Vermont HIE Tightens Integration With Public Health, Medicaid
In 2019 Beth Anderson was named president and CEO of VITL, the nonprofit organization that runs the Vermont Health Information Exchange. She recently spoke with Healthcare Innovation about how working more closely with public health and the state Medicaid agency has increased the number of use cases the HIE supports and further demonstrated its value to the state.
Prior to joining VITL, Anderson served as the chief administrative officer for the City of Burlington. She also served as the city’s first chief innovation officer, the director of operations at the Committee on Temporary Shelter (COTS), and as the director of operations and IT at Vermont Oxford Network. Before coming to Vermont, she held positions in financial services, including vice president of e-commerce at Goldman Sachs Asset Management and job manager at Oliver Wyman.
Healthcare Innovation: What would you say is the biggest change you've seen in the organization's operations or impact since you joined VITL in 2019?
Anderson: The pandemic really shifted the work that we do, how we deliver our work, how we work as an organization, but also it led to a brand new partnership with public health. We had traditionally provided a bit of data for the Vermont Department of Health, but we didn't have a strong partnership by any means. We very quickly started working with them to get them the data they needed to do case investigations and do contact tracing and to inform their tracking of immunization data and get testing data. It was great to be able to deliver that and help inform the state's response. It really built a new partnership with public health, and allowed them to understand the data that we have and how we can focus on getting the data that they need. They realized that they can focus on the public health expertise that they have and that they didn't necessarily need to be the ones obtaining the data.
Since then, we have done a number of projects with them, separate from COVID, and last year, we worked together with a consultant to develop a long-term strategic plan for how to better integrate our work.
HCI: Do you think that before the pandemic, people identified the lack of a closer relationship with public health as a gap or limitation?
Anderson: I think some people did, yes. But the funding mechanisms to support public health were different from the funding mechanisms to support an HIE, right? So there was not the same level of encouragement to work together, and I think we were put in a situation where we had to figure it out, regardless of the funding sources, and that helped us all think differently. At a federal level, there was some learning around that. You can see it in the way some of the funding sources now encourage reusing infrastructure capabilities, or actually specify using your HIE if you have one.
HCI: In 2022, I wrote about a panel session you participated in at the Civitas Networks for Health annual meeting about this shift in thinking toward being a health data utility. Does the work you just described with public health and the state Medicaid agency as well fit with that idea, and perhaps help make the case for sustainability of the HIE?
Anderson: Yes, I think that's a really important piece. We’re a small state. I think we do a lot of innovative stuff for a state our size and with the resources and the people that we have. I think that we do operate as a health data utility. We talk about our data as serving as a utility, similar to electric and gas. It really can drive a lot of different needs or use cases. We work with public health. We are working with our Medicaid agency to provide them data. We work with payers to get them information. In addition to the providers, we work with Blueprint for Health, a quality improvement program at the state level. The more cases where we are providing data for different types of organizations or types of providers, the better it is for us.
Connecting to the HIE for a provider organization can really reduce the burden on them. They don’t have to deliver their data to the Blueprint for Health program, to Medicaid, to Blue Cross/Blue Shield. We can do that on their behalf. I think there's value across our provider community, which doesn't necessarily play into our our sustainability, but it does show the value. The more we're working with these different programs, it may bring in different funding sources, different grant programs, but also just cements the value.
HCI: In 2022 VITL, Maine’s HealthInfoNet and the Rhode Island Quality Institute announced a collaboration aimed at advancing interstate interoperability to improve population health. Are there some tangible results that have come out of that announcement since then?
Anderson: We do a lot of work together. We have not done data sharing yet. We continue to talk about that. We all have patients who go to Boston for specialty care, and we'd love to figure out ways that we can get that data. Instead of us doing that independently, we're exploring opportunities to do that together, to save the burden for everyone. We all know patient care does not stop at borders, so can we start sharing information and making it all available?
We also are learning from one another, and collaborating on different pieces of work. For example, in 2020 we switched to an opt-out consent policy for sharing of data. Rhode Island's going through a similar process now and we’ve helped them understand how we did the education to the public and how we technically implemented that on our side. The collaboration agreement just put a little more regularity into our communications and conversations and time presenting to each other about what our platforms are and what we do and are learning.
HCI: Will the Vermont HIE connect to TEFCA through eHealth Exchange or another QHIN, and will there be some benefits that Vermont providers and patients will see from that in the next few years?
Anderson: That is a great question that we're exploring, quite honestly. Right now, we do some direct connections through eHealth Exchange to some Vermont providers, and for the VA and the DoD. But two years ago our state put in some shield laws around reproductive health data and gender-affirming care data that are hard to protect on a national level right now, so we have slowly explored what participating in data sharing on a national level might look like while making sure we can protect the types of care that we as a state think are important to provide to citizens. So it's definitely on our radar, and we are paying attention to it, but we're not jumping in quite yet.
