The Department of Veterans Affairs provides medical care to nearly 9 million veterans, many of whom seek health care from non-VA facilities and providers.

Keeping track of all their health records is a monumental undertaking. But new technology advances are making it easier.

The military healthcare system is built around service members and a unified record follows troops wherever they go. But once they leave the military system, veterans face a bewildering world of choices – ranging from private doctors and insurance to the massive VA system. Maintaining a comprehensive health record in that maze isn’t easy.

Even after years of struggle, VA and Defense Department systems are only partially compatible. The Joint Legacy Viewer (JLV) and a patchwork of other solutions provide VA clinicians only limited direct access to veterans’ military health histories. Today, as the Defense Department begins to roll out its new electronic health records system, the hope remains that sooner rather than later the two agencies can lick this problem.

The question is how.

One option is to wait for DoD to complete its EHR rollout, then expand the system to include VA, as well. Another is to rely on JLV and several other stop-gap technical solutions now in place. But a third way could offer the best chance for progress: expanded use of health information exchanges (HIEs).

Advances in commercial HIEs could be the key to making the whole system more transparent to patients and providers alike. HIEs act as translation software, enabling disparate health systems to interpret shared data even when they use different formats and codes to organize their records.

Both DoD and VA already use HIE technology to share data today. The Bidirectional Health Information Exchange (BHIE) enables VA practitioners to see defense records now. But commercial applications have now advanced to the point where HIEs now routinely and transparently share data across the industry, suggesting that VA and DoD could share more now if they adopted those solutions.

In the state of Maine, where 12 percent of the population are veterans, VA joined a statewide HIE called HealthInfoNet in 2013. The system shares data with 37 acute care facilities and more than 500 ambulatory practices, including VA facilities across the state.

“The value of the HealthInfoNet HIE goes beyond a shared record,” explains Shaun Alfreds, chief operations officer at HealthInfoNet. “It is one patient, one record: Within three clicks, providers and patients can get a statewide view of a patient, aggregated and standardized.”
“If the VA wants to support veterans right now, then perhaps having an HIE serve as an intermediary [between the agency and DoD] might be the right solution,” Alfreds says.

Robert Guajardo, director of software engineering with General Dynamics Information Technology, agrees. “Utilizing a federal HIE will be the fastest way to share patient records between the DoD and the VA – while having the added benefit of creating a consolidated patient record that can be viewed and shared across the entire VA.”

Suzanne Cogan, a vice president with Orion Health, whose Amadeus platform underpins HealthInfoNet, says HIEs have come a long way in recent years. “In the beginning, you saw federated HIE models that were based on query and response,” she says. Back then, providers would request a record, view it, and then manually pull an image of a record into their own medical record systems. The Joint Legacy Viewer, which gives VA a window into DoD health records, follows that model.

But newer HIEs employ a centralized architecture that supports more functional records transfers.

By consolidating patient records from multiple providers in a single one-patient/one-record system, HealthInfoNet has helped streamline care, avoiding duplicative procedures and flagging providers when patients show up seeking expensive emergency room care when other options would be more cost effective.

“Some patients are using the emergency department for conditions that don’t need” that level of care, Alfreds says. With the HIE“ providers can assign care management to patients so they can make better choices.”

On a macro level, the HIE also supports what Alfreds calls public health surveillance, providing state health officials the ability to monitor statewide trends in real time.

Cogan agrees: “You can do more with the curated and aggregated data, such as predictive analytics” that can spot health care needs ahead of time, so medicine or other interventions can be pre-positioned ahead of a health crisis.

For a vast agency like VA, which is transitioning from having once provided all its own care to a model where more patients now use private health care providers, HIEs promise the means for capturing, coordinating and tracking care from multiple providers.

“Soldiers leave military service where DoD medical personnel know everything about them and suddenly they are on their own,” says Cogan, who is married to an Army veteran. “It’s critical for the veterans with health care problems – especially in this era of increased veteran suicide – to get continuity of care after they leave the service.”

The original article can be found at the GovTech Works site here.