Vermont Legislature SmartTranscripts:

[Alyssa Black (Chair, House Health Care Committee)]: Good morning. It is House Healthcare, and today is Wednesday, January 14. We're continuing testimony on H84, which we started yesterday, or actually yesterday was a continuation of last year. Have in with us, Kelsey, you want to come first? Okay, Karen and Kelsey from Two of our designee agencies.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Do I I'm running right now.

[Alyssa Black (Chair, House Health Care Committee)]: Oh, I go here.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Oh, but there's there's not people back there.

[Alyssa Black (Chair, House Health Care Committee)]: Okay. So good morning. As we know that, you know, since telehealth has become much more prolific, I believe that almost 50% of telehealth visits have some sort of component of medical healthcare. Think that's the numbers I saw. Lower than 50%. So it's really important if we're talking about recording that speak to people who are actually using it or not using it yet.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: So good morning, I'm Karen Curley, and I am the Chief Clinical and Program Officer at Washington County Mental Health. And I'm also a licensed psychologist. And we're here today in support of age 84. And I thought what I could hopefully provide for helpful information from a clinician's perspective is why we're in support and also how we use it. So why we're in support of being able to record by audio and video therapy sessions is there's three reasons. The first is related to it's a graduate school requirement of most, if not all, school programs when you're in your internship experience. And the reason that graduate school so in order to become a mental health therapist or mental health clinician, you need to go to graduate school. And in that program, you need to complete an internship. And we become a site, and I would become a site supervisor. And it's imperative that you have access to an audio or video recording of a clinical session to provide the best training and supervision for folks. Because when a clinician who's a trainee or any clinician, myself included, if I'm talking to a supervisor and I relay what's happened in the session, I just relay what has happened from my perspective of what I think is important or also what I think might be important to the supervisor, it's not accurate information necessarily because it's through that lens. So as a supervisor, having access to the actual session and being able to see it for myself helps me then be able to provide the trainee with the best supervision to become the best clinician. So that's one reason. Another reason is related to evidence based practice and modalities. So an example would be parent child interactive therapy or dialectical behavior therapy. In those specific models, you need to adhere to the specific framework of that model. And for fidelity purposes, you record so that you can then again, a supervisor who has expertise in that model can then provide you with feedback to ensure that you're adhering to the model and have the best fidelity for best outcomes. The third reason why it's really important for us to be able to record sessions is related to one and two, and it's related to our workforce development. So as you know, in the state of Vermont, we have many folks who are experiencing mental health distress and need access to therapists In order for us to both sustain and also grow our clinicians, A, we need them to go to graduate school. We need to adhere to the requirements of graduate school. And B, we need to train them in the best ways we possibly can to be the best clinicians to serve our clients. And audio and video recordings allow us to do that. It's also just helpful the one last thing I will say is it's helpful as a clinician. It's intimidating and scary as a clinician. And I'm going to talk from the client's perspective in just a moment in terms of how we provide informed consent. But it's anxiety producing. It's also an incredibly valuable training experience having done it numerous times. And it doesn't really matter where you are in your clinical development. It's a tool that is super helpful to then continue to grow as a clinician and provide best care. So that's the why for us that whether it's telehealth, whether it's in person for therapy sessions from a mental health professional's perspective, it's important and vital that we have access to be able to record. In terms of the how we do it and how it affects clients, one of our pillars, most important principles is about informed consent for our clients. And so of course, what a clinician does, whether they're an intern, whether they're an experienced clinician, anywhere on that gamut, you get verbal consent from the client. So you give the same explanation I just gave to you all to your client. We also, at all of our designated agencies, we have policies and procedures that we follow in terms of ensuring that we are getting both verbal and written consent. And so we also, in addition to the verbal consent of explaining and asking the client how they feel about it and why we're doing it and what we do with the recording, we also then get written consent. Of course, it's all voluntary. And so someone can certainly opt out, and that's completely understandable. And then you just ask another client. Most clients say yes. It's a little bit an analogy I would make is if you've ever had a doctor's appointment or a physical health care appointment at a teaching entity and they ask, can they bring in a med student, it's the same thing for us in terms of you could say no to that at that point in time, and that's fine. They move along. And it's the same thing for our clients. And then the last thing I will say about it is it's important for clients to also know what after we utilize the recording. So we destroy the recordings after we utilize them to best protect their protected health information. And we let them know that. So there's a beginning, a middle, and an end to the life of and use of that recording. If ever you're going to keep the recording like sometimes, for example, I'll go to a training in an evidence based practice, and that trainer will show us the video clips you need to inform the client that that's how you're going to use that clip and you get verbal and written consent. So that, in a nutshell, those are the reasons as to why it's imperative to us that we have access to audio and video recordings, whether in person or via telehealth. And that's how we do it, to the point that you made earlier of the percentage that we utilize now for telehealth in terms of mental health therapy sessions. That absolutely has increased exponentially since the pandemic. So it's absolutely a mode of therapy that clinicians in the state of Iran use and need to be able to continue to use in order to best serve our

[Alyssa Black (Chair, House Health Care Committee)]: mothers. Thank you. Upper and then Allen.

