The U.S. Department of Veterans Affairs needs to prioritize the interoperable exchange of health data and improved patient safety as it transitions from its VistA electronic health record (EHR) system to a commercial-off-the-shelf EHR system provided by Cerner.
The letter, written by Pew president and CEO Rebecca Rimel and addressed to VA Secretary David Shulkin, M.D., as well as chairmen of the Senate and House committees on Veterans Affairs, said that the VA’s health information technology strategy and its health IT investments provide an opportunity to make progress in both areas—interoperability and improving the safety of EHRs.
The letter notes that the VA has indicated that the agency’s health IT enhancements, among other things, will focus on ensuring that patients’ records can be electronically exchanged with the Department of Defense (DoD), where veterans have records, without manual entry of information. “Seamless data exchange between the VA and the DoD is particularly important as the agencies share more medical information than any other public or private health care organizations in the country. In addition, as veterans seek care outside the VA in private practices and form specialists, the exchange of their information to those facilities and back into the VA system is similarly important for seamless care. Moreover, as health IT is used to coordinate and improve care regardless of where veterans obtain medical treatments, unexpected safety challenges can emerge,” the organization wrote.
The Pew Charitable Trust points out that patient matching and standards are critical to seamless care. Pew is researching multiple approaches to patient matching, including the use of unique identifiers (i.e. biometrics), enhanced use of demographic data elements and patient-led solutions. The organization urges the VA to study and prioritize enhancements to patient matching as part of its health IT strategy. “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,” the organization wrote.
Enhanced use of standards also can aid computerized clinical decision support for physicians. The organization recommends that the VA outline how it intends to advance the use of standards, and this could include identifying data elements and associated standards that should be prioritized, or other solutions wherein the VA, DoD and leaders in the private sector agree on how to communicate information so that it can be used to improve care for veterans, the organization wrote.
In the letter, Pew also encouraged the VA to focus on reducing health IT-related medical errors by focusing on enhanced testing of EHRs and collaboration with the private sector. The organization points to a number of standards that can be used, such as the Association for the Advancement of Medical Instrumentation (AAMI)’s work to provide a framework for how to assess the safety of health IT across the product life cycle, as well as the Leapfrog Group’s standard to test Computerized Provider Order Entry (CPOE) tools that simulate patients receiving medications to evaluate patient safety problems with EHRs.
The organization also urged the VA to advance collaboration on health IT safety with federal partners, such as the DoD and the Office of the National Coordinator for Health IT (ONC). Specifically, the organization says the VA could work with ONC to establish or fund a health IT safety collaborative to foster health IT safety, both as the VA implements its health IT strategy and to enhance safety when veterans seek care outside of the VA system.
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