How the Veterans Administration is Accelerating Interoperability

Moving clinical data and images across America’s largest integrated health system.

While serving in the military, many service men and women experience health risks that civilians would never imagine. Active duty personnel transitioning to veteran status are offered social services, including healthcare, through the Department of Veteran Affairs (VA) to support reintegration into civilian life.

Overseen by the Veterans Health Administration (VHA), healthcare services include any and all types of medical care from mental health counseling to management of chronic health conditions and everything in between to approximately 9 million enrolled members. Offering convenient services and coordinating care across the largest integrated health system in America is a challenge. VHA is on a mission to better serve its patients with easier access to care.

Developing a connected care network

By expanding care options for veterans, especially those in rural areas, through the MISSION Act, the VA has created a growing network of nearly 2,000 non-VA providers nationally where veterans are receiving care. Over one-third of veterans that VHA serves seek some form of care through these community care network (CCN) providers.

To be most clinically effective, and as routinely occurs in private care, referral providers (CCN providers in the context of the VA) must have access to the medical history and essential records of the veterans in their care. Unfortunately, historical VHA medical systems were not built with the intent of ever sharing patient data outside of the tightly controlled and secure military-like environment. So, as it exists today, veterans records are primarily shared through manual efforts – CDs for imaging and paper files for other data types.

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Not only does this increase risk of delay in essential care, but it also increases the risk of avoidable medical errors and can lead to poorer care coordination than that experienced by non-veterans in the private systems where essential data is becoming more accessible daily. Compounding the clinical impact of poor data access, the cost of these outdated data exchange practices is huge. The VA spends an average of more than $170 million of taxpayer funds per year for unnecessary repeat imaging and dependence on CDs.

The technology available today can drive that cost down while making data exchange more efficient. To modernize and improve patients’ experience and providers’ need for data, the VA is on its way to establishing digital connections with its CCN network that will accelerate interoperability and enhance access to electronic health data for both veterans and providers.

9,000,000 patients create a lot of data

Every patient encounter generates a considerable amount of clinical data, from patient demographics to imaging orders, reports and scans. Together they create a comprehensive explanation of a patient’s health. But more often than not, the data is disparate – diagnostic images are trapped in a silo separate from lab data or separate from pathology data which is, then, separate from the electronic health record (EHR).

Providers often have an incomplete patchwork of patient data when providing optimal care requires that patient information be available to any provider at the point-of-care. Healthcare data is still far from this ideal, and this important clinical information is often inaccessible when it is needed most.

When treating veterans found to have a higher instance of substance use disorders, depression anxiety, post-traumatic stress, or other mental health conditions, and traumatic brain injury than civilians, data access and exchange across care teams is even more vital. It is not unusual for veterans to have chronic or complex conditions that need to be managed by multi-disciplinary clinical teams, including primary care physicians, specialists, radiologists, second opinion specialists, physical therapists, and so on.

A patient’s entire care team should have information access in near real-time, and each provider should be aware of what other clinicians involved have done, noticed, or thought, no matter what their specialty or where their facility is located. And when treatment is complete, records concerning treatment in a private facility need to make it back to their VA primary care physician.

Adopting technology to resolve interoperability challenges

Interoperable technology to exchange important clinical data and images has existed for nearly 15 years, but adoption has been slower than the need. Implementing new technology and driving change management within a healthcare facility to shift workflows and processes across a health system as large as the VA is a huge undertaking. It may involve growing pains during the transition, but the value of enhanced accessibility of data will be substantial in addition to significant cost savings when repeat imaging is reduced and outdated technology eliminated.

Historically, health data generated by devices and systems, such as imaging machines were not designed to communicate with similar devices by other manufacturers. Additionally, valuable clinical data is often in unstructured formats, difficult to convert to movable, digital formats.

Clinicians that rely on fax machines, pagers, and landlines, or worse – crucial diagnostic imagery traveling via CD taped to a trauma patient’s chest – can resolve these challenges with interoperable technology.

The rules apply to everyone

The VA is not the only health system with data sharing challenges and reliance on outdated physical media and technology. However, that is changing with the finalization of the federal interoperability rules in 2020. The data sharing rule from Office of the National Coordinator for Health IT (ONC) requires the adoption of modern technology to accelerate interoperability and has jurisdiction to enforce hefty monetary penalties for those that practice info-blocking after the upcoming April 5, 2021, compliance date. It sets out parameters for clinical data that is required to be available in electronic format with milestones to expand on those requirements over time.

These rules will have a tremendous impact on advancing interoperability with a mission to improve care and keep patients at the center with access to their health data in convenient formats. Veterans and civilian patients alike will be able to access their health data and share it with care teams through apps, creating an experience similar to how banking information is accessed and money is transferred or how photos are shared through the cloud.

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