- In a recent letter to the Department of Veterans Affairs, The Pew Charitable Trusts has called on Secretary David J. Shulkin, MD, and the federal agency to prioritize health data exchange and patient safety in its forthcoming EHR implementation.
“As the VA enhances the health IT used as its facilities, advances in the interoperable exchange of health data and patient safety can improve quality and seamless care for veterans,” wrote President & CEO Rebecca W. Rimel. “We encourage the VA to prioritize these issues as the agency transitions to a commercial-off-the-shelf (COTS) electronic health record (EHR) system and embarks on other efforts to upgrade its health IT systems.”
In early June, Shulkin announced the federal agency’s decision to replace its VistA EHR after decades of development and support with a commercial EHR replacement technology similar to that developed by Cerner and being implemented by the Department of Defense Military Health System, MHS GENESIS.
Pew leadership seeks to keep VA to its word that its health IT investments will lead to improved health data exchange between the two federal branches.
“That information sharing is essential to successfully implement your vision of seamless care, which is the ability for clinicians to have the data they need to coordinate how they treat veterans,” Rimel added.
Likewise, the organization emphasized the importance of health IT interoperability between providers at public and private facilities. “In addition, as veterans seek care outside the VA in private practices and from specialists, the exchange of their information to those facilities and back into the VA system is similarly important for seamless care,” she continued.
To achieve these improvements to health data exchange and patient safety, Pew identified three challenges for VA to address.
The first is positive patient identification:
To achieve seamless care for veterans, health IT systems should be able to accurately match records wherever they are located. As part of Pew’s focus to advance patient matching on a national scale, we are examining multiple approaches—including the use of unique identifiers (i.e. biometrics), enhanced use of demographic data elements, and patient-led solutions. We encourage the VA to study and prioritize enhancements to patient matching as part of its health IT strategy, and coordinate with the private sector. Such prioritization may include regular analysis or publication of the match rates, or setting requirements for accurate match rates (i.e., the percent of records that must be automatically matched without human intervention) between the VA and the DoD or private practices.
Another is the advanced use of health IT standards for clinical data elements by reducing variation. Doing so would require leaders from VA, DoD, and the private sector to “agree on how to communicate information” for the benefit of veterans.
Concomitant with its recommendations for patient matching and health IT standards, Pew has advised VA to collaborate with the private sector on EHR testing and health IT-related patient safety.
“EHR developers currently test their products to gain certification according to criteria set by the Office of the National Coordinator for Health Information Technology (ONC),” Rimel explained. “That testing often focuses on whether the technology can perform certain functions (such as medication orders), but not whether it can do so safely (e.g. ensure the right dose). To further safety, the VA can ensure that the health IT implemented is tested for safety throughout its life cycle — including during development and after implementation in a facility a facility.”
Additionally, Pew has recommended that VA work with its federal partners — namely DoD and ONC — and the private sector to ensure patient safety beyond the four walls of its own facilities.
“By prioritizing ways to enhance patient matching, the standardization of data, and EHR usability, veterans can have assurances that they are receiving high quality, seamless, and safe care,” Rimel concluded.