From left, Meg Marshall, the VA's director of informatics and regulatory affairs, and Dr. Jonathan Nebeker, the VA's executive director of clinical informatics and CMIO, present at HIMSS26 in Las Vegas.
Photo: Andrea Fox/HIMSS
LAS VEGAS – Earlier this month at HIMSS26 here, leaders from the U.S. Department of Veterans Affairs offered updates on how the agency is operationalizing interoperability, strengthening cross-sector collaboration and accelerating data exchange outside the VA system to improve care coordination with community providers that treat veterans.
During the session "Setting the Standard: VA's Leadership in Advancing Interoperability Through the Veteran Interoperability Pledge and National Initiatives," agency leaders explained how efforts such as the pledge could be a catalyst for standards adoption and shared accountability.
They also showed how the Veteran Confirmation API can help outside provider organizations more easily confirm a patient's veteran status, enhance access to VA benefits and improve health outcomes within their existing workflows.
Use of the API has already helped veterans seeking care at upward of 20 participating health systems outside of the VA system and made them aware of their VA benefits, said Meg Marshall, the VA's director of informatics and regulatory affairs.
It's "really become a mechanism for us to reach out not only to the veterans that haven't raised their hands as veterans within the health system, but to really get a mechanism for education," said Marshall.
With the Veteran Interoperability Pledge, meanwhile, the agency is engaging with outside providers and vendors to improve data quality and other strategic initiatives.
"As a geriatrician, most patients have had private health insurance," said Dr. Jonathan Nebeker, executive director of clinical informatics and chief medical informatics officer for the VA.
While the VA is focused on VA-paid care, "I have to coordinate all this – all the care [patients are] getting from their private insurers as well as from VA-paid care that they're getting in the community," he said.
The agency's pledge targets veteran care improvements outside of the VA health system, but driving enhanced provider data quality and exchange initiatives that can support all patients because it generally improves coordination across payers, according to Nebeker.
"This is not about the VA telling them what to do, but the VA really empowering them to lead pilot implementations and then scale those nationally," he said, noting that the pledge goals were written with healthcare systems' input.
"We want to make sure that we have a quality assessment for the entire veteran's care, not just the care that the VA may be paying for," he explained. "We want to see better benefits coordination."
The API is a simple way for providers to implement programs for veterans, and it does not exchange any protected health information.
"Basically, it's a demographic match, and it runs against a VA master list of Title 38 veterans," Marshall explained. "It will return, based on your demographics query, a 'yes' or an 'I don't know.'''
Once the AI returns an answer, each healthcare organization can create a veteran indicator in its electronic health records to trigger an action that may get them that much closer to using the VA benefits they may be unaware of.
For example, Boston-based Tufts Medicine has used the API to make a payment policy decision. A veteran "will not go into collections if they're behind on their bills," Marshall explained.
Making veterans aware of their benefits
Another health system has trained its administrative and clinical staff to offer a patient with a veteran indicator a brochure on accessing benefits.
"If they hadn't been aware of benefits before, now they have their local VA contact that they can get in touch with," she said.
Because some hospitals and health systems are using the API to identify eligible veterans, their veteran patients may receive VA benefits for specific conditions, even if they aren't enrolled in the VA system, Marshall explained.
There are benefits under the Compact Act, which expands suicide prevention care to veterans, and the PACT Act, which provides VA-funded care for diseases that relate to known toxic exposures during their military service.
"You don't have to be an enrolled veteran at VA to be covered for these benefits," Marshall said. "Since this program has been live with the few that we have live right now [18-19 health systems as of the session], we've already identified a million patients who are veterans across all of those health systems."
With military toxic exposures, there are 38 presumptive diagnoses, she noted. The PACT Act, made law in 2022, added 20 new presumptive conditions and locations for Agent Orange and radiation exposure, and authorized toxic exposure screening for every veteran enrolled in VA Healthcare.
Informing veterans of their potential opportunities for PACT Act care and benefits became an important focus of VA outreach.
"What we're finding is, and it varies depending on population, but anywhere between 2% and 8% of these queries that we're receiving are coming back as veterans," Marshall said of the API's efficacy.
Sanford Health, the largest rural health system in the United States, has created an algorithm that can identify veterans with status confirmed by the API against the PACT Act's 38 presumptive diagnoses, she said.
The result is a patient engagement workflow within its EHR that prompts caregivers to ask their veteran patients about related screenings.
Tacoma, Washington-based MultiCare Connected Care is another API user connecting veterans to their local Veterans Service Organizations. Under the Veteran Interoperability Pledge, the health system is now working with the VA on a workflow to determine a veteran's disability status and screening eligibility.
This past year, Healthcare IT News spoke with Matthew McCay, MultiCare's veteran advocacy manager at Yakima Memorial Hospital, about how the Veteran Confirmation API had already enabled the health system's doctors to rectify medication lists at the point of care, as well as connecting them to their VA benefits.
McCay said that "situational awareness" has proved invaluable to patient care, especially for veterans who are dual managed with the VA health system. "We have two different medication lists that sometimes we need to reconcile, and we are only aware of one."
Enhancing data quality, ensuring compliance
Data quality is another important focus under the VA Interoperability Pledge. Healthcare systems can access APIs, but the data may not be usable because of how individual healthcare systems configure their systems to exchange data.
"Without the quality data at the data element level, you can't do the rest. [Artificial intelligence] won't fill the gap," said Nebeker, who recommended that health systems get involved with the PIQI Framework to improve the quality of electronic patient data.
He also said that clinical exchange with FHIR-based APIs is a future practice area that could help the agency capture patient health data for veterans who have not been to a VA facility.
If a veteran who has been flagged through the API has never been to a VA hospital or clinic, they won't have an agency EHR record, he noted.
"I think that might be where we would start seeing the intersection of where that community provider wants to send and receive data from VA, even if [the veteran] hadn't been enrolled before," said Nebeker. "If they are being referred there, there's probably a vested interest with that health system to maintain some sort of communication [with the VA]."
He added that by joining the VA Interoperability Pledge, private entities (health IT companies can and have joined the pledge, too) may not only improve veteran care and help them access their VA benefits, but can also get involved in deeper conversations about interoperability compliance on the federal level.
While the VA does not regulate interoperability, it can act as an advocate in conversations with the Department of Health and Human Services for health systems that have taken the pledge, he said.
"It gives [providers], by working with us on the Veteran Interoperability Pledge, an inside track to getting to policymakers," said Nebeker. "It's not like you're going to get direct influence on policy; no, that's not going to happen – everything will still be proper – but it helps us be a better advocate."
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
