Would Increase File-Sharing With Community Providers
Rep. Tom Barrett (R-MI)
WASHINGTON, DC — While DoD and VA have strived for years to create a system that can encompass a veteran’s lifetime healthcare record, such a thing does not currently exist due to data gaps between the federal agencies and private providers, health experts say.
Thanks to legislation passed at the beginning of the year, those gaps may soon be bridged.
For years, lawmakers have received reports detailing VA’s difficulty in sharing and receiving records with community-care providers, resulting in delays in care and incomplete patient medical records. Now, as part of the Elizabeth Dole Act signed into law in January, VA has been directed to adopt health information interoperability standards for itself and its community partners.
“Roughly one-third of VA care is provided through the community care network [and] every appointment produces new information,” explained Rep. Tom Barrett (R-MI) at a hearing of the House VA Subcommittee on Technology Modernization. “VA has made a ton of progress exchanging data with larger hospital systems but struggles to exchange data with many smaller hospitals and physicians’ offices. There’s only so much a provider can do with all these results, if each hospital documents and displays the results differently. This is the difference between a read-only file and data that is searchable, sortable and able to be analyzed and utilized.”
In the past, the barrier to this kind of seamless record-sharing was technological. Hospitals were working with different computer systems, and many physicians’ offices were still using paper health records. According to lawmakers and other health information experts, the issue is no longer technological but a matter of policy and organizational will.
Invited to speak at the hearing was Rick McGraw, chief growth officer of the Michigan Health Information Network (MiHIN)—a public/private partnership formed in 2010 and housed in the state’s Department of Health and Human Services. Their work, McGraw testified, is proof that seamless sharing among multiple healthcare organizations is possible.
“Since the MiHIN’s inception in 2010, we have interfaced with nearly 80 individual electronic health record systems (EHRs) and two national networks,” McGraw said.
The network facilitates data-sharing between hospitals, primary care facilities, payers, community mental health facilities, skilled nursing facilities and local city and county health departments, among other clients. Since 2010, it has routed over 8.3 billion pieces of healthcare data across the state.
However, according to McGraw, both VA and DoD remain cut off from their network.
“If a veteran goes to their primary care doctor who uses one EHR but also goes to a community mental health facility that uses a different EHR and also sees a specialist on a third EHR, without an HIE like MiHIN, these providers wouldn’t be able to access critical patient information from those other encounters,” McGraw said. “Because of our broad network of connectivity, MiHIN has all interactions from all three facilities available in that patient’s longitudinal record to improve overall care coordination. Today, however, in Michigan, the VA and DOD are a blind spot to a veteran’s overall healthcare. The VA does not only not submit data through the network but cannot access its patients’ records from encounters outside of the VA.”
He added, “There is no such thing as a lifetime record of a veteran’s healthcare existing in one system. It simply does not exist.”
VA’s Chief Medical Informatics Officer Jonathan Nebeker, MD, MS.
VA is currently not a member of any regional HIE, explained VA’s Chief Medical Informatics Officer Jonathan Nebeker, MD, MS.
“We’ve been in discussion on this topic for about 10 years on how we participate or not,” he said.
Nebeker called the data-sharing provision in the Dole Act a gift, saying that it would push VA to “do things the same way as the rest of the community.”
When VA has a different process for record-sharing, it puts a burden on smaller providers, who must create a separate workflow for what amounts to a small percentage of its patient load, he said.
Democrats on the subcommittee noted that, while technology may no longer be a barrier to data sharing, recent firings at VA are.
“While it’s great that VA is exempting doctors and nurses from these cuts, that ignores the fact that there are dozens of other jobs, clinical and nonclinical, that make delivery of healthcare possible,” said Rep. Nikki Buzinski (D-IL). “For example, scanning and file clerks in the health information management service were impacted in the secretary’s probationary employee purge. Without sufficient HIM scanning and filing clerks, medical records will continue to pile up, not being entered into the veteran’s files, and further risking quality of care.”
The Dole Act gives VA a year to submit a report detailing initial steps to improve data-sharing, and five years after that to make the first update in quality standards.