[Allen "Penny" Demar (Member)]: Can you, or Russ, can you just elaborate on how it helps the patient?

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Sure, absolutely. Great question. It helps the client for a few different reasons. One, if I'm a better trained therapist, I can better help you. So for the client, it's best for my training in order to provide the best service. And so that's how we explain it to them. We explain to them also, the outset, if you're seeing an intern for therapy, we provide informed consent and information to the client as to the fact that they're seeing somebody who's an intern. Here are the benefits to that. The benefits to it, are a little bit, Again, it would be analogous to me of being at a teaching hospital, and you get a resident and an attending who both are seeing you. It's the same thing in therapy around you have the intern who's developing their skills. But the client knows that then that person is going back to their supervisor and their supervisor is seeing it. So in lots of ways, the client has two sets of eyes in the development of the clinician. It allows us to provide the best services to the client, and that's how it's beneficial to them.

[Allen "Penny" Demar (Member)]: I'm all set topper an iron on the same day, Leslie.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Daisy, can you talk a little bit about You mentioned the importance of implementing things to Fidelity. Can you talk a little bit about the difference between the quality component and the compliance component? Because I know a lot of SAMHSA grants, for example, you write in that you're going to use a certain approach, and you're required to implement that to Fidelity. So can you just talk about that factor? Because I'm just contemplating how this seems like it is a necessity, not Yes, it is. From my perspective, as someone trained in the profession, it's absolutely a necessity. So give an example of the way that we're trained as clinicians. When I went to graduate school, I went to graduate school to become a psychodynamically trained psychologist. So that is in my training. I get a base similar to medical school. It's the same thing. And then from that, I can make decisions based upon wherever my areas of interest are. Just like a physician, I could decide that I want to become a dialectical behavior therapist. That of crucial importance to that modality is that you utilize the steps and the techniques in that modality in the best way for the best interest of your clients and the best interest of outcomes. And so I absolutely learned that through books and graduate training of professors and materials and conferences and what we would call passive learning. I absolutely learned it that way. I absolutely learned it that way from role plays, active role plays with my colleagues and other clinicians And an incredibly important pillar also is, how am I then providing that service in vivo, in real time, to actual clients? And it is imperative that I get feedback from a neutral outside entity who's also an expert in the area. So you're absolutely right. In order to adhere to evidence based models, which is best practice, you need to ensure that you are following the steps and the techniques and the interventions that are outlined in those models. What absolutely can happen to us as clinicians is what I would call mission creep or creep from your model and the fidelity of that model. And that just comes from comfort in providing of like, oh, I've got that. I don't need to do that step, or I don't need to utilize that spreadsheet or that worksheet or whatever it may be. And the risk in doing that is you creep away from the actual model that has been researched that shows best outcomes. Leslie?

[Leslie Goldman (Member)]: I'm just curious. You said that you destroy whatever it is, Tate. I don't know why. Yes. When we were talking to UVM, it seems like there are two pathways. One is there's a copy of the EMR of the note, and then the actual recording lasts thirty days. So wondering where your, do you have an EMR? And how does it interface with that?

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: We do. And Kelsey might also talk about this related to compliance. So we have an EMR. That's not how we record sessions. We record sessions. So we, at our agency, we use Teams for telehealth, for example. Or somebody could just use their agency cell phone and actually make a recording on it. So the recording that you utilize is outside of the EMR.

[Leslie Goldman (Member)]: You mean it might be on my phone? Is that legit?

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: It's a work phone. And it used to be I'll go back to your point around the way we used to record is you use a recorder. And you just use the recorder, and then you can just destroy the tape. It is legit in that it's an agency sanctioned phone, and you utilize that to then forward it to it's all done through Teams. So we have a Teams on my phone. I have a Teams app. And I just hit record on my Teams app, whether the person is in person or whether it's by telehealth. If it's by telehealth, I'm using my laptop. So it's recorded there in Teams. And then honestly, I don't know how long the recording lasts because protected health information is incredibly important to us. And so I am actively involved in destroying that recording prior to thirty days. I don't need that recording thirty days later as the supervisor. And I really honestly see that as my job as the supervisor, particularly with interns, responsibility from my perspective to ensure that that gets destroyed.

[Leslie Goldman (Member)]: So that's your process, other standards across all these different organizations or not necessarily? That's a great question that I

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: don't know if I couldn't answer that. We could get back to you about that. I only know at my own agency how we do it and how our clinical team interprets. But we all have the same standards and regulations. How folks do that, I couldn't answer across the state.

[Alyssa Black (Chair, House Health Care Committee)]: Can I interject here real quick? I've got some questions. Is Teams HIPAA compliant?

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: It's a great question. It is. It wasn't. It wasn't. You're absolutely right. So when we started, you are absolutely right. When we started, we started with Zoom. And Zoom wasn't either.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: So they have yeah, I think from the compliance standpoint is that and I can speak to us, but feel confident about how other agencies do that. But we have BAAs. We make sure that lawyers vet HIPAA compliant software. So it is vetted very thoroughly anytime we utilize something to provide service and we contract with an outside entity. It is absolutely HIPAA compliant and embedded through an internal process. I think that's pretty standard at most healthcare organizations.

