VA Interoperability: Are the VA’s Digital Efforts Paying Off?

If you have been following our not-a-blog and the work we do, you know we are interopera-nerds and have covered interoperability on several occasions. There’s a lot to say about large organizations that take necessary steps to modernize their health data infrastructure.

One such organization is the Department of Veterans Affairs (VA), which provides healthcare to America’s veterans. As a massive government agency, the VA has its own unique challenges in addition to familiar health IT needs. The VA is charged with both making health records easily accessible and digitizing those records in the first place.

Over the past several years, the VA has worked to catch up with private sector data sharing. In this first half of a 2 article series, we’ll discuss how they did it. They’ve embarked on a journey of tech-driven interoperability, which came just in time to save lives during COVID-19.

From Dusty Paper Records to Easily Accessible Digital Files

The VA provides care to over 9 million beneficiaries every year within and outside its network. Some of these members have been under VA care for decades, which means millions of paper files containing veteran records that can only be shared manually.

How many files are we talking about? If stacked together, the paper files would be 5 miles high according to a 2019 audit by the VA’s Inspector General. Many of these records were typewritten decades ago, with uncorrectable typos waiting to cause trouble.

Digitization is a surprisingly big problem. A year after the audit was released, the VA was still asking for help to even begin the digitization process. One legislator who supported the digital transition said it was “a long journey, and in all likelihood the challenges will become more numerous moving forward.”

By May 2021, the VA acknowledged it was years behind on fulfilling requests for over 500,000 paper records. Staffing delays due to the pandemic were one of many challenges facing the VA.

MISSION Act Takes The VA In A New Direction — Bi-directionality

The VA does have one advantage over your average health data warehouse. Active duty service members can’t opt out of data sharing, so they’re in the system from a young age.

However, using that data is a challenge. Things were still turning around in 2018, when Congress passed the MISSION Act (really the VA Maintaining Systems and Strengthening Integrated Outside Networks Act. A mouthful, we know).

The MISSION Act made it easier for VA members to receive care outside of the VA system, including nursing homes and urgent care facilities. A side effect of this legislation was promoting health data exchange as a way to ensure out-of-network providers had access to years of VA medical history.

To realize the goals of the MISSION Act, the VA created several agency-wide platforms, including one of the largest Health Information Exchanges (an HIE). Remember, we have an article about HIEs too — great for reading when you’re off duty with some afternoon tea. 

The concept of bi-directionality was key during implementation. Bi-directionality involves both passing and receiving data, so that encounter data outside of the VA can be returned to the VA. After all, veterans are expected to visit the VA system time and again even after receiving private care.

Bi-directionality is one concept that makes a unified record possible. As the VA continues to digitize, it will eventually allow for the creation of integrated, or longitudinal, medical records - essentially, one record per patient. According to the VA, select providers outside of the VA’s existing network now have bidirectional access to a VA patient health records.

Moving from fragmented records to a longitudinal, single source of truth for a patient’s medical history is a basic goal of interoperability for the entire healthcare system. That’s crucial wherever patients are cared for.

HIE integration was a big step forward for the VA as an organization, given that it had previously failed to implement a seamless and secure method of exchanging health data. 

On a human level, it also means that individual veterans will eventually no longer have to memorize, store, or fight to get their data. From now on, it will be simpler for vets to focus on their care.

Stay tuned for our next article, where we talk about what improved health IT made possible!