Improving VA and Select Community Care Health Information Exchanges

The VA Office of Inspector General (OIG) reviewed VA facilities and community providers for usage of health information exchanges (HIEs) in their respective communities and to identify any barriers that may impede the use of HIEs. HIEs share patient health record information electronically and coordinate care for enrolled veterans. The VA MISSION Act of 2018 included language to improve information sharing between the Veterans Health Administration (VHA) and the community. The Veterans Health Information Exchange program office has two methods to share information with the community, via internet exchange (VA Exchange) and email exchange (VA Direct). Exchanging health information electronically provides a secure method for healthcare providers to share veteran health information. The OIG conducted a survey and interviewed the 48 lower complexity level 2 and 3 VHA facilities because of the higher expected use of community providers. Additionally, the OIG interviewed staff from the offices of Veterans Health Information Exchange (VHIE), Information Technology, Community Care, and Rural Health; two state health information exchanges; and Cerner Corporation. VA has two contracts establishing community coordination for VHIE. The performance work statements for the contracts require coordinators to provide training, policy, and process assistance to VHA directors and staff. The OIG reviewed the performance work statements for these contracts. During facility interviews, the staff cited the most challenges in training, the need for more community partners, use of contract community coordinators, and technology. Those using either VA Exchange or VA Direct cited successes and felt with more community participation the goals of the program were achievable. The OIG made four recommendations to the Under Secretary for Health related to the need for increased utilization of VA Direct, education for staff and veterans on VA Exchange and VA Direct, expansion of community partnerships, and use of contract VHIE community coordinators.