When the departments of Defense and Veterans Affairs (DOD and VA) announced in the spring of 2020 that they had established a joint health information exchange (HIE), allowing them access to patient data from each other’s community providers, it was a big deal – but that may not have been obvious to many outside the community who provide medical care to service members and veterans.
Before the joint HIE, the DOD and the VA built their own HIEs through which they exchanged patient data with different community health care providers. A community health care provider had to join each HIE separately to access patient data from both departments. Thus, a community provider, caring for a VA patient, may not be able to access previous record information from the Military Health System (MHS), or from any community provider who cared for the veteran when he or she was in service.
Bill Tinston is the director of the Federal Electronic Health Record Modernization program office, chartered by the DOD and the VA to implement a single, common federal electronic health record (EHR). The joint HIE is part of this larger effort. The joint HIE, Tinston said, breaks down the last obstacle community providers face in accessing the data they need to inform and provide care for patients. “We’ve shifted away from our homebuilt information gateways,” he said, “to a single commercially provided gateway that serves both departments, so that a community provider, or a health information exchange that a community provider belonged to, would only have to sign up with the departments once, and both departments would have the advantage of that bidirectional exchange of data.”
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It’s easy for civilians to imagine why a VA community care provider might need access to MHS community records, but the way in which health care delivery is evolving makes it imperative for information to flow in other directions, Tinston said. One of his colleagues at the Defense Health Agency, for example, is a retired Army officer who was injured in an accident two years ago. “He sees the VA for certain things,” Tinston said. “He goes to community providers for certain things. And he goes to the Military Health System for some things. … If you’re a beneficiary who retired or left the service, you can see whatever community provider you want. You could be referred to those community providers either from the Military Health System or the Veterans Health Administration. And community providers can refer patients to one another.”
The whole point of the joint HIE is to not make distinctions about who is providing care to a military or veteran patient, or where the care is delivered. “It’s about getting the right data about the patient to the provider to support the health care encounter where and when it needs to happen,” Tinston said. While the joint HIE honors all existing provisions protecting patient health care data, the DOD and the VA also honor patient consent by allowing any patient who is not an active-duty service member to opt out of sharing data through the joint HIE.
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About 46,000 community partners had joined the joint HIE by October 2020, when it expanded dramatically: CommonWell Health Alliance, a nonprofit network of more than 15,000 hospitals and clinics, signed onto the network, moving the DOD and the VA one step closer to a nationally interoperable network of data with community providers. The joint HIE, Tinston said, not only simplifies the retrieval of health record information, “It improves the active usability and availability of the patient data, and gets it to the providers on whatever side it needs to be shared, commercially or within the federal government. Providers will be able to make the right clinical decision and deliver better patient care. That’s why it’s a big deal.”
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