Duplication causes headaches for state patient exchange

Posted on: Friday, October 19, 2018 By: KorchekStaff

Duplication causes headaches for state patient exchange

Mike SmithMike Smith, the president and CEO of Vermont Information Technology Leaders, or VITL. Photo by Mike Dougherty/VTDigger

Since last year, the most-publicized problem plaguing the state’s health information exchange has been a lack of patients.

But as it turns out, there also are far too many patient records.

That seeming paradox is the latest issue being tackled by Vermont Information Technology Leaders, the Burlington-based nonprofit that runs the exchange and is under state orders to fix it.

Even as they try to get Vermonters into the database, VITL administrators also are working to reduce the hundreds of thousands of “duplicate” records – sometimes logged under various versions of a person’s name – that can lead to confusion when medical providers try to access a patient’s information.

“It’s a huge task,” said Mike Smith, VITL’s president and chief executive officer. “We’re going to bring (the number of duplicate records) down 40 percent.”

The health information exchange – not to be confused with the exchange where Vermonters buy health insurance – is a secure database of patient records including lab results, discharge summaries and medication histories.

It’s supposed to allow a single, consolidated record to follow a patient wherever he or she seeks treatment, thus increasing efficiency and safety.

But VITL has struggled with administrative and financial problems. Those issues were summed up last year in a consultant’s report that said many users had “lost confidence” in the exchange, and Vermont is “at the crossroads” in terms of making the system work.

What followed was a new state statute laying out clear improvement goals, as well as a commitment from VITL and the Department of Vermont Health Access to make improvements.

There’s also a contingency plan in place in case those improvements don’t work. But in presentations to the Green Mountain Care Board on Wednesday, officials said they’re making headway.

VITLRobert Turnau, right, the chief financial officer for VITL, and then president and CEO John Evans in 2016. File photo by Erin Mansfield/VTDigger

Emily Richards, health information exchange program director for the department, said both the state and VITL are “on track” in meeting goals set by the Legislature. A new assessment from the consultant that performed last year’s VITL evaluation came to a similar conclusion, reporting that “progress is at a satisfactory level” so far.

VITL executives made their own presentation to the care board, showing significant expense cuts due, in part, to staff reductions and technology projects that have been deferred while the nonprofit re-evaluates its operations.

“VITL is in a much stronger financial position than it has been in prior years,” said Robert Turnau, the organization’s chief financial officer.

VITL also is continuing to boost the number of patient records in the health information exchange. That was a key problem cited in last year’s report, as fewer than 20 percent of Vermonters had records in the system at the time.

That number is now up to nearly 38 percent, beating the 35 percent goal that had been set for year’s end. “We have already surpassed that number, and we’re not stopping,” said Kristina Choquette, VITL’s chief operating officer. “We are trying to maintain that momentum.”

A big driver behind that improvement is VITL’s work with two hospitals – University of Vermont Medical Center and Northeastern Vermont Regional Hospital – to streamline the process by which VITL gets word that patients have consented to have their records included in the exchange.

Smith said that’s had “a huge impact,” and administrators want to take the same steps with more hospitals. The Green Mountain Care Board tried to push that process along by including, in each hospital’s budget order for fiscal year 2019, a mandate to consult with VITL “to facilitate patients’ ability to electronically consent to adding their clinical data to the Vermont health information exchange.”

electronic medical recordsAn ER nurse discusses a patient’s diagnosis and symptoms with a doctor in Atlanta via the hospitals Electronic Medical Records System. USDA photo by Bob Nichols.


Duplicate patient records represent VITL’s newest frontier.

VITL administrators discovered last year that there were about 1.7 million unique patient records in the exchange, while Vermont has only 623,657 people according to the latest federal estimate. While Choquette said there will always be more patient records than residents – partly due to out-of-staters being treated here – the difference shouldn’t have been anywhere near that great.

VITL estimates that 35 percent of its records are duplicates. The problem is that, if a patient’s identifying information varies slightly – say, a record is submitted to the exchange without a middle initial – that can lead to multiple records on the exchange that actually belong to one patient.

That defeats the primary purpose of the exchange. And for health care providers, it can lead to confusion because “you may not get all the records,” Smith said. “You may have ‘Michael K. Smith,’ for example. You’ll get that record, but you may not get ‘Mike Smith.’”

Choquette said one solution is adjusting the exchange’s algorithms in order to accommodate for such variances. Another solution is to work with medical providers to emphasize “the need to send us really clean data,” she said.

VITL is working to merge duplicated records already in the system. But officials said that is difficult work that must be conducted under “really stringent” guidelines to prevent mistakes.

“We’re hoping to go from 35 percent of the records being duplicates down to 21 percent by the end of December,” Choquette said. The number is now 28.1 percent, and “we are well on the way to meeting our October target,” she added.

Smith, who took over as VITL’s top administrator in February, said that’s another sign of positive change for the health information exchange.

“We have accomplished much – actually, in my estimation, an incredible amount of progress over the last eight months,” Smith said. “But there’s definitely more to do.”