[Alyssa Black (Chair, House Health Care Committee)]: I actually had a couple, I see you.

[Brian Cina (Member)]: There was an answer to the question though, because I think it's important that we're accurate that Zoom was HIPAA compliant when the pandemic hit and nothing else was. Now you can purchase, but you had to purchase a HIPAA compliant plan, And now you can purchase HIPAA compliant plan with Teams, hence me switching from Zoom to Teams because

[Alyssa Black (Chair, House Health Care Committee)]: it's cheap.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Thank you. I'm not an IT expert. I just know my IT guru said this is compliant. I also should say there is a component, we at our agency, we utilize an EHR called My Avatar. And you can schedule now. This is another evolution we've had in the last year or so. But you can now schedule your appointment within My Avatar and record it that way as well. They're all again, there's been evolution in the last six years in terms of the compliance related to the telehealth platforms that we're using.

[Brian Cina (Member)]: There's high-tech as well as HIPAA now that we have to be compliant with. It means something else, but whatever.

[Alyssa Black (Chair, House Health Care Committee)]: I'm so out of it. Val, if you have any questions?

[Brian Cina (Member)]: There's even a new one.

[Alyssa Black (Chair, House Health Care Committee)]: So when you record and you press save through the app, does everyone within your entity have access to that?

[Leslie Goldman (Member)]: No, that's a great

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: question. Again, I can't describe how this works. This is a tech I only know on Like the other dropping Totally. So there are the only way I can describe it is there are guardrails around the permissions that our IT department allows you to have to access, whether that's in our EHR, whether that's in Teams, whether that's in Zoom. And I should say that we do have clinicians who also have Zoom licenses as well. Our IT department safeguards it. So you can't if you and I both work at Washington County Mental Health and I'm seeing a client and I record that session, you can't go in and see that.

[Alyssa Black (Chair, House Health Care Committee)]: So what happens if your phone is destroyed by mistake? If you walk out and you leave your car on your phone, you drive away and it's smashed or something like that?

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: It's saved. Again, I apologize. I'm not the tech person. So I just know it's magically then when I go in my laptop and I go to Teams, it's magically there. But I couldn't tell you how that happens. Or I rely on my partners in IT to say, yes, Karen, this is HIPAA compliant. We have vetted it. We have vetted it with our attorneys and with BAAs. Then

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: There are a lot of guardrails in terms of accessing anything. If your phone is connected to the cloud, that requires you to sign into a secure network. Network spaces are protected by clinician or person who can have access to certain things. So if it is saved in network, again, either password protected or just not visible to other staff who don't need access to clinical information. The EMRs are all protected based on your profile. So if you're a clinician, see if you're ES, you do have access to a larger thing. And there are checks in the background saying like, is someone accessing this person's thing? So there are a lot of technological security checks in place, not only to access that through multiple layers of passwords. And so your phone example is saying, one, you have just the login for your phone, which is it could be your face or your pin number. Then to access the software, it's also protected and has dual factor authentication. So you're getting the code sent to your email or text to log in. And if it was saved to your phone, most of it's cloud now, but if it was destroyed, then it's just destroyed, the copy's gone there. But if it's saved to the network, then that's also protected by multiple guardrails for specific people to access specific sites.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Thank you for helping me with that. I only know how to do the steps. Don't know.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: I think it's important for question about like, one of the things, especially around designated specialized service agencies is that being highly regulated, we can come and talk about the administrative burden, but there's a lot of purpose to some of that oversight. So a lot of our policies and procedures are connected to privacy, how we use technology, and then that it's audited by the state. Our internal IT departments do have checks on people's EMR saying like, if there's an unauthorized access or something looks weird, we will pull that. We randomize that. We do trainings internally. So the person's privacy is always at the tip of what we're doing here and drives a lot of how we engage with folks. So I think the person receiving services is always going be prioritized first and we have to be really thoughtful when we talk about, can we use this for learning? Can we use this for training? I think, Clarence pointed it is really important to make sure that the services you get are good. And so we can do some of that in the background. We can check notes. We now have technology that helps see if we are to fidelity, but being able to observe again, there are pros and cons of having secondary person. If you go to physical healthcare, think it's a good analogy, and you have an intern come in, it changes the dynamic, but it's also helpful to them. And so being really thoughtful about how we ask about recordings, about how we use that is really important and needs to be driven by the therapeutic relationship with the person. And that comes from training, comes from policy review. It's not just saying, hey, if you want to record, just ask the person and do it. I think there's a thoughtful way to ask somebody and say, how is it going to be used? Why aren't we doing this? Why is this important to me? But also how is this going to help you in the long term if we're using and having good oversight and supervision does require observation, but thoughtful.

[Alyssa Black (Chair, House Health Care Committee)]: Just because I'm assuming there's nothing that we need to do around informed consent or for in person. I don't have legislative counsel here right now, so because if you're making recordings in person, this bill is only addressing for telehealth. I'm assuming that this will follow what is already in place for in person, which exactly has probably been around forever. Forever. Or at least my twenty eight years. At least while there was such thing as a recording. I like Leslie said it on the tape when I thought of a little cassette.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: That's how we did when I was too trained. That's exactly the paper kind of gal. Do you

[Alyssa Black (Chair, House Health Care Committee)]: have another question?

