This story has been updated with a clarification from DirectTrust.

The Office of Inspector General released a report this past week evaluating how Veterans Affairs facilities are using health information exchanges to share information and coordinate care.

The report, "Improving VA and Select Community Care Health Information Exchanges," found that only 28 VA facilities out of 140 had implemented VA Direct, which allows providers to send and receive patient information over the internet via encrypted messaging. 

Meanwhile, every VA facility has used VA Exchange, which shares health information with community partners via eHealth Exchange.

Associated costs, technological hiccups, the need for more community partners and training deficits were cited as barriers to program implementation.

"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 the OIG in the report.

WHY IT MATTERS

The ability to share health data has become increasingly important to safeguard continuity of care, reduce costs from duplicated services and improve patient safety. From 2009 through 2012, the VA implemented a HIE pilot among 12 facilities, eventually leading to VA-wide expansion of HIEs and a rebranding in July 2014 to the Veterans Health Information Exchange.

VHIE enables VA and community providers to share health information through VA Exchange and VA Direct.

Although there are no costs to share information via VA Exchange, becoming a member of eHealth Exchange costs between $5,000 and $27,000 annually.

A community partner must be a member of DirectTrust, which has costs associated with it, to exchange trusted, identity-verified endpoints within the DirectTrust Network.

Although the OIG reported that community members could not exchange information using VA Direct without being a member of DirectTrust, DirectTrust President and CEO Scott Stuewe clarified after publication that VA community partners do not need to be a member to send messages to or receive messages from the VA using Direct Secure Messaging.

"The VA became an Accredited [health information service provider] in 2019 and retains this status through September 2021. All VA community partners using 2014 and forward Editions of certified electronic health record technology can use Direct Secure Messaging within their platform," said Stuewe.

Some of the smaller facilities in rural locations reported that costs prevented community partners from joining an HIE or DirectTrust.

Other provider challenges included technology, such as a dual sign-on requirement to access patient information.

The OIG found a need for increased training and communication, noting that some staff had trouble evaluating the differences between VA Exchange and VA Direct.

THE LARGER TREND

In 2018, VA announced that it was contracting with Cerner to overhaul its legacy EHR, a project slated to take a decade and cost $10 billion. 

Although the OIG report noted that the EHR modernization would address many of the issues it outlined, the project has also been delayed because of interoperability problems and enduring complications stemming from the coronavirus pandemic.

"With the expansion of community partners and the ability for bidirectional sharing, EHRM implementation could help create a seamless platform that should provide VA the ability to ensure secure access to all available veteran health information," said the OIG report. 

"According to the VA Executive in Charge, the deployment of the initial testing phase of the EHRM has been postponed from its scheduled implementation date," it continued.

ON THE RECORD

"VA’s use of VA Exchange and VA Direct to electronically share health information with community partners coordinates and could improve the continuity of care for veterans. Expansion of utilization of VA Direct by all facilities could possibly increase the timely exchange of health information while VA continues developing community partnerships through a common HIE," said the OIG report.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.