HIT infrastructure. Vermont has expanded its existing investments in HIT through Blueprint. The two core pieces of infrastructure are the VHIE and the central clinical registry; the latter was developed for the Blueprint framework. VHIE stores demographic and clinical data from practices' and hospitals' EHRs. The VHIE, in turn, interfaces with the central clinical registry.
To support Blueprint's PCMH practice reforms, the state contracted with Covisint DocSite to establish and support the central clinical registry. The registry enables practices to conduct panel management, generate reports, and track their efforts with individual patients in a user-friendly and web-based environment. The registry also offers work flow and planning tools, and it includes an activity tracker so CHT members can track their referrals, actions taken on patients' behalf, and outcomes. A goal is to have the registry become an integrated health record used by the different individuals and organizations who work with a patient. There were 363 licensed registry users at the end of 2012 (DVHA 2013b). Basic access to the registry is free for practices and CHTs; an enhanced version is available for a fee.
The registry is an important tool for sharing information about care and prescriptions received in multiple locations, which may be especially helpful for treating patients with mental illness. For example, a CHT member working within a PCMH may be able to learn if a patient has visited a hospital or a partner at a specialty mental health clinic since the patient's last visit to the PCMH (if this information is available in the registry), and may follow up with the specialty provider or patient to offer additional support.
System and reporting requirements. Blueprint does not require practices to use EHRs or to use the central clinical registry. A state objective was to refrain from having practices report more data than what is required as part of their normal course of care. The only required reporting is for practices to record their staff so the state can administer quality incentive payments. However, use of EHR systems is widespread due in part to PCMH standards for tracking care and conducting panel management, and in part to state efforts to encourage PCPs to adopt EHRs. Most PCPs in Vermont now use EHRs; practices that do not (and even those that do) can enter data directly into the registry. CHT members can also input data directly into the registry to track information on the patients they work with.
Data quality efforts. To standardize the data in the central clinical registry, Blueprint created and routinely updates a data dictionary and condition measure set that is based on national guidelines for preventive health maintenance and treatment of chronic conditions. To support integration of EHRs, VHIE, and the registry, Blueprint created Blueprint Sprint teams, composed of representatives from Blueprint, Covisint, Vermont Information Technology Leaders, and the practices. In 2013, teams continued to work with practices to improve data quality and transmission, both of which have been a major challenge (DVHA 2013b).