[Allen "Penny" Demar (Member)]: Yeah. This is a personal question. If you don't want to answer it, you don't have to. Do you work from home or do you work from the office?

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Oh, no, that's a great question. I'm happy to answer it. I personally prefer to be in the office. So I am an in person gal through and through for lots of different reasons, personally and professionally. That being said, I have great respect and adoration for many of my colleagues who provide primarily telehealth services. And they provide it from wherever they provide it and adhere to the professional guidelines. It's essential, I believe, to have access to telehealth. So I'll give an example. I have a client who I see. I see her in person. I prefer to see her in person. I think probably she would say she prefers to see me in person. She has small kids. If her kids get sick or the roads are bad and school gets canceled, she has to cancel her session with me to come in person. We can then see each other by telehealth. Albeit the way that I prefer to do it is I'm in the office setting. She's at her home. But that is incredibly important. And what I will say for my colleagues who primarily provide telehealth services, I just have great admiration and respect for the way they do it. They're so seamless in terms of their tech knowledge is amazing and incredible. And I'm always humbled by watching it I'm a little clunkier in that way. And it's just a vital importance from my perspective in 2026 that it's a modality or a mode of therapeutic access that people have.

[Allen "Penny" Demar (Member)]: The reason I asked you that question is because I have a grandson that needs help and I talk to him all the time. And he said that he likes in person. And the only time that they do the telehealth is how you described it, if it's raining or snowing or something. I'll tell you what I'm afraid of. That we do this and then everybody says, oh, it's much easier to do telehealth. I don't want to see that happening.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Absolutely, so I'll just quickly say that I'm in full agreement around, I believe really strongly that it should be a client, a person, a citizen of Vermont has access to different options available to them of what works for them. And so I just see it as another tool we could possibly use rather than to supplant in person therapy. That's my opinion.

[Allen "Penny" Demar (Member)]: And I believe that recording during the tele health session is fine.

[Alyssa Black (Chair, House Health Care Committee)]: Okay. You raise a really good point, and when Jen comes in at 10:00, why don't we have her walk us through existing statute around telehealth and concerns that you because that's a good concern. But I think we've already addressed that. Already in statute.

[Allen "Penny" Demar (Member)]: All good.

[Alyssa Black (Chair, House Health Care Committee)]: Okay. But it's a good reminder. So let's ask Jen to

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: And I just want to We, Methodist designated agency systems also do culture and climate surveys. We do consumer satisfaction surveys. And we take that into account saying if you want to be seen in person, you should be seen in person. And it's again, Teams, telehealth is a tool and it is really important to saying, we worked our way out of that sometimes saying if someone wants to be fully telehealth, you can do that on your own. But like, we should be providing the opportunity that's driven by the person. And so if they want to be seen in person, they're going to be seen in person. And that's the value of being person centered. It's like it should be driven by the person who's receiving services. So, we definitely hear your point and take that seriously.

[Alyssa Black (Chair, House Health Care Committee)]: Did you have a? Yeah,

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: I'm getting confused because this is the

[Alyssa Black (Chair, House Health Care Committee)]: only files recording of the telehealth.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: People can still choose telehealth right now.

[Allen "Penny" Demar (Member)]: Yeah, that's why I said the recording, doing telehealth is good.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Yeah, that's all this does, it's not changing what people, the choices that people can make, it's just allowing them to record it.

[Alyssa Black (Chair, House Health Care Committee)]: Kelsey, did you wanna?

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: I mean, we've kind of touched on it. Did have a PowerPoint, probably give a little context. I'll go quickly, but I just want to speak. It's a little bit broader.

[Alyssa Black (Chair, House Health Care Committee)]: I like having both of you because it's a good reminder that I keep thinking of this in terms of AI and documentation described, but I forgot about the training aspect of it as we're trying to support our workforce.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Thank you.

