Evaluating Patient-Mediated Health Information Exchange

BACKGROUND:
Effective health information exchange (HIE) is intended to improve communication by allowing information to follow the patient across care settings and systems to provide safer and more effective care. In 2013, VA's Office of Rural Health and the Department of Health and Human Services (Office of the National Coordinator) partnered to promote the use of My HealtheVet's Blue Button capability to facilitate the transfer of Veterans' health information to non-VA providers to improve care coordination for Veterans living in rural settings who use both VA and non-VA care (dual users). This partnership resulted in the Veteran-Initiated Electronic Care Coordination pilot study, which sought to: 1) train rural-dwelling dual-use Veterans to use Blue Button capabilities to share their health information with non-VA providers, and 2) evaluate whether or not the availability of VA information during community clinical encounters impacted the care they received. From September 2013 through September 2015, Veterans (n=620) from nine VA healthcare systems were enrolled and trained to access and share their VA Continuity of Care Document (CCD) with their non-VA providers. [CCD is part of My HealtheVet.] Veterans were then asked about the quality of training materials, experiences in accessing their CCD, perception of the CCD for sharing information with their community providers, and intent to use the CCD in the future. After training, 256 Veterans attended 277 community appointments, with 133 non-VA providers completing a survey on their experience with the CCD. Providers were asked about their satisfaction with the CCD, including whether it had an impact on the care they provided, such as improving their ability to have an accurate medication list for patients.

FINDINGS:

• With brief training, Veterans were able to generate their CCD in My HealtheVet, share it with non-VA providers, and benefit from improved communication about medications and reduced laboratory duplication. After training, 78% of Veterans reported that the CCD would help them be more involved in their healthcare, and 86% planned to share it regularly with non-VA providers.
• The majority of non-VA providers (97%) were confident in the accuracy of the information, and 96% wanted to continue to receive the CCD. Moreover, 50% of non-VA providers reported that they did not order a laboratory test or other procedure because of CCD information.

IMPLICATIONS:

• Collaboration between patients, providers, and health information technology (HIT) that spans more than one healthcare setting will lay the groundwork for truly comprehensive patient-centered care. However, patient training and outreach is needed to expand awareness and utilization of this consumer-mediated HIE option. Further studies on VA and community provider perspectives on data sharing are underway.

LIMITATIONS:

• There was site variation for patient engagement/training, and there was no comparison group.
• There is potential for selection bias as Veterans with greater health and technology interest may have been more likely to enroll in the pilot.
• VA providers were not surveyed, and not all non-VA providers (49%) receiving CCD information responded to the survey.

Klein D, Pham K, Samy L, et al. The Veteran Initiated Electronic Care Coordination Pilot: A Multi-site Initiative to Promote and Evaluate Consumer-Mediated Health Information Exchange. Telemedicine and e-Health. October 11, 2016;e-pub ahead of print.