A lack of adequate staff training and communication is disrupting the way the VA is able to productively use its variety of health information exchanges.
– Editor’s Note 8/17/2020: This article has been updated with a statement from DirectTrust.
A recent report from the Office of Inspector General (OIG) found training challenges, the need for increased community partners, the use of community coordinators, and technology issues that need to be addressed to enhance the Department of Veterans Affairs’ (VA) ability to effectively utilize its health information exchanges and the ability to exchange patient data.
However, OIG found respondents who utilized either VA Exchange or VA Direct cited successes and said VA goals were more attainable with more community participation.
Patient data exchange and interoperability is crucial for the VA to enhance patient care. Not only does the Veterans Health Information Exchange (VHIE) program use the VA Exchange and VA Direct, which is directly connected to DirectTrust, but it also has community partnerships to promote patient data exchange and accessibility.
OIG interviewed and surveyed faculty at the 48 Level 2 and 3 Veterans Health Administration (VHA) facilities. The group also interviewed the VHIE Program Office, while meeting with the Office of Information Technology, Office of Community Care, Office of Rural Health, Cerner Corporation, and two unnamed state HIEs to gain a variety of differing perspectives.
Based on the VHIE Program Office, 140 VA facilities have access to VA Exchange and VA Direct, but only 28 have implemented VA Direct. Facilities that did not have VA Direct access were either not adequately trained by DirectTrust, did not have community partners that used DirectTrust or were using other HIE options.
“Expansion of VA Direct usage to all facilities would increase the instances of health information sharing and improve the timeliness of health information exchange while efforts continue with development of community partnerships through VA Exchange,” wrote OIG.
“The VA OIG report provides valuable insight and recommendations on how to enhance the Veterans Health Information Exchange program.”
“DirectTrust is a volunteer-driven membership organization and standards body serving as custodian of the Direct Standard, the foundation of Direct Secure Messaging. As such, DirectTrust is not set up to provide end-user training. Typically, vendors provide training on how to use Direct within their platform, as Direct Secure Messaging is implemented differently across vendor platforms. We’re pleased to report that the DirectTrust EHR Roundtable, in which the VA participates, recognizes the variability in utilization across vendors, and is creating ‘best practices’ guidelines to advance the usability and utilization of Direct Secure Messaging.”
“The VA provides a critical service to our veterans, and coordination of care with community partners is extremely important. DirectTrust values our partnership with the VA, and we look forward to continued expansion and improvement of health information exchange and interoperability throughout all of their facilities and with their community partners.”
But according to additional survey responses and interviews from the 48 VA facilities, OIG found 46 facilities use either VA Exchange or VA Direct, while two facilities do not use either. And of those 48 facilities, 22 said they exchange patient data by mail, fax machine, or scanner.
Respondents noted additional training, an increase in community partners, and an overall better understanding of how to use the health information exchanges as common ways to defeat these HIE challenges.
“In addition, facilities reported technology challenges to viewing community health information through VA Exchange, including the dual sign-on requirement for VHA providers to first sign into the electronic health record and then sign into the Joint Legacy Viewer (JLV) to access community partner patient information,” wrote OIG.
“The JLV data quality was not ideal, information naming and access was not user friendly, and facilities reported a cumbersome process that resulted in delays in finding needed information.”
Currently, VA has two separate contracts that establish community coordination for VHIE, and OIG found 56 community coordinators who work to enhance infrastructure, outreach, and training.
But while there are 56 community coordinators, the organization found a varied level of coordinator engagement from high to little or no participation. Respondents also noted that once a coordinator leaves her position, a lack of communication and training issues typically occurs.
“With the addition of more training, communication, and future planned technological changes, VHA could more effectively streamline the continuity of care received by veterans,” OIG wrote.
“Electronic Health Records Modernization should alleviate some of the technology challenges currently experienced with the use of VHIE,” OIG continued. “Cerner reported the implementation of Millennium/Power Chart would eliminate the need for dual sign-in to review community care documents and allow for exchange accesses between VHA, the Department of Defense, and community providers.”
In late April, OIG found major patient safety issues and EHR capability problems centered around the new Electronic Health Record Modernization (EHRM) system and a recent POLITICO report stated VA leaders have acknowledged those issues.
“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,” wrote OIG.
OIG said it would follow up with VA until the recommendations are completed or acknowledged.