The Veterans Affairs and Defense departments intend to test more complex health data sets and include more participants in its second "VLER Community" project, the latest in a planned series of live tests of a Virtual Lifetime Electronic Record for military community members and their families.
The first VLER Community test is currently under way in the San Diego, Calif., region and focuses on data-sharing between VA and Kaiser Permanente medical centers.
The second test, scheduled to start in the Hampton Roads, Va.-area on July 31, will pilot data sharing among VA and DOD clinics and several local private sector medical centers from which the military purchases healthcare services.
With each pilot, VA and DOD will test another clinical data exchange function, which, when vetted, would be added to the capabilities of other VLER community pilots, said Stephen Ondra, MD, VA's senior policy adviser for health affairs.
The aim is gradually to build health information exchange features among VA, DOD and private providers who also treat members of the military and veterans.
"We are taking small, quick steps in a purposeful approach," Ondra said at a health IT conference April 6 sponsored by AFCEA Bethesda. "We want to make sure that we have backwards and forwards compatibility, and that it is a smooth process."
Several pilots planned
In the Hampton Roads project, VA, DOD and private providers will exchange laboratory report data in addition to the types of patient data sets shared in the San Diego project, Ondra said. There, VA and Kaiser began in January to swap data in a standard continuity of care document (CCD), such as patient emergency information, allergies, problem and medication lists.
In the next set of pilots this fall, VA and DOD will test the ability of the participating providers to be able to transmit electronic patient consent to share their medical records. "That will allow us to really amp up the size and scale of the project," he said.
Ondra said he expects the VA will roll out VLER nationally in calendar year 2012. "That will mean that any private sector provider can engage with VA through the nationwide health information network," he said, referring to the set of standards and services that enables providers to exchange information securely through the Internet.
Although the San Diego project has been small in the number of participants, the VA has garnered lessons from the experience, which the department is sharing with the Health and Human Services Department, Ondra said.
The VA found that some standards had too much flexibility in how they are put into practice, resulting in allowing "some different interpretation of how the data is presented," he said. "We actually found some problems where we had to go back to our partners and make sure we were defining the same way."
VA will explain to HHS where flexibility in standards was helpful and where it needs to be tightened, he added.
One of the challenges in exchanging health information is in identifying patients correctly, said Norma St. Claire, director of information management in the Office of the Under Secretary of Defense for personnel and readiness, who also spoke at the conference.
Providers need to make sure, "that Joseph Smith is the same person as Joe Smith from this system and J. Smith from that system," she said. "Social Security numbers are something we try not to use. But we are challenged in making sure that people are the same person and the right person."
The VA and the DOD need to be able to exchange health information with private providers because half of their members seek treatment outside of the federal facilities. The VA and the DOD have established interoperability through their bi-directional exchange program and the departments' clinical data repository/health data repository interface. However, said Ondra, these services "don't interoperate with the private sector, so we're leaving half the data on the table."
Ultimately, VLER will incorporate administrative and medical information for members of the military and veterans from the time they enter the service to the end of their lives.
