The Department of Veterans Affairs has signed up 30,776 veterans so far to participate in the health pilots around the country for the virtual lifetime electronic record (VLER) program, says Roger Baker, VA CIO. Demonstration communities are San Diego, Hampton Roads, Va., Spokane, Wash., and several others.

The pilots with the most veterans participating as of Nov. 22 are the Indianapolis pilot with 6,692; Richmond pilot with 4,643; and Buffalo with 4,359.

With VLER, VA and participating local providers share patient data through access to the nationwide health information network (NwHIN), a set of standards and services to exchange information securely through the Internet.

VA is assessing whether to go nationwide as planned in 2012 with the program to exchange the health records of veterans when they seek treatment with private providers.

“What generates the exchange of the information is that veterans actually show up to be seen at a VA facility or a private sector provider that is part of the health information exchange,” Baker said at a Nov. 23 media briefing.

During the call, Baker answered several questions, what follows are the most pertinent. 

Q: At what point is VA in its implementation of VLER?
Baker: We are in the evaluation phase now for a go or no-go decision for 2012 relative to national availability of the nationwide health information network (NwHIN) portion of VLER. Implementation and interfacing with the Defense Department, the private sector, the Centers for Medicare and Medicaid Services and Social Security and others has gone very well. From a usage standpoint initially, we didn’t see as much exchange of information between VA and the private sector as we had expected. We have seen that picking up as we’ve gotten out to the broader pilots. From an information usability standpoint, we have expanded the data elements that have been exchanged. We know from measurements that when that information is exchanged, it’s very valuable to the clinician to have a list of drugs, lab tests or radiology for the individual.

Q: What other aspects of VLER are gaining traction?
Baker: VA also has a pilot for NwHIN Direct aimed at smaller providers exchanging directly with the VA as well. Our eBenefits site, which is part of VLER, is a joint site for benefits information where you log in as a service member and it carries over when you become a veteran. Over 1 million have registered at that site for information, like their education benefits, status of compensation claims, getting printed copies of their forms.

There are a lot of moving parts to VLER in which we are making progress, like half-a-million downloads on Blue Button so far by veterans and service members and folks who have CMS as their provider who come online and download their information in ASCII format to their computer and they take control of it and share it with whomever they want. Blue Button at this point is exceeding our wildest dreams. The expectation for FY 2012 is upwards of 60 million individuals will have access to their medical information through Blue Button. We’re getting a lot of adoption by private sector organizations.

Q: The Open Source Electronic Health Record Association (OSEHRA) is VA’s path to modernizing VistA and contributing to the DOD-VA integrated EHR. What is the progress in sharing code?
Baker: OSEHRA is progressing slightly ahead of schedule and slightly ahead of expectations. It has been stood up and has made the code available. We expect other organizations will contribute code and proprietary information to OSEHRA and that it will begin to produce capabilities sometime in calendar year 2012.

OSEHRA now is involved in the analysis of the refactoring or restructuring of VistA into something that is more easily modified by private sector organizations. That analysis will be posted in the open source community for comment before we move forward based on it. Internally, we’re quickly moving to the policy that every project we do related to VistA must be done through open source.

Q: How are department employees and contractors reacting to this change to open source?
Baker: The biggest issue is that this is going to cause VA internally to go through a real culture change in the way that we develop software for our medical records systems. The culture change is what we are pursuing at this point. Moving from a culture where we develop, we own, we decide what we’re going to do, to one where we’re working with lots of other interested parties on the technologies that we are moving forward is a culture change for a government organization. That includes all the work we’re moving forward with the iEHR as well.