[Allen "Penny" Demar (Member)]: So,

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: if I can introduce myself, my name is Kelsey Stavzep and I'm the Executive Director of Northeast Human Human Services, but also the Co President of the Board of Vermont Care Partners, which is an association of the designated agencies and specialized service agencies for mental health and DS. So I just want to go through a couple of things, which is like, it's just really important. Sometimes the bill is very simple, which is nice, but also leaves room for how does it get implemented. Just to remind folks that that's one of the most important things to do. There is a power differential in therapeutic services. We know a lot about people. You're expressing very intimate personal things in therapy, and so we take that really seriously. So I just want to put this up here saying a lot of organizations are driven by their values, which are only as good as they're implemented. And so I just want to say a couple here is the person center, how do you want to drive your own services? We're here to support you in your own treatment goals. And then dignity, I would highlight those two here. I'm just saying these are really important aspects and saying, it's okay if we report it. It's like, let me walk you through why we're going to do this, how this could be helpful and also impact your own treatment. Not saying, hey, my supervisor needs to see me do this because we have to achieve CCBHC fidelity. Those might be true and we do have to do that, but we shouldn't be leading with that and it shouldn't be making someone feel like they need to support us to achieve a goal. They're here to get services from us. So I just really want to highlight the fact that we take this really seriously and that our compliance and policy is really driven by serving and supporting providers. So one thing, so we use Helios, which is an ambient, we call it augmented technology. So there's a couple, there is a scribe feature, which is essentially dictation and then suggested notes that are compliant from evidence based saying, and it can help from a data perspective saying like, are you using models like CBT or DBT to fidelity? So we do have technology. Some of the technology adoption is driven by regulation and compliance, so this is helpful to shortening some of the documentation, but isn't a shortcut to documentation. And so when we do use technology to record, it's not a replacement of actively writing your notes. So it does generate some opportunities just like a recording isn't like I did the task, it's like, did we learn from it? Did you go back to it? Did you sit with someone? So there is still manual effort in making sure that your note is representative of the person. Best practice would say you can do it together. So you can look at your note at the end, you can do it collaboratively. So there are a lot of ways that are driven by the person, but saying when we use technology, we have policy, we have oversight approved by the board, go through the designation process, they look at this and may spot check what we're doing. So again, from the HIPAA compliance confidentiality and then the person centered treatment goals, everything should flow out of those things before we get to, we would like to use this. So it'll be thoughtful. This is just a little information when we go through this, but we have adopted it. It has been helpful. Clinicians do like it in saying technology's here and we're trying to adapt, but make sure we're staying centered in how we're providing services. We do use it pretty significantly. We've adopted it across not only our clinicians, but for community based. So it doesn't record in the community, but can't help help just you shape your notes. And so we have found this helpful across the spectrum. This is just different activities, so individual case management. So just to demonstrate that it has different functionalities to help with the therapeutic documentation, but also geared towards your treatment goals and outcomes. So these are really meant to again be driven by the person who's getting support to saying like, we doing a good job? And so we do use it fairly frequently and providers are using it pretty frequently find it to be helpful. I just wanted to go over our employment data. I have presented this before, this is a lot of data, saying we do provide a lot of internships, especially at designated agencies. We are helping to grow the workforce in this area. We know it's needed and saying internships, field placements, desired. We do help license people. We have rostered people who are not licensed but can get licensed under the supervision rules. We have licensed therapists who can supervise folks and we do supervise them for free and get them licensed. Part of the training is to saying like, can we observe? And so that could be in person, let me sit in with you, or it could be a recording. And so there are different things on how effective that is. You need to be thoughtful. I think there's pros to saying, hey, can I record? Can I be a part of this? And saying it can be really helpful as a learning tool. You need to be able to understand the dynamic, the therapeutic relationship and saying like people can feel stressed, they can feel anxious. Like when you're being observed, are you at your best? I think so there are pros and cons to that. We think the net positive is like recordings can't help, but again, how you approach it needs to be super thoughtful and there needs to be really good oversight about how we're managing confidentiality, privacy and the individual choice.

[Leslie Goldman (Member)]: Leslie, did you? It's okay. I have a question on that slide. Yeah. But you may want to review it for

[Alyssa Black (Chair, House Health Care Committee)]: second. Brian?

[Brian Cina (Member)]: Taxpayer money currently being spent on this Helios product?

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: So yeah, we get funded through various means and so we use technology to help support the clinicians.

[Brian Cina (Member)]: So I don't want to go down this rabbit hole too much, but I got it. Do you know where it's going?

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: I understand that it has Israeli based roots and that it's a technology company and we have talked about that internally.

[Brian Cina (Member)]: Good. Pierre, we got emails in the past and I just love to confirm from people about how the CEO is in the Israeli military and this technology has been potentially used in questionable ways against the Palestinian people. I don't know the details, it just makes me get nervous about us spending money that might be causing such grave harm and genocide somewhere else.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Well, it's saving lives here in Vermont. That's the irony. But it's not relevant.

[Brian Cina (Member)]: No, no. Just want to make

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: Every rabbit hole of technology or gas companies, I think it's pretty hard. Could deeply question every single thing that we do. So I just want to be really mindful that we do vet this. We're thoughtful about it and understand that there's implications, but find that this is helping to support Vermonters.

[Brian Cina (Member)]: Yeah. I think that political issue aside, let's take the conflict in Israel Palestine out of it. My concerns are ultimately about how these companies are using data, and we will address that regardless of who the company is. I don't want to make it about the company, but I had to do my due diligence and ask to make sure you were aware that we had gotten some, I don't know if others got them, but I had gotten some emails about this. I'll forward it if you want to see it. Believe you.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: Okay, moving on. I think that comes into the BAA, how do you use data, it gets deleted, it's not stored anywhere. This is for us, it's for the clients and like how, when, then we follow all of the requirements for keeping medical data on-site.

