Diagnosing and treating patients with incomplete information is often a reality in medicine, but officials at the Department of Veterans Affairs are working to fill those gaps by exchanging information electronically with clinicians outside the VA system.
As part of a pilot program launched in 2009, physicians at the VA and Kaiser Permanente in San Diego have been exchanging data on problem lists, medications, and allergies. Although it usually takes weeks for patients to submit requests to get paper records and then bring those to another physician, the test project allows electronic information to be transmitted in seconds.
“The net effect is clearly an improvement in quality, an increase in patient safety, and a tremendous improvement in the efficiency of how we share information and how we deliver the best possible care,” said Dr. John Mattison, assistant medical director and chief medical information officer for Kaiser Permanente Southern California.
Right now, the pilot involves about 450 veterans who receive their health care at both the VA and Kaiser Permanente in San Diego and who have agreed to allow their records to be shared. In the future, VA officials want to expand the pilot to include veterans around the country by partnering with other private health care institutions.
In the first quarter of this year, the Department of Defense will join the pilot in San Diego and begin exchanging patient data with Kaiser Permanente.
This type of information exchange is especially important for veterans, said Dr. Stephen Ondra, a senior policy adviser for health affairs at the VA and a neurosurgeon. About three out of four veterans receive a portion of their care in the private sector, he said, so VA physicians can't provide the best care unless they are able to see the types of treatments and medications they are getting outside of the system. Even though the VA and DOD have been leaders in exchanging information for years, the missing link has been information on care provided in the private sector, Dr. Ondra said.
The pilot relies on standards developed as part of the Nationwide Health Information Network. Using these national standards, clinicians can send electronic patient data securely and privately. In the pilot, the standards allowed the VA's VistA record system to connect with Kaiser Permanente's HealthConnect system.
The Web-based exchange required patients to opt in at both sites of care. Once consent was established, clinicians at both institutions were able select a patient, see their site of care, and pull up information on their problem list, allergies, and medications.
The response from patients has been positive, Dr. Ondra said. After an initial mailing announcing the program, more than 40% of the invited patients volunteered to be part of the pilot. VA and Kaiser officials invited more than 1,100 veterans who had recently received care at both institutions to participate. Although the initial response was fairly high, officials at the two institutions plan to go back and try to get more veterans interested as the project continues in San Diego.
“While this is a major milestone along the way, there is much work ahead of us,” Dr. Mattison said.