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VHIE Operational Summary

The Vermont Health Information Exchange (VHIE)— with its depth and breadth of connections around the state—is a clinical data network built to deliver valuable services to providers and provider networks across the state.

Today, the VHIE securely receives clinical data from all 14 Vermont hospitals, Dartmouth-Hitchcock Medical Center, all of Vermont’s 11 Federally Qualified Health Centers, 120 other primary and specialty care locations, five member agencies of the VNAs of Vermont, and three commercial laboratories. The clinical data are then made available to health care providers and organizations in meaningful ways to improve health care outcomes for Vermonters.

Examples include:

  • 97 health care locations receive timely and accurate laboratory results directly into their electronic health record (EHR) systems from the hospitals and commercial labs that generate them, ensuring primary care providers have the latest patient information.
  • The Vermont Department of Health receives electronic immunization reports from 121 health care locations around the state,improving the efficiency and accuracy of the Vermont Immunization Registry.
  • Two Vermont accountable care organizations (networks of providers who have joined together to reduce the per-patient cost of health care) rely on VITL to collect clinical data to meet their commitment to improve patient outcomes.
  • In support of the Vermont Blueprint for Health,the VHIE collects information for the Blueprint clinical registry, which in turn is used to manage chronic diseases in Vermont.

VHIE Interface Count by Organization

VHIE New Data Contributors 

Early in 2015 a project with Southwestern Vermont Medical Center (SVMC) completed VITL's goal of connecting all of Vermont’s hospitals to the VHIE. An innovative teamwork model was used during this project that brought together SVMC, their EHR vendor, VITL and VITL's HIE vendor to successfully expedite completion. VITL now receives immunization reports, laboratory results, encounter reports, radiology reports, and other transcribed reports from SVMC.

Other hospital projects included the completion of additional interfaces with Brattleboro Memorial Hospital (pathology results), and Northwestern Medical Center (radiology, transcribed and pathology results). The Vermont Department of Health and VITL continued to work together to connect facilities that provide vaccines to the Vermont Immunization Registry. Seventy-one new immunization interfaces came online in 2015, bringing to 121 the total number of sites that can report immunizations directly from their electronic health record systems.

Continuity of Care Documents 

A Continuity of Care Document (CCD) contains a summary of valuable medical information about a patient who may need to transition from one care setting to another, such as from a hospital to long-term care facility. A CCD does not contain a patient's entire medical record, but does include important clinical information that providers need for making informed care decisions. This information is also used by the Blueprint for Health and accountable care organizations to determine if they are meeting their goals for better care. During 2015 VITL doubled the number of health care organizations contributing CCDs to the VHIE, including home health agencies, hospitals and primary care practices.

VHIE Cumulative Interface Count by Calendar Year

Data Receivers 

The VHIE delivers certain types of information (lab results, radiology reports and transcribed reports) directly to providers’ electronic health record systems. During 2015 VITL added lab results delivery connections to one nursing home (Derby Green), three locations of Northeast Kingdom Human Services, 15 locations of Northern Counties Health Center (FQHC), Mountain Health Center (FQHC), and six independent primary care providers. Transcribed report and radiology report connections were added for 15 locations of Northern Counties Health Center (an FQHC) and five independent primary care providers.

Data Management & Reporting 

VITL has completed the development of a clinical data warehouse that captures information messages coming in to the VHIE in a manner suitable for analytics. The warehouse takes advantage of the connections and interfaces already established with data sources (hospitals, primary care, etc.) and collects incoming messages into a dataset that can be utilized for a variety of clinical analysis purposes. A unique capability of the clinical data warehouse is the ability to parse a CCD into unique data elements. This parsing capability can now extract important elements, such as blood pressure or cholesterol levels, into a regular structure to dramatically improve analytics. VITL is using the clinical data warehouse to create the datasets necessary for ACO analytics, replacing a data message passing infrastructure that operated through 2014 and much of 2015.

These datasets—or data marts as they are often called—provide more complete information to OneCare Vermont for their Medicaid, Medicare and commercially insured beneficiaries. VITL is employing the same data warehousing technique to create a data mart for Community Health Accountable Care (CHAC) Medicaid beneficiaries.

VHIE diagram-senders and receivers

Security Enhancements 

VITL is always working to maintain the highest level of security for data in the VHIE and to protect it against cyberattacks. VITL currently meets all of the security requirements of the Health Insurance Portability and Accountability Act (HIPAA) and is working to reach a higher standard defined by the National Institute of Standards and Technology (NIST). NIST 800-53 Revision 4 defines a set of security and privacy controls for information systems and organizations which need to protect their assets from an ever increasing and diverse set of cyberattacks. In 2015, VITL engaged an independent security consulting firm to assess VITL's position against the NIST security framework. The comprehensive review confirmed that VITL is fully HIPAA compliant and is moving toward the more rigorous NIST security compliance.

VITL's security polices are available at: https://www.vitl.net/about/vitl-policies

eHealth Exchange Compliance

The VHIE became eHealth Exchange Compliant on October 1, 2015, giving VITL the technical capability to connect with other health networks that are part of the Sequoia Project. Now Vermont providers will be able to query other networks for patient information. This makes it possible for VITL to access health records from the U.S. Department of Defense Military Health System and the Veterans Affairs health care system. VITL will also be able to connect with other state and regional HIE’s to access patient records in the future. For example, VITL may be able to query patient records in Florida for Vermonters who are seasonal residents of that state.

eHealth Exchange