VA, Kaiser Permanente launch e-health records exchange

Integrated eHealth Records system will be offered to 5.4 million veterans

In a first-of-its-kind public-private partnership, health care network giant Kaiser Permanente and the U.S. Department of Veterans Affairs today unveiled a pilot program they have been using to share patient electronic health records (EHR) over the past several months.

The program connects the VA's VistA (Veterans Affairs Health Information Systems and Technology Architecture) and Kaiser Permanente's HealthConnect electronic health records systems. VA beneficiaries and Kaiser Permanente members in the San Diego area were the first to be offered the opportunity to sign up for the pilot. The VA is the nation's largest integrated health care system, serving 5.4 million veterans out of 7 million eligible current and former service members.

The information, which the patient must agree to share, includes any previously diagnosed health problems, medications and allergies.

At a San Diego press conference, Dr. Robert M. Smith, chief of staff of the VA San Diego Healthcare System, compared the importance of the electronic health information program to the first moon landing, saying, "Much like President Kennedy's charge, we're going to take President Obama's charge [to create a nationwide EHR system] and move forward quickly."

Dr. Stephen L. Ondra, the VA's senior policy adviser for health affairs, said three out of four U.S. veterans and active duty service members receive some portion of their health care outside of the VA or Department of Defense facilities. Interoperability between federal agencies and the private sector is essential to providing the best care for veterans, service members and their dependents, Ondra said.

With the new health data exchange capability, when a veteran visits a clinician, medical history data will be available instantly to help guide treatment in any Kaiser location that participates in the program. Before this project, patients frequently consented to sharing this information, but it could take weeks or even months for doctors to receive the paper documents.

"What we have achieved with this pilot is that process of taking weeks to get stale paper records now occurs in seconds," he said. "So the net effect is clearly an improvement in quality, an increase in patient safety and a tremendous improvement in efficiency in how we share information and deliver the best possible care. This is the first of many steps to come."

Ondra said that if any physician was asked to choose three things he could know about a patient from an outside institution, he would pick health problems, medications and allergies. "That's why these things were selected for the first three," Ondra said.

Although the data exchange is Web-based, the pilot program has less to do with proprietary technology and more to do with using a set of standardized protocols for displaying patient information on a common network that allows two computer systems to view data regardless of the underlying software or computer systems.

The organizations are using the Nationwide Health Information Network (NHIN) to exchange data. The network was developed over several years by the U.S. Department of Health and Human Services (DHHS) Office of the National Coordinator. In June, the VA and the DOD agreed on a single NHIN standard.

Almost two-dozen public and private health care entities are testing the NHIN. In February of 2009, the U.S. Social Security Administration started receiving EHRs from MedVirginia, the regional health information organization for Virginia.

According to Smith, of 1,144 recent VA patients who were asked if they would be willing to participate in the information exchange, 40% said yes. "We think we can get a higher number by following up and making sure they know what kind of an opportunity this is for them," he said.

The NHIN provides a technology "gateway" to support standards and a legal framework for the secure exchange of health information between physicians treating a patient who has authorized the release of his medical information. Clinicians from the participating organizations can electronically, securely and privately share authorized patient data, ensuring round-the-clock access to critical health information, the DHHS said. This immediate electronic access supports increased accuracy, efficiency and safety. It also helps to avoid redundant care and testing.

Smith said the same NHIN framework that allows information exchange also enables accountability. "Any retrieval of information also results in the recording of [data] to track who pulled up that information," he said.

A national effort is under way to promote the use of EHRs that can be shared among multiple health care facilities, eliminating the need for patients to physically carry their health records with them from one doctor's office to another.

As part of the American Recovery and Reinvestment Act, $19 billion has been earmarked for health IT spending, $17 billion of which is designated for incentive payments for e-health records use beginning in 2011. To date, however, only about 25% of the nation's 5,000 hospitals have rolled out EHR systems, and only a small fraction of physician practices have done the same.

Part of the problem has been a lack of standardized methods for sharing patient data between disparate computer systems as well as the government's slow progress in establishing what will constitute "meaningful use" of EHR technology for the purposes of federal reimbursement monies.

Smith said that similar to financial institutions' ability to securely and seamlessly share customer information from different locations and systems, EHRs from different systems can securely provide access to health data from multiple sites of care.

The next phase will add the DOD's health care system to the exchange in the first quarter of this year. The program will eventually be made available to all 5.4 million veterans who receive benefits from the VA and all military service members.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure, and health care IT for Computerworld. Follow Lucas on Twitter @lucasmearian, send e-mail at or subscribe to Lucas's RSS feed .

Copyright © 2010 IDG Communications, Inc.

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