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Improving VA and Select Community Care Health Information Exchanges

Report Information

Issue Date
Report Number
20-01129-220
VISN
State
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Hotline Healthcare Inspection
Report Topic
Electronic Health Records Modernization (EHRM)
Recommendations
4
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
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.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The Under Secretary for Health reviews the barriers related to the utilization of VA Direct and ensures the Veterans Health Information Exchange Program Office increases the number of facilities using VA Direct as a secure option to share health information.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The Under Secretary for Health ensures the Veterans Health Information Exchange Program Office evaluates the VA Exchange and VA Direct training and education programs and increases accessibility to Veterans Health Administration staff, community partners, and veterans.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The Under Secretary for Health ensures the Veterans Health Information Exchange Program Office increases the number of community partners, including more state exchanges and other Health Information Exchange stakeholders, to facilitate the expansion of bidirectional health information exchange.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The Under Secretary for Health confirms the Veterans Health Information Exchange Program Office evaluates the performance work statements of the Veterans Health Information Exchange community coordinators and ensures compliance with the scope of work.