In 2006, Vermont legislated statewide healthcare reform. As part of that effort, the state has been piloting electronic health records (EHR) and the health information exchanges to share EHR data among providers. Now, there’s a big chunk of money from the Recovery Act (and the subsequent health care bill) going to such efforts and it felt worthwhile to see what other states might learn from Vermont’s experiences to date.

Right now, Vermont is expanding from a pilot phase in three communities serving about 60,000 people (about 10% of the state’s population). Hunt Blair, the state’s Assistant Director of Health Care Reform is confident that the state will be able to scale up successfully. “We've been able to succeed . . .” he explains, “because we've been able to get everyone in rooms together. In Vermont it isn't 6 degrees of separation; it is zero degrees of separation. Everything is designed to scale." That said, Blair believes that Vermont’s success isn’t just a benefit of being a small state, but owes more to the approach the state has taken to integrating health IT into broader healthcare reform.

“Health information technology in Vermont has been embedded in reform from the beginning,” says Blair. “It is not a separate thing, but about improving the system of care and improving outcomes—not just having computers talk to each other for the sake of that. We have been focused on using EHR and health information exchanges to advance health goals.”

“EHRs are just a means to the larger end of having a more systemic, less fragmented system of care,” he goes on, comparing the state’s blossoming health information exchange to the Internet. “Everything is just a click away. We want everything that physicians need to be just a click away.”

And what of the patients? They “should be able to have much better communication with their healthcare providers. The idea that you provide the same info over and over and over again on pieces of paper on a clipboard drives people crazy. Health care is the last bastion of paper!”

And though some people across the country are worried about the privacy and security implications of the transition from paper to electronic records, Blair isn’t as concerned about that risk. “There are ways to demonstrate it is more secure in a computer than on a piece of paper." And on the other side of the discussion, Blair points out that paper records in hospitals are vulnerable, and can be lost or stolen, whereas computer records usually have a trail. What’s more, the medical risks of not switching to electronic health records—“millions of people are getting potential problematic prescriptions in conflict with each other"—may be at least as great as the risks posed by data privacy and security.

Blair worries about the timetable for the national rollout of such systems. “I think the deadlines that Congress enacted in the stimulus bill were unrealistic,” he says. He understands why doctors may be taking a wait-and-see attitude, wanting to know which EHRs will be certified before purchasing one. But that delay may affect the ability to meet subsequent rollout goals.