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The Department of Veteran Affairs (VA) Office of Inspector General (OIG) has conducted a review of VA facilities and community providers to identify any barriers that are hampering the use of health information exchanges (HIEs). OIG identified several issues that need to be addressed to improve the exchange of health information.
HIEs are used to share healthcare information for the purpose of coordinating and improving the continuity of care for veterans enrolled in a VA facility. Following a pilot program, the VA introduced the Veterans Health Information Exchange (VHIE), which uses two methods for sharing veterans’ data between VA facilities and members of VA healthcare teams: VA Exchange and VA Direct.
OIG conducted a survey and interviews at 48 lower complexity Level 2 and 3 Veterans Health Administration (VHA) facilities, along with interviews of staff in the VHIE Program Office. OIG also met with the Office of Information Technology, Office of Community Care, Office of Rural Health, Cerner, and two state HIEs.
According to the VHIE Program Office Director, all 140 VA facilities have access to both VA Exchange and VA Direct, but currently only 28 of the 140 facilities have implemented VA Direct, which connects directly to DirectTrust. The facilities that had not yet implemented VA Direct report that they had not received adequate training by DirectTrust, did not have community partners using DirectTrust, or were using alternate HIEs.
OIG suggests in its report that “Expansion of VA Direct usage to all facilities would increase the instances of health information sharing and improve the timeliness of health information exchange while efforts continue with development of community partnerships through VA Exchange.”
Based on the survey results, OIG found 46 of the 48 facilities were using VA Exchange, VA Direct, or both, and only two facilities used neither. 22 facilities reported exchanging healthcare data by scanning, faxing, or mailing patient information.
Survey respondents indicated they needed additional training on HIEs to give them a better understanding on health information exchange and expressed a need for more community partners. There were also technology challenges with viewing community health information through VA Exchange, which required them to sign in to view the electronic health record and then sign in to the Joint Legacy Viewer (JLV) in order to access patient information from community partners. There were also issues with the quality of JLV data, access was not user friendly, and the cumbersome process delayed accessing patient information.
There are currently two contracts establishing community coordination for VHIE and 56 VHIE community coordinator positions to support facilities and Veterans Integrated Service Networks. Coordinators are required to provide training, policy, and process assistance to VHA directors and staff to enhance infrastructure, outreach, and training.
OIG found there was considerable variation in engagement across the 56 VHIE community coordinator, ranging from a high level of participation to next to none. OIG also discovered that when a coordinator leaves the position, it is common for communication issues to be experienced and training to suffer, which creates a barrier for staff knowledge and ability to use the programs.
“With the addition of more training, communication, and future planned technological changes, VHA could more effectively streamline the continuity of care received by veterans,” wrote OIG. “Electronic Health Records Modernization should alleviate some of the technology challenges currently experienced with the use of VHIE.”
The Under Secretary of Health concurred with the 4 recommendations made by OIG:
- Review the barriers related to the use of VA Direct and increase the number of facilities using VA Direct to share health information.
- Evaluate the VA Exchange and VA Direct training and education programs and increases accessibility to VHA staff, community partners, and veterans.
- Increase the number of community partners, including more state exchanges and other HIE stakeholders to facilitate the expansion of bidirectional health information exchange.
- Evaluate the performance work statements of the Veterans Health Information Exchange community coordinators and confirm compliance with the scope of work.