came from a capital fund, and $5 million or $6 million of which will come down the road in incentives after the standards are met.

The benefits of an EHR system are many, according to doctors, technology experts and hospital administrators.

Lab results, imaging results and doctors write-ups are all available to other providers as soon as they are entered into the system. So, if your primary care doctor refers you to a cardiologist, not only can the cardiologist look at any lab results instantly, he or she can review the notes your physician and nurse made about your visit that led to the referral.

Which brings up another benefit: No handwriting. While illegible handwriting may be the punchline to countless jokes about doctors, it can actually contribute to errors in prescriptions and treatment. With electronic records every note and prescription is spelled out with typographic precision.

“We no longer will be dealing with handwriting issues,” said Rutland Regional Medical Center CEO Tom Huebner. “It's actually documented as one of the leading causes of error in the health-care industry.”

While the EMR effort is exerting a major impact on health-care providers, it is also a window into the changes sweeping across almost every industry in the country and Vermont. The move to using technology to create efficiency, reduce errors and improve service is accelerating. This, coupled with government incentives and timelines, has created fierce competition for both resources and expertise in installing and supporting the technology.

“The good news is that (the stimulus program) provides funding for us, and incentives to do it,” said Cochran. “The bad news is that all 50 states are trying to do this and the same set of vendors are getting pulled in all different ways”

While the payoff can be tangible in the incentives and higher reimbursement, there are also less direct benefits to the health-care system.

“It forces providers to document their care in the same or similar fashion,” said Central Vermont Medical Center CEO Judy Tarr. “In that way it is much easier to pull or track information you need to study.”

For instance, although some form of electronic record has been in use for more than 15 years in various parts of CVMC, there was no way to track the health of diabetics in the entire hospital patient community. Now the medical center, which includes 17 provider practices, can assess the statistics and begin to use them to make better choices on treatment.

That will hopefully translate into a healthier population, which will use the hospital services less, Tarr said. CVMC is considering joining the system that is used by Fletcher Allen Health Care in Burlington and the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., she said, which would increase that effect.

However, challenges remain, namely integrating the 200 to 300 medical practices with patients in Vermont into a system that will allow sharing of records from a practice in Brattleboro with a doctor in Burlington in a matter of seconds. VITL is at the lead of this effort, with the framework of a Health Information Exchange (not an Insurance Exchange, which is part of the federal Affordable Care Act of 2010) in place to facilitate what amounts to translation of records for access on disparate software and systems.

Before that can happen, the state has to work out policies and rules for the sharing and release of health information in that system. For instance, can a doctor who is treating an Emergency Room patient pull that patient's record before getting a signed release? It must also meet the standards of the Health Information Privacy and Portability Act, which strictly limit the use and disclosure of patient information.

That can be important even at the level of emails between providers.

“The big, big thing is the HIPPA issue, that's the umbrella that's over everything in medical care,” said Zoltan Sachs, practice manager for IT Operations & Support at Competitive Computing in Colchester. “You can get programs that scan outbound emails and look for what looks like patient information and block it. There are others that will encrypt it before sending.”

Competitive Computing helps private practices move to EHR systems with specialized knowledge of the needs for the medical business.

“You don't want to underestimate the complexity of this installation,” Sachs said. “Successful practices spend a significant amount of time planning. When they partner with a company like C2 we really smooth out the process.”

Everything from decisions on whether to use laptop, desktop or tablet computers, to the level of security and connectivity can impact the installation, but Sachs said it really comes down to change management. Installing the technology is just the first step, he said. His company provides ongoing support, 24-hour monitoring for security and keeping the practice up to the latest upgrades and software versions.

“We help them with their decision, so we untangle the technology for them and apply it to their business need. We help them with the business decisions going forward,” he said. “It's really a multiyear investment.”

VITL's Cochran sees the continuing need in the next several years for more of that expertise.

“The main question we get is, ‘can you do more faster?'” he said. “Because it's clearly seen as a foundational piece. One of the challenges that we all face is that this is important work that we want to get behind us, so we can get to the more important work of making care better.”

rob.mitchell@rutlandherald.com