September 01, 2020 – The VA Office of Inspector General (OIG) recently uncovered various technology challenges associated with health information exchange in various VA facilities, which are preventing utilization.

The OIG surveyed and interviewed the 48 lower-complexity, Levels 2 and 3 Veterans Health Administration (VHA) facilities.

Additionally, watch dog interviewed staff from the VHIE Program Office, and met with the Office of Information Technology, Office of Community Care, Office of Rural Health, Cerner, and two state HIEs.

OIG found that provider challenges included the need for dual sign-in to view community health information through Computerized Patient Record System (CPRS), JLV training, and the need for community partners.

The same concerns with providers were also concerns for the VA facilities as well.

The OIG also noted common concerns shared by the facilities, including knowing when community documentation was available and the time it took to locate the document.

The Veterans Health Information Exchange (VHIE) program leaders stated that JLV is the software used by VA providers to view community care records for patients, but there is no alert notifying providers.

Some facility staff reported that their administrative staff notified clinicians that data were available as part of the alert process. But others use the JLV Remote Data button, which was not always reliable.

Specifically, more than half the facilities reported lack of alerts. But the facilities that were using VA Direct stated that they received an email when community providers shared health information.

Once in JLV, providers reported challenges with loading documentation and said that “it look additional time and made it difficult to quickly review the information.”

In its 2018 Annual Update to Congress on the Adoption of a Nationwide System for the Electronic Use and Exchange of Health Information, the Office of the National Coordinator for Health Information Technology said, “the cost of developing, implementing, and optimizing health IT, is a barrier.”

Other barriers included limited interoperability and legal and business incentives.

Essentially, these challenges could create an inability for a community provider to share information through a health information exchange.

“One facility indicated that if a community partner used VA Exchange, a successful exchange of health information occurred; another facility stated that once documents are completed by the community partner, the information is available in JLV almost immediately,” OIG stated.

Overall, the OIG found that eight percent of the 48 facilities surveyed did not believe VHIE was meeting its established goals of improving care coordination and continuity of care.

Additionally, these facilities said that VHIE was not creating immediate provider access to health information electronically or creating access by non-physician team of providers for care coordination.

These facilities noted that overall, HIE has not been leveraged to the fullest extent possible.

In contrast to health information challenges that facilities frequently reported, OIG found examples of VHIE meeting the above established goals.

For example, one facility stated that before VHIE, community partners could not access VA patient information 24 hours a day. This is a challenge, especially for care provided after hours.

Despite potential challenges, electronic exchange of health information benefits health professionals by improving patient safety, continuity of care, and cost reduction associated with readmissions and procedure duplications.

In the past few years, HIE use has increased across the nation.

In 2018, the Statewide Health Information Network (SHIN-NY) reported that its HIE use of admission, discharge, and transfer (ADT) notifications grew by 95 percent among users from 2016 to 2017.

Additionally, optimized HIE use can play a critical role during public health crises, including cases of natural disasters.

“By working together, our HIE members are uncovering ways to better serve vulnerable populations and provide valuable support in emergency preparedness and response to natural disasters, for example,” SHIEC CEO Kelly Hoover Thompson, said in a statement.

“We all get stronger through collaboration, and together, our members are playing an important role in addressing and overcoming health disparities across the country.”