[Brian Cina (Member)]: Can I ask one more question related to AI stuff? Are you aware of the state inventory about how government uses AI on the state level? Because if not, I'll send it to you.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: Yeah, that

[Brian Cina (Member)]: would be Which is something internally for you to look at because the state has standards about how the state government's using AI and how we disclose to the public all these details about data sharing. And it may be something that healthcare providers want to voluntarily do, or it may be something we support people using taxpayer money and doing just so the public knows how the data is being. It's really like when I send it to you, you'll see it's not the hardest thing to do. You just create a sheet that's public facing saying, here's how this AI system operates. Who should I send

[Allen "Penny" Demar (Member)]: it to?

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: Send it to Amy, I think that'd great.

[Brian Cina (Member)]: Okay, and maybe you can share with all the designated agents. Yeah, exactly. Great, thank you. Thanks, Brian.

[Alyssa Black (Chair, House Health Care Committee)]: Leslie, think Leslie. You to review your slide? Yes.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: I have a question about

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: it when you got it. Again, policy and procedures are two different things, but this is just a demonstration of a draft which we're still working on, but saying like this is present, it's prevalent, we are trying to help in administrative functions. And so again, if we're using some of this stuff again, is a kind of high level, like how do we approach IT? I know this is slightly different than like should we record, you know, and it has nothing to do with AI at that point, but these are technology based and just want to say, look, we are being thoughtful about how we approach this. So if you have specific questions, but again, we haven't implemented any AI. Know that Ilios is augmented and saying like it's supportive, but it's very clear about how you're supposed to go about doing that and saying you're not just doing it and press and send, need to go back and look at it and make sure it represents to your clinical judgment you are responsible for whatever gets put in there. But in terms of transcription and synthesis, we know that these things are here. We know people can download them and just use them whenever they want. Right And now it's fairly easy to spot if someone's been using AI and sends you an email. They're getting more sophisticated and we want be really thoughtful in trying to get ahead of that. So I think that's based around how is data being used, how is it stored, and what's the impact on people who receive services at healthcare agencies.

[Leslie Goldman (Member)]: So my question is about, in the purpose line, AI must be used as a supportive tool, not as a final decision maker. And I was thinking about your use of AI as merely a tool to record and store forward. Here is the first time I've seen anything about decision making input. And I found that worrisome because we know that people have had terrible outcomes because of AI and interact. So I was just not understanding your organization's thinking about allowing it to be thought of as a, even thinking about it as a decision maker or authoritative source, that's worrisome to me. That last line in purpose.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: So not as a final decision maker or authority?

[Leslie Goldman (Member)]: The fact that it even has any access to decision, that your clinicians have access to a decision making tool as part of your notes using AI. But

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: if you use Google, the first thing that comes up is a bunch of summation that's

[Leslie Goldman (Member)]: like, ignore that. Yeah.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: Move down. You have to look at the citing. So everything is just so it'd be like if you use Google, you can't just say, well I read this fact here. It's like, did you cite it? Did you go into it? So it's more saying, look these things are out here. You need to be thoughtful if they do get used. So again transcription and synthesis is saying like, is it correct? AIs can repeat themselves. We've gotten professional documents from contractors saying like, here's what happened and then it's repeated. The second bullet is repeated in line six. You're like, I don't think anybody read this. And so you can get lazy and loose around a supportive tool which can help with transcription synthesis for themes and things like that. It can be very helpful as a thought partner, as a way to do research, but only if you're citing sources, only if you're tracking how it's being used.

[Alyssa Black (Chair, House Health Care Committee)]: But it seems like there's

[Leslie Goldman (Member)]: a distinction or should there be between the clinical use of it and the use of it in other contexts in an organization? And that's what's worrisome to me. Having it used is a clinical sense as opposed to decision making sense.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: And I think there's more coming. So there's two policies and we have one for how we use it clinically and then one how So this is the oversight saying like, yeah, we have two different policies for that and saying, again, trying to emphasize, like, don't want go down the AI rabbit hole here because we're talking about recording, which has nothing to do with AI actually. And so recording is not done by AI, it's just recorded so you can look at it. Saying why I included some of this is that there are overlays of things and saying like, we take it seriously, there are policies and procedures. So just using examples of saying like we are very thoughtful about how these things get implemented and so that includes technology. So I apologize if this kind of has taken us down a rabbit hole, but just wanted to demonstrate that like these are things that we take seriously. So this policy is about oversight and making sure we have good governance from the board standpoint, that we have good internal controls operationally, but this one is not related to the recording and the testimony. So I apologize that we've kind of taken us off.

[Alyssa Black (Chair, House Health Care Committee)]: No, apologies. It's something we have to talk about. We can't skirt around this issue.

[Leslie Goldman (Member)]: No, no, can't.

