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Explore our coverage of government and politics.

Battle Over Funding Threatens Electronic Medical Records Project

A decade ago, Vermont embarked on an ambitious project to digitize medical records, and give health care providers easy access to patients’ medical history. But some lawmakers are growing weary of using taxpayer money to fund the private initiative. And a battle over funding now threatens to derail the entire undertaking.

In 2005, policymakers celebrated the creation of Vermont Information Technology Leaders. Commonly known as VITL, this new nonprofit was going to lead a technological revolution in medicine, and give doctors and hospitals unprecedented access to the medical histories of patients walking into their offices.

Ten years later, many lawmakers are unimpressed with VITL’s performance. And some, like Warren Rep. Adam Greshin, say it’s time to reconsider the more than $3 million in taxpayer money lawmakers invest annually in the enterprise.

“My thought is that maybe that money is better spent in other health care initiatives,” Greshin says.

The battle over VITL’s funding is now playing out in the same health care bill that uses a half-a-cent per-ounce tax on sugary beverages to support about $20 million in reform initiatives. The lion’s share of VITL’s budget comes from a tax on health care claims, and that tax is set to sunset at the end of fiscal year 2017.

The Shumlin administration wants lawmakers to eliminate that sunset, and ensure longer-term fiscal stability for VITL. The repeal of that sunset had been written into the health reform bill.

But the House Committee on Ways and Means has rejected that plan, and reinstated the sunset.

John Evans, CEO of VITL, says that if he can’t count on claims tax money being there after fiscal year 2017, then he can’t make investments in products and services under development now.

“If we cannot rely on funding to deploy the technology, then developing it and designing it are almost fruitless endeavors and wouldn’t make any sense,” Evans says.

Evans delivered the dire warning to members of the Ways and Means Committee last week. He says VITL is currently in the midst of software projects that will take years to develop.

“You can’t just put that on hold and then come back to it. It’s incredibly disruptive, and we will not be able to accomplish I think the goals this leadership wants us to accomplish for health reform,” Evans says.

Evans says the technology firms VITL relies on to execute its mission won’t enter into contracts with an organization that can’t guarantee the money will be there to pay them. And he says it would create a human resources nightmare.

“If my employees are under the impression that VITL may not have funding in the next year or so, I will lose them,” Evans says. “And they have plenty of other options, as you can appreciate.”

Chief of Health Care Reform Lawrence Miller says he appreciates lawmakers’ concern with the slow pace of progress at VITL. About 700 doctors or other “users” are using the VITL portal to patient data; only about 15,000 patients have given consent for their medical records to be on the system.

But Miller says VITL is on the verge of realizing its potential.

“It would be a shame to step away from something on the brink of success,” Miller says.

Burlington Rep. Chris Pearson, a Progressive, is a former member of VITL’s governing board.

“It’s easy to kind of beat on VITL because it’s a lot of money, we don’t really understand the ins and outs of it,” Pearson says.

Pearson, however, says VITL has helped outfit nearly every provider in the state with electronic filing systems. And he says it’s only a matter of time now before those disparate systems can communicate with each other, and more patient data comes online.

“The years and years of investment is about to really come to life, in a way that most of the states are far behind where we’re at,” Pearson says.

Greshin says he doesn’t challenge the value of the product VITL aims to deliver. But he says Vermont is investing millions in a private organization over which it has little oversight. He says the push for electronic medical records is a worthwhile one.

“But it’s not clear to me we’re doing any better than any other states that don’t have specific dedicated funds toward electronic medical records,” Greshin says.

The Shumlin administration agrees with Greshin about what it views as a problematic lack of government oversight; the governor has asked lawmakers to put VITL’s operations under the regulatory authority of the Green Mountain Care Board.

But Miller and Pearson say continued state funding is needed to ensure VITL’s focus on projects that will deliver maximum benefit to the public good.

VITL has been criticized in recent years for exploring ways to generate revenue outside the state of Vermont.

“And you can’t critique that, and at the same time put their state funding up in the air,” Pearson says. “It’s incongruous.”

House lawmakers have so far rejected Evans’ pleas to address the funding sunset. And House leaders say they think the conversation can wait until next year.

The Vermont Statehouse is often called the people’s house. I am your eyes and ears there. I keep a close eye on how legislation could affect your life; I also regularly speak to the people who write that legislation.
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