VA Health Information Exchange Implementation Barriers

Health IT leaders at the US Department of Veterans Affairs (VA) said the complex interrelationship correlation between local and national VA entities is a more significant technical obstacle than the interoperability between the two health IT systems, according to a study published in JMIR Medical Informatics.  

In 2009, VA launched the Virtual Lifetime Electronic Record Health interoperability program, which was later rebranded to the Veterans Health Information Exchange (VHIE) program.

Veteran patient records are available to the Veterans Health Administration (VHA) and outside providers. This interoperable patient record also allows the patient to seek care and bring her EHR to providers outside of the Veterans Health Administration system, a main goal of the 2018 MISSION Act.

The policy enabled VA to share EHR data with outside providers “for the purpose of providing health care to patients or performing other healthcare-related activities.”

The Study authors interviewed several VA HIE implementation leaders at Richard L. Roudebush Veterans Affairs Medical Center (VAMC) in Indianapolis, Indiana. Researchers also interviewed three Indiana Health Information Exchange (IHIE) leaders to further survey implementation details, such as barriers and facilitators.

Overall, respondents said they were enthusiastic about the HIE, and they were optimistic that the VA would “eventually get it right.” All respondents said they imagined a future with accurate and secure patient data exchange.

VA and community HIE leaders said health IT training was a major factor when implementing the HIE. Both respondents said they worked together to implement separate training styles and locations.

The respondents noted the “high-touch approach” training method, which helped enroll patients and ease the opt-in process. Several leaders noted the vast health IT complexity levels as patient data exchange boundaries.

“Part of the complexity stemmed from the interconnected web of information systems and human teams necessary to implement VA-HIE information sharing,” wrote the study authors. “These interrelationships must be effectively managed to guide organizational decision making.”

Sustainability was another common HIE implementation challenge. The most significant sustainability challenge was how to continuously fund VA and HIE integration, the community leaders said.

The VA HIE network must accurately exchange patient data to provide usable results, the groups added.

“We need to have a product that’s prime time ready,” said an anonymous operations leader. “It’s not because the information isn’t there [now]. It is there but we need to have something that’s clinical, that’s usable in a clinical environment that’s fast, that’s structured appropriately.”

A VA health IT leader echoed a similar point of view.

“Obviously, it takes a long time—years, decades—whatever, to get to a point that...the system is mature enough to be able to make it work well across all the different data systems,” the anonymous VA leader said.

Many were proud of the VA’s long history of secure information sharing between VA health care organizations across the country. All leaders, including our community HIE partner, imagined that the need for interoperability between information systems (ISs) would continue to increase in the future. From among the leader interview responses, we describe observations across several phases of HIE adoption: recruitment and consent, training, organizational memory, implementation, and sustainability.

In October 2020, VA launched its Electronic Health Record Modernization (EHRM) system at its initial location in Spokane, Washington. VA will now implement the EHR system at smaller medical facilities across the Midwest, called EHR 1.1. The second round of deployments should occur in spring 2021.

Although numerous delays occurred throughout the implementation process, VA leaders said the updated EHR system should allow the agency to achieve its interoperability and HIE goals.

“The lessons learned advance implementation science and can be applied by other national and regional networks that seek to achieve interoperability goals across health care delivery systems,” wrote the study authors.

The researchers said these interviews provided more information about how data integration across complex networks could work in the future.

“Leaders at one VAMC and its community partner HIE described the importance of information sharing and its value in providing high-quality patient care,” concluded the study authors.

“Further discussion with them revealed the daunting levels of complexity VA personnel navigated to send and retrieve information. These VA and HIE leaders discussed the time-intensive process of asking patients to share their medical records. This VA found success in having veterans speak to other veterans, yielding the highest recruitment levels in the country.”