[Alyssa Black (Chair, House Health Care Committee)]: Brian, you kind of

[Brian Cina (Member)]: just said what I was going to say, which was that I appreciate that you're being transparent that this is the direction we're heading though. We need to face this before you're here to your asking, oh, there's this thing that you need to do that you didn't do yet that's holding us up. This is the future, we have to address it. So I appreciate that you're putting it out there, and I appreciate your patience with our questions. Yeah, no.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: And I totally agree with you as a clinician that I should not be reliant on AI to make decisions for me, whether it's the final one or the third step. That's Here's the daylight time

[Alyssa Black (Chair, House Health Care Committee)]: to me, but

[Leslie Goldman (Member)]: Yeah, go ahead.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: No, I think that's why we should be really thoughtful. It's just, you know, I think these are answers to pressures that clinicians are facing with the administrative burden of documentation and notes and assessments, and it can be a good solution, it can. It can also be a really bad one and so we need to be really thoughtful about how we monitor, how we provide supervision, how we check what's happening, how we read and review notes. So again, could expound on like there's a lot of connected dots here about how we support people to do good services for Vermonters and saying, again, we want to use tools thoughtfully and tools can be used for creating things and tools can be used for negative purposes. And so we just want to be thoughtful and that can be intentional or unintentional. So we just want to emphasize that anytime we have personal information, health information, we take it really seriously from a compliance standpoint. We have a lot of technology and a lot of people dedicated to making sure that only the people who should be seeing information are seeing it. And that includes contractors and software that we use. So I just want to emphasize that.

[Leslie Goldman (Member)]: Any other questions?

[Alyssa Black (Chair, House Health Care Committee)]: Thank you, I know it's not on our schedule, but I've asked or the health care advocate has asked if he could weigh in on H84 before, and then we're expecting legislative council at eleven. Do we have a break coming- Ten. We don't have a break.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Thank you for coming on-site Thank very much.

[Brian Cina (Member)]: Day. Thanks for enduring all the questions that went beyond age 84.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: Happy to help open the door, sorry.

[Mike Fisher (Health Care Advocate)]: Yes, you did.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: Yes, you did.

[Brian Cina (Member)]: My door is locked and it's already been opened.

[Alyssa Black (Chair, House Health Care Committee)]: Yeah. This is

[Brian Cina (Member)]: what it's like. Yeah.

[Alyssa Black (Chair, House Health Care Committee)]: Good morning.

[Allen "Penny" Demar (Member)]: Can I ask I don't know?

[Mike Fisher (Health Care Advocate)]: Mike Fisher, health care advocate. I am not going to oppose this bill nor am I going to ask you to make any edits to the bill. So I understand you're driving towards a vote, and I'm not gonna get in the way of that in any way. I support a lot of the stated motivations for this bill. I know we're talking about telemedicine, but I I I love the use of technologies that help providers look at patients when they're sitting with the patient. And I love the use of technology to make providers' lives easier, to deal with burnout. And I'm sure there's other things that have been set, and and I apologize. I haven't been here for all the testimony. So I'm sure there's other things that have been said that, I would, support. I just want to also recognize that the use of an AI tool for clinical note taking also could be and is likely a tool that helps with generation of claims and, therefore, creating the opportunity for more revenue for providers. And and so I just really wanted to sit in the seat for a minute to recognize that in the face of the health care financing crisis we're in the middle of, and to note that as we move through the session that we are, I think, taking an action here for some good reasons that has the potential for exacerbating some of our problems. Mhmm.

[Alyssa Black (Chair, House Health Care Committee)]: Do

[Allen "Penny" Demar (Member)]: you have any concerns?

[Mike Fisher (Health Care Advocate)]: Well, think that was my attempt at expressing a concern.

[Allen "Penny" Demar (Member)]: Was kinda like a roundabout.

[Mike Fisher (Health Care Advocate)]: Yeah. I have a I have a concern that this technology, actually, whether it's in the telemedicine context or in the face to face context, a tool that helps generate more claims. And let me just say, we often talk about utilization as if it's somebody showing up to the doctor with a need, and that is a form of utilization. Utilization is also the number and complexity of claims generated out of that visit. So that's my concern. And, you know, I I grappled with, you know, is there anything that could be should be done in the context of this bill? I don't think so. I think my statement of concern is a a higher level concern. So

[Alyssa Black (Chair, House Health Care Committee)]: I I have a couple of questions, but I have a question on this. I I've made very clear that this was my concern from the get go with this bill Mhmm. Even though I think I sponsored it. And I've expressed that. I believe last year we had Blue Cross Blue Shield come in on this bill. We do have tools though. I mean, it's been expressed to me, well, utilization, when we talk about utilization, it's the number of services that are being provided, but it's also the complexity of the service that's being provided, AI takes it out of the human coding it and codes it, we do have mechanisms in place.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: If we

[Alyssa Black (Chair, House Health Care Committee)]: acknowledge that it is a revenue generator and it can increase revenue, we have mechanisms in place, mainly through the Green Mountain Care Board, to say, okay, well, we recognize that maybe we're coding higher, but that doesn't mean that we need to reimburse higher and there should be an offset. I think that that is a way, I think we need to Would you agree that we need to recognize that and make adjustments? I

[Mike Fisher (Health Care Advocate)]: think you're right.

[Alyssa Black (Chair, House Health Care Committee)]: Moving in this direction.

[Mike Fisher (Health Care Advocate)]: Think the work that's underway at the Green Mountain Care Board with provider rate setting is the answer to my concern. But I just want to add the complexity that you hear me, and I often sit down in the seat and like, we have to deal with price. We have to deal with price. I say it over and over again. But we also have to deal with utilization. Hey, And no simple task here, because we want people to get the care they need, and we want to reimburse providers for that care. But yes, I agree.

