VA Tests Nationwide Health Information Exchange

A six-month pilot project that connects the VA with military and private providers may finally turn health data exchange into a national priority--if it works.
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The VA has joined forces with military and private-sector healthcare providers in a pilot project that tests the value of using the Nationwide Health Information Network (NHIN) to share data among providers that care for veterans and active military personnel.

The project, if successful, could lead to a national rollout of the platform, which is a key part of the Virtual Lifetime Electronic Record (VLER). But Joseph Paiva, VLER project director in the VA's Office of Information Technology, told InformationWeek Healthcare that even if the rollout gets the green light, the evolution of private health information exchanges will determine how quickly the VLER linkage spreads.

The VLER is designed to facilitate the sharing of medical, benefits, and administrative data between the VA and the Department of Defense healthcare systems. The demonstration will begin on October 1 and will run through March 31, 2012.

Two weeks ago, the VA announced that it was increasing the number of sites for the VLER connectivity pilot from five to 11. The new sites, which will begin exchanging data this fall, include Grand Junction VA Medical Center in Grand Junction, Colo.; Asheville VA Medical Center in Asheville, N.C.; the VA Western New York Healthcare System in Buffalo, N.Y.; the Ralph H. Johnson VA Medical Center in Charleston, S.C.; the Minneapolis VA Health Care System; and the VA Puget Sound Health Care System in Washington State.

The existing sites are in southern California, northern Virginia, Spokane, Wash., and Indianapolis. These VA hospitals are already exchanging data with DoD and private facilities in preparation for the pilot.

When all sites are in operation, the VA hospitals will trade data with five "military treating facilities," two healthcare systems--Kaiser Permanente in southern California and MultiCare in the Seattle area--and eight private health information exchanges (HIEs).

According to Jamie Bennett, VLER Health Program Manager for the Veterans Health Administration, these HIEs are among the more robust in the field, and all include large hospitals in their networks. Examples include MedVirginia, the Utah Health Information Network, and HEALTHeLINK Health Information Exchange in Buffalo, N.Y.

The VA hopes that 50,000 veterans will give permission to have their data used in the pilot. But Paiva said it doesn't matter whether the VA has that many participants, as long as there are enough to provide solid data on performance.

The VA will use an outside firm, he said, to measure the pilot's results. Besides data on how the exchange performs, the VA will look at veterans' and providers' perspectives on the benefits of data exchange; how the information is used; the clinical outcomes as perceived by providers; and whether the availability of data affects clinical decision making.

The early reaction to the data interchanges at the existing sites has been very positive, Paiva said. He cited a VA emergency department physician who said that medication data from a DoD facility probably saved one patient's life.

The VLER pilot is using the NHIN exchange that all government agencies are expected to use. The NHIN Connect gateway is in the public domain, and any HIE that meets NHIN standards for privacy and security can connect to the NHIN.

While this demonstration is testing the "query and response" capability of NHIN, the VA is also doing a separate pilot with the Direct Project, a protocol for secure clinical messaging that was developed by a public-private consortium. That protocol allows clinicians to "push" e-mail and attachments to trusted partners, but not to search for specific information.

Paiva noted that the two methods of exchanging information might be useful in different situations. A rural provider who is not connected to a health information exchange, for example, might send or receive data via Direct. But if a veteran shows up in an emergency department in New York City with a traumatic injury, the NHIN exchange would help physicians track down information about that patient.

At this point, the VA is using NHIN only to exchange Continuity of Care Documents (CCDs) that contain clinical summaries. But Bennett noted that the VA is continuing to add more data elements to these summaries, which are designed to flow directly into EHR data fields.

The VA and the DoD have come under fire for the slow pace of integration between their electronic health record systems. The VLER is supposed to accelerate the exchange of information between the two departments. But true integration won't occur until there is a single medical record for military personnel and veterans. The VA and DoD tried to jump-start that effort recently by launching an open-source community to help them design a new combined EHR.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

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