Current VA/Veterans Health Information Exchange (VHIE .

Current VA/Veterans Health InformationExchange (VHIE) Approachto Health Record Integration and AvailabilityJoseph R. Nelson, MSA, Community Engagement Program Manager, VHIE1

Conflict of InterestJoseph R. Nelson, MSA, has no real or apparent conflicts of interestto report.2

Acknowledgements Thanks to Margaret Donahue, M.D., Director VHIE and JonathanNebeker, M.D., Deputy CMIO Work funded by VHA Office of Health Informatics3

Agenda Veteran Health Information Exchange (VHIE) Overview Growth and Progress Sharing More VA Health Information (VA Mission Act Section132) VHIE Modernization Network Expansion4

Learning Objectives Describe the Veteran Health Information Exchange (VHIE)business approach to enable VA to fulfill the requirements of theMaintaining Systems and Strengthening External Networks(MISSION) Act of 2018 Describe VA/VHIE Network Expansion5

How VHIE Provides InteroperabilityThe VHIE Program works toward seamless care between VA andcommunity care providers through their two main products, VAExchange and VA Direct Messaging.VA ExchangeVA Direct MessagingAllows VA to securely exchange healthinformation at the organizational levelAllows VA providers to exchange healthinformation at the individual levelPartners include other federal agencies,health care organizations, electronichealth record vendors, and HealthInformation Exchange (HIE) networksPartners include individual communitycare providers within DirectTrustExchanged health information sharedthrough the Joint Legacy Viewer (JLV)and the My HealtheVet Blue ButtonShare health information through asecure, email-like messaging portal6

Timeline: VA ExchangePre-NHIN*NwHIN* Pilots2006-2008*NHIN/NwHIN – Nationwide Health Information Network7

Timeline: VA Direct MessagingDirect Growth (2014 – Present)Validated Non-VAPartners: 500Shared Messages: 40,0008

Growth of VHIE through 2018Steady growth in # partners, inbound and outbound documents2,500,0002,351,064250197Number of nd Documents999,245881,000,000292Outbound 0*33,49700201520162017Calendar Year20189

10Rapid Acceleration in the last 24 monthsVA Clinicians viewing community health dataCommunity Health Clinicians viewing VA health dataVHIE Inbound ExchangesVHIE Outbound ,000Feb100,000Dec40,000Feb60,000 49,998Dec80,0000*excludes Social 20182018Explosive growth in the last 24 months: 197 partners10

Exchange - Community CarePartners NationwideValue: Over 2,710,246 unique Veteran patients supported by bi-directional health informationexchange with 197 Community Care Partners that support the following types of healthcare facilities.Exchange PartnerDemographicsClinics - 28,974Hospitals - 1,495FQHCs - 818Labs - 975Pharmacies - 8,770Nursing Homes - 267Other Ancillary Sites - nersFY19 PrioritizedPartnersVA Medical Centers11

Direct Messaging: Last 60 MonthsConnected Community ProvidersTotal*: 1,454New in FY19**: 265FY19 Goal: 360Total Direct Messages Sent/ ReceivedTotal*: 91,958New In FY19**: 14,4741000008000060000400002000002000150010005000* 3/1/14-12/31/18** 10/1/18-12/31/18Direct Messaging has grown steadily12

Direct Messaging: ValidatedPartners/Community CareProvidersClinic - 757Hospital - 432LTC/Rehab - 199Home Health/ Hospice - 21Behavioral Health - 19Laboratory - 10Pharmacy - 6FQHC - 5Federal Agency - 3Dialysis - 1CCP/HISP - 1VAMCs with DirectMessaging partnersVAMCs with no DirectMessaging partners yetCommunity care partners/ providersconnected with VA Direct Messaging13

Sharing More VA HealthInformationVA MISSION Act Section 13214

VA MISSION Act Section 132:Improving Information Sharingwith Community ProvidersAmends 38 U.S.C. Section 7332(b)(2)From allowing the Secretary todisclose Veterans’ protected healthinformation with consentTo allowing the Secretary todisclose Veterans’ protectedhealth information without consent(H) To a non-Department entity thatprovides hospital care or medical servicesto Veterans as authorized by theSecretary (H)(i) To a non-Department entity(including private entities and otherFederal agencies) for purposes ofproviding health care, including hospitalcare medical services and extended careservices, to patients or performing otherhealth care-related activities or functions.15

MISSION Act, Section 132VA plans to implement an informed Opt Out model for Veteran careconsistent with DoD and will be available nationwide June 2019Section 132 of the MISSION Act streamlines the VA healthinformation sharing with community partners. It removessharing restrictions between VA and community providers.VHIE will now be securely sharing Veteran health informationelectronically with participating community partners (unlessthe Veteran chooses to not allow VA to share their healthinformation).This does not create an exception to, or weaken in anymanner, the protections of the Health Insurance Portabilityand Accountability Act (HIPAA).16Public Law No:115-182, VA MISSION Act of 2018, was signed June 6, 2018.

Benefits for VeteransSharing health information saves time and improves Veteran care. It could even save aVeteran’s life. The more information a provider has about a Veteran’s medical history, thebetter. Currently, health care providers can share information*, such as: Prescriptions and medicationsAllergiesIllnessesLaboratory and radiology resultsImmunizationsProceduresClinical Notes* Unless the Veteran chooses to not allow VA to share their health information17

Improved Care CoordinationHow will this affect VA clinicians?VA and participating VHIE community care providers have access to complete andaccurate information about their shared Veteran patients. VHIE shares the rightinformation at the right time with providers to improve patient safety, coordination ofcare, and continuity of care for our Veterans.18

VHIE’s Plan for the MISSION ActDramatic GrowthVHIE has growndramatically. Its usageplays an important role inVA interoperability withcommunity providers andthe nation.Current ProductsCannot SustainGrowthVHIE’s current productscannot meet the needs ofthe rapid growth that theVHIE program sees andpredicts.Commercial-offthe-shelf (COTS)Product SolutionA COTS solution will improveVHIE’s performance, and willmeet the expectations ofgrowth moving forward.19

VHIE ModernizationThis effort will modernize the VHIE information system and incorporate newpolicies for information sharing, and supports the following activities: Improve performance Increase Health Information Exchange rates Support Mission Act Support future growth and expansion Improve Data Quality scalability Position VHIE in line with the new Electronic Health Record Modernization(EHRM) transition20

Timeline21

Network Expansion We plan to continue engage with eHealth Exchange partners. As the eHealth Exchange National Level Gateway Service (NLGS)hub becomes available, we plan to connect to it to optimize ourconnections. As we implement the Cerner HIE, we will enable our CommonWellConnection. We plan to connect to Carequality partners and are determining thebest path.22

VHIE Web ResourcesWebsitesVHIE Program - VA Exchange and VA Direct Messagingwww.va.gov/VLER/eHealth Exchange nge/participants/Share Your VA Health RecordHow VA Direct Works video*(Describes the functionality and benefits of VA Directto Veterans and VA /mAIKaUy-7ak23

VHIE Program Office Point of Contacts24

Questions?Visit us online at www.va.gov/vler25

11 Value: Over 2,710,246 unique Veteran patients supported by bi-directional health information exchange with 197 Community Care Partners that support the following types of healthcare facilities. Exchange - Community Care Partners Nationwide Production Partners Testing Partners FY19 Prioritized Partners VA Medical Centers