HCI: Does that speak to the need for more tools that offer granular control of consent?
Anderson: I think there are different ways that can happen. Part of it is just the education of patients and individuals so they understand how their data can be shared, and giving them options on what that looks like. It's easy to say granular consent, and that makes sense, and it sounds logical, but it's hard sometimes to identify what pieces of the patient record are truly reproductive care as opposed to other types of care. In many cases, medications are not medications specific to one situation, right? So we are absolutely exploring what that might look like as a state, but it's something we want to tread carefully on, because we also don't want to mislead anyone on what protection means or what their decision means.
If you think about the 42 CFR Part 2 — the substance use disorder data — we’ve had those rules in place for years, and systems still don't handle that well. We're just making it more complex with different types of sensitive data.
HCI: VITL’s 2024 annual report said that the Vermont HIE must adapt and grow to incorporate data about mental health and substance use treatment and the social drivers of health. Is there a roadmap for making that happen? Are there some challenges to overcome on the social drivers of health data, for instance?
Anderson: It's actually a project we have going on right now. For most providers in the state, we are collecting the health-related social needs survey data under the CMS Accountable Health Communities program. We are working to define specs for getting that data into the HIE. We are making sure that regardless of how providers are capturing it in their systems, we are standardizing it to the FHIR structure appropriately, following some Gravity Project standards, so we can then make that data available for organizations. Our first step as a state is getting that data in and making it available for providers to see about their patients, and hopefully that helps them identify needs. Also, if someone has frequent doctors appointments, perhaps this will prevent them from having to answer the same questionnaire every few days. A steering committee in the state is asking: if we have this data, what else do we want to do with it? What else is possible? So we're working on that roadmap now.
HCI: The annual report also said that in 2024 VITL advanced the vision of delivering more types of data directly into the clinician workflow in the EHR. Could you talk about how important that is? If clinicians have to go to a portal to look things up, is that less valuable to them than if it's in their workflow?
Anderson: Yes, we hear it on a regular basis. Providers don't want to have to remember a password to log in. They don't want to have to leave their system. They want a complete record in front of them. What we're trying to do is get more data to the point of care, but we're trying to do it in a way that's actually delivering the data that they want and need, and not just shoving data at them. A good example is our immunization work. Public health has an immunization registry available that providers can log into to get data on their patients. But to access the system, they have to have a password, and log into the system. They have a patient in front of them, and they want to know what immunizations they have, and which ones they need. We worked with public health to enable query of the immunization registry through VITL, so while the providers are in their EHR, they can click a button and it will pull back both the history of immunizations for that patient, but also what the forecast is, what they have coming due.
That enables having data not only for the patient in front of you, but a lot of organizations are doing it to gather data at the beginning of the day or the beginning of the week for patients who are coming in, to be prepared for what their needs are. We had one organization estimate that their nurses are saving one and a half hours a day by having that ability to do it in their system, instead of having to go to the other system and log in on a patient-by-patient basis, because we also allow them to do it on a whole list of patients.
We also do delivery of results into provider systems for about 600 providers across the state. We will get lab or radiology reports or transcribed reports from the hospitals and labs, and we can deliver that into the system of the patient's primary care provider or the prescribing doctor or clinician, right into their EHR and it shows up in their patient record, so they're not having to wait for a fax or have someone make a phone call to get those results in.
That's something we've tried to expand the use of, because it's really impactful. It's great for the providers at the point of care to have that data. We're also saving the burden on the hospital labs from having to fax or maintain those interfaces. We can get it out to multiple community providers instead of them having to maintain all of those connections.
HCI: Could you talk about little bit about your work with the state Medicaid agency?
Anderson: We have a long relationship with segments of the Medicaid agency. They have a chronic care initiative that does care management for individuals with multiple conditions, and they've been using our data to help inform their work on a regular basis.
We also have a quality improvement program across the state called Blueprint for Health, which falls under the Medicaid agency, and they've been using our data for years to inform some of their quality measures and metrics as they evaluate some of their community-focused programs.
Two years ago the Medicaid agency moved forward with building a new system to support their operations. That's the Medicaid data lake and analytics solution, and that's where they're pulling in a lot of their Medicaid data from across the Agency for Human Services to inform their work. We worked with them to get clinical data for the Medicaid patients into that system, which they are still in the process of building out now. That is going to be used for their internal operations and analytics, and also to do some of the required federal reporting.
HCI: Any other projects going forward in 2025 that you want to mention?
Anderson: We're integrating some of the public health data sets into the HIE. We have a couple of projects going on where we're hoping to make access to the data more streamlined, so you can do single sign-on to get into systems and not have to remember another password. We have a FHIR-native platform, so we're looking at ways to make some of the HIE data available to query. So providers’ systems might be able to query for allergies on specific patients. They may not want a full record; they just want to know their allergies. And that's something we're really excited to start to deliver and hopefully meet some more specific needs.
