The Veterans Affairs Department will incorporate options for rudimentary health information exchange (HIE) into its strategy for creating a virtual lifetime electronic record (VLER) for its beneficiaries, a senior VA official said.
Options would include methods for direct secure exchange of clinical messages over the Internet, as well as ways patients could initiate low-level HIE by downloading their own health records to share with a physician or hospital, said Dr. Stephen Ondra, VA's senior policy advisor for health affairs.
VA is in the midst of launching a series of complex health information exchange pilots to test health record sharing with military and commercial "purchased care" providers.
The VLER Community pilots " recently begun in San Diego, Hampton Roads, Va. and soon to start in Washington State " involve testing advanced versions of the Nationwide Health Information Network.
However, many smaller commercial clinics and providers VA hopes to attract to VLER may not have the technical ability to participate in comprehensive exchange through NHIN.
For these organizations, the road to VLER could include other, less sophisticated forms of health record sharing, according Ondra in remarks at the Government Health IT Conference in Washington, DC, on Tuesday.
"VA is pushing out top-down, thoughtful engagements by steps to a full national rollout for VLER," he said. "We'll also look at engaging on these other levels for exchange in providing the encouragement and to get to higher levels of exchange."
These would include a VA version of NHIN Direct, a set of tools now being developed by the Office of the National Coordinator for Health IT, to facilitate simple and secure health messaging and record sharing over the Internet.
The VA will produce a VA version of NHIN Direct, Ondra said.
In addition to NHIN Direct, VA is developing another set of specs, dubbed "Viral VLER," that would enable sophisticated commercial providers not connected to the VLER network to nonetheless exchange patient information with a local VA medical center. VA will provide a primer on NHIN and the VLER requirements to enable that exchange, Ondra said.
"There is tremendous interest and people willing to engage in the field. We don't want to wait, and we're going to learn from them," he said.
Ondra also cited VA's "blue button" initiative as a form of health information exchange that supports the VLER.
VA and the Centers for Medicare and Medicaid Services recently announced they will add to their electronic patient portals a button to enable beneficiaries to download their personal health information into a patient health record or other electronic media of their choosing.
"You've got your health record with your doctor, you click save as and download it to a CD or thumb drive to carry along to another doctor," Ondra said. "That's a low level of exchange but it's a level of exchange, and we want to make sure we embrace this."
Ondar said VA plans to have the health component of the VLER project largely complete by 2012. By then, he said, "we expect to have all VA medical centers connected to NHIN through a gateway and adapter, connected to each other and DOD, as well as any other private sector members of NHIN."
