MIDDLEBURY — For 28 years now, Betty Diette has been battling a formidable foe: multiple sclerosis, a neurological disorder that has confined her to a wheelchair — but has not diminished her intellect or her dignity.
Now a resident of Helen Porter Healthcare & Rehabilitation Center, Diette often finds herself shuttling to medical appointments throughout Addison and Chittenden counties. Being in a wheelchair, she can find it hard to access some buildings.
Sadly, her access problems aren’t only associated with venues that are not ADA-compliant.
Diette and patients throughout the state and region have been searching for a universal access ramp for their electronic medical records, which currently can’t be easily shared among doctors, therapists, hospitals and specialists within the University of Vermont Health Network that includes Porter Medical Center.
In some cases, that means a patient has to physically take his or her medical record to a specialist’s office that has different electronic software than the patient’s primary care provider. And for patients like Diette, it’s not just an inconvenience. The more disparate the medical records systems, the more chances for miscommunication that can lead to poor medical outcomes.
“People like me who have complex medical conditions need coordinated care,” Diette explained. “We need all of our providers to be able to share critically important medical information in real time in order to ensure that we receive the right care in the most efficient and safe way possible.
“Currently, I have three distinct medical records and two patient portals that frankly do not communicate with each other.”
Diette shared her comments on Nov. 6 with the Green Mountain Care Board (GMCB). The health care regulator is considering a $151 million solution to the communication conundrum affecting Porter and three other members of the UVM Health Network: The University of Vermont Medical Center, Central Vermont Medical Center and Champlain Valley Physicians Hospital.
The proposed solution is to equip the four medical centers with an Epic electronic medical record system that would allow patients’ histories — including medication lists, past procedures and hospital stays — to be seamlessly transferred and viewed by health care professionals within the network.
Porter currently uses a Meditech health records system for its patients. Meditech can’t effectively communicate with Epic software and many other electronic records systems in a health care industry that is quickly evolving, noted Porter CEO and President Dr. Fred Kniffin.
“A complex patient in Addison County currently has multiple electronic health records; an office record, an emergency room record, a hospital record, a Helen Porter record, a Home Health record and a UVM Medical Center record,” Kniffin noted. “These records don’t talk to each other.”
Porter officials have been seeking a remedy to this for several years, but a switch to Epic-brand software and services would have been cost-prohibitive for the organization to pursue on its own. That upgrade became a lot more realistic this past spring, however, when Porter affiliated itself with UVM Health Network. The network also includes University of Vermont Medical Center (formerly Fletcher Allen Health Care); Alice Hyde Medical Center; Central Vermont Medical Center; Champlain Valley Physicians Hospital; and Elizabethtown Community Hospital. Together, the member-organizations employ 1,219 physicians and recorded a combined total of 1.8 million patient visits during fiscal year 2016.
An electronic medical records system was a key factor in Porter’s affiliation decision, Kniffin explained.
“Epic is a huge deal,” Kniffin said. “We listed it as one of the four reasons for affiliation, along with integration, facilities and efficiencies. I don’t think it’s one-fourth of the reason; I think it’s at least half. It’s a big chunk of why we would want to affiliate. It makes a ton of sense.”
UVM Health Network needs a Certificate Of Need from the GMCB before it can proceed with Epic. Kniffin and Diette were part of the UVM Health Network contingent that made a three-hour pitch to the board on how Epic would improve communications and promote efficiencies.
“I felt the presentation went as absolutely well as it could,” Kniffin said.
He praised UVM Health Network officials for a thorough “planning and vetting” of the Epic proposal.
NOT WITHOUT RISK
It will now be up to the GMCB to determine whether UVM Health Network made its case for such a substantial investment in tech infrastructure. Porter officials said they anticipate a decision within the next few weeks.
Kniffin said that among other things, GMCB members will need to feel confident that UVM Health Network can pull off the project.
“Electronic medical records projects are notorious for blowing up and putting health care organizations into trouble,” Kniffin said. “Nobody wants that. Nobody wants the state’s largest medical center on the ropes of a bungled EMR implementation. So I think the GMCB is looking hard at, ‘Can these guys do this operationally and financially?’ And I believe we have put a good foot forward.”
The University of Texas MD Anderson Cancer Center, Brigham & Women’s Hospital in Massachusetts and Pittsburgh-based Allegheny Health Network are three examples of U.S. health care institutions that each reported multi-million-dollar budget shortfalls in 2016 associated with cost-overruns related to their electronic medical records systems projects, according to Becker’s Hospital Review, which provides business and legal information for the health care industry.
But UVM Health Network Chief Information Officer Dr. Adam Buckley and other members of the team are confident they’ve put together a sound proposal with a realistic financing plan.
UVM Health Network is proposing to pay the Epic project costs over six years, with payback tied to patient counts among the four participating medical centers. Porter’s overall share — also referred to as the Epic “subscription licensing fee”— has been placed at $4,734,147. But when one factors in the savings of taking disparate, antiquated electronic records systems off-line (and related staffing offsets), Porter’s ultimate cost would be $1,985,148, Buckley noted in a Tuesday phone interview.
Porter will need to absorb Epic costs within the annual budget-growth targets prescribed by the GMCB. The four medical centers won’t be able to simply tack a surcharge onto patient stays or procedures to help pay off the Epic debt.
“They have built this project within the guardrails of ‘We can’t grow revenues faster than 3.5 percent per year,’ which is really a pretty limited growth rate in the world of health care,” Kniffin said of recent GMCB budget guidelines.
It should also be noted that UVM Health Network officials believe it would be financially imprudent not to invest in Epic.
They argued to the GMCB it could cost a combined total of $200 million for the four affected hospitals to independently upgrade their respective electronic medical systems, with no guarantee those systems would be able to communicate with one another.
“It sort of puts that $151 million (for Epic) in a different light,” Kniffin said.
And the payoff would be clear, according to Kniffin, who has seen the communication problems as both a hospital administrator and as an Emergency Department physician.
“If you visit a Porter-employed physician, your electronic medical document is on LSS,” Kniffin explained. “You visit the emergency room, you regenerate a record on Meditech. You get admitted to the hospital, it gets on Meditech. You go to Helen Porter, it’s on ESS. There’s zero communication — not your name, date of birth or medications list. No communication with Addison County Home Health & Hospice. You go to Burlington — in-patient or out-patient — for consultation, care or an admission, there is zero communication. And any time you go to one of these places for your medications, medical problems, medical history — it all somehow has to be transcribed or re-entered. It’s a mess for providers, but really it’s a mess for patients.”
Diette is a former, longtime nurse, so she has seen the medical records mess on multiple fronts. She is cheering for a transition to Epic, which would allow her to stop worrying about whether her records will arrive at the next health care venue she visits.
“It’s an added burden,” she said of her current system. “But it’s something I have to do.”
Reporter John Flowers is at [email protected].