[Alyssa Black (Chair, House Health Care Committee)]: I would argue, as somebody who has looked at numbers over the course of twenty some years, that one of the reasons why I think some of our prices are so inflated is because there has always been a tendency to undercoat. And so we're almost riding the ship now. The problem is that we've inflated the prices to mitigate the undercoating. And now we're left with correct coating at these high rates, the high costs can I just

[Mike Fisher (Health Care Advocate)]: add the complexity of I think that's happened in some areas and not in other areas? And so there's so riding the ship even within an individual organization is no simple task, but it's the work in front

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: of us.

[Alyssa Black (Chair, House Health Care Committee)]: So I have Daisy and then Brian. Or Brian or Daisy, don't remember who's Brian's being turned off had

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: a lot of airtime. I just want to

[Alyssa Black (Chair, House Health Care Committee)]: remind everybody who we're talking about here. We're talking about mental health providers primarily using these services. Are we concerned about mental health providers making more money? Great point.

[Mike Fisher (Health Care Advocate)]: Thank you. I had the thought as I was approaching the chair, and I didn't say it clearly. I don't have that same concern for all providers. And no, I am not expressing that concern for particularly for the independent mental health provider, but also for you know, I I saw who was just in the seat, and I I know the the pressures on mental health providers provider systems. So that that is not the place I'm intending to make to express this concern. So it's primarily other the other parts of health care and the wiggle room they have in terms of how they code? Yes.

[Karen Curley (Chief Clinical and Program Officer, Washington County Mental Health; Licensed Psychologist)]: And so you're saying potentially it's a fiscal

[Alyssa Black (Chair, House Health Care Committee)]: I'm saying, yeah, I'm saying that this is more of an equity issue in that the providers who are predominantly using this technology are the ones who are being under reimbursed and not benefiting from that. And because we have banned the recording and not given them this tool. So, I mean, giving them this tool back, I think we're leveling the playing field for them. Yeah, I agree.

[Mike Fisher (Health Care Advocate)]: Fair point.

[Alyssa Black (Chair, House Health Care Committee)]: Brian?

[Brian Cina (Member)]: Only UptCharge, I don't what you would call it, the only additional utilization I'm aware of that designated agencies or I should say mental health providers might use is an interactive complexity code and I can assure you we're already looking to add that when we can and it only adds like $7 to the repayment. It's

[Allen "Penny" Demar (Member)]: very

[Brian Cina (Member)]: small, So if this was catching that, I don't know what the utilization would be over the whole system if we're already looking for that. There's billing departments at designated agencies already looking for how to bill and make them, it's like scrounging for money, that sort of how it feels. But that being said, are there any other concerns that you have besides utilization? Are there any concerns about patient rights, patient privacy, patient access, care, or is it just utilization?

[Mike Fisher (Health Care Advocate)]: I think the train has left the station way down the track, there's not really a reason for me to express those kinds of concerns. We're doing it. We're using these tools in the clinical setting now. So any concerns about security and sort of I think some of this was discussed yesterday, so sort of fair disclosure about whether the patient really knows the purpose of the recording. You know, I could I could go there. But But I think these are tools that are a part of our health care system now, and they're going to be.

[Brian Cina (Member)]: Thank you. And then my last question, which you haven't gotten this one in a while, so people probably miss it, is

[Mike Fisher (Health Care Advocate)]: Shouldn't we have a fingerprayer?

[Brian Cina (Member)]: If you're concerned, I mean, you need would this be an issue if we just had it? You you know, we have fully the the the promise of act 48.

[Mike Fisher (Health Care Advocate)]: Representative Cina, there is far better ways for us to raise money to pay for the health care system that we have. And I long for a day when we can really approach that.

[Alyssa Black (Chair, House Health Care Committee)]: Okay. Thank you. I wanted everyone to remember that when Jill Olson came in here to give an overview of the Rural Health Transformation Program grant award, a big component of that was ensuring that all community providers have access to IT and these AI scribe things. I I share your concerns. However, this horse left the barn a long time ago. Horse leaves the we are not

[Mike Fisher (Health Care Advocate)]: at the train leaving the station.

[Alyssa Black (Chair, House Health Care Committee)]: The horse horse

[Brian Cina (Member)]: left the wild horse across the border.

[Alyssa Black (Chair, House Health Care Committee)]: You. Quite amazing that we just did this like five years ago, and we didn't even conceive of this at the time.

[Brian Cina (Member)]: We were dealing with a lot at the time. COVID was really difficult.

[Alyssa Black (Chair, House Health Care Committee)]: So let's take a little break. Thank you, Mike. Thank you, Mr. Bishop. Thank you. Sorry. Care advocate. Mr. Houghton. HCA. Thank you, Ms. Abbott. Let's take a break while we're waiting for legislative counsel here. Let's be back here at 10:15. Okay, we can go off of luck.

[Kelsey Stavzep (Executive Director, Northeast Human Services; Co‑President, Vermont Care Partners Board)]: That's an epic break.