Sharing Quality Lessons—and Health Records—with the Veterans Health Administration

As work continues throughout the country on seeking healthcare reform and improving quality of care, observing how veterans' healthcare has evolved in recent years could be very instructive to the private sector—in more ways than one.

Just two decades ago, the veterans' healthcare system focused largely on inpatient hospital care and had a poor reputation for quality. However, beginning in the mid 1990s, the organization underwent a major transformation—improving the quality and efficiency of the care it provides to its patients, the Congressional Budget Office observes in a new paper on veterans healthcare and quality.

The Veterans Health Administration of the federal Department of Veterans Affairs ended up eliminating underutilized inpatient beds and facilities, expanded outpatient clinics, and restructured eligibility rules. And then, a major VHA change occurred when it began to track computerized performance indicators—including quality of care measures—and holding senior managers accountable to make improvements.

Today, with the return of veterans who have served in Iraq and Afghanistan—and with more veterans from earlier eras who are turning to the VHA for at least a part of their healthcare—more than 8 million veterans are receiving some of their care each year from VHA.

However, sharing individual patient data between VHA and other providers, specifically private sector providers, has been challenging. VHA's clinicians must proactively follow up with each veteran to ask about outside services. And, even if the records of those services are obtained from outside providers, they often must be entered into VHA's patient records systems by hand, CBO said in its report.

As more providers find themselves held accountable for quality measures such as Health Plan Employer Data and Information Set scores, the exchange of data on shared patients is going to become more important for both VHA and providers outside the system as well.

Also, providers outside of the VHA—some of whom provide a substantial amount of care to veterans—have expressed an interest in getting data from VHA on shared patients. However, issues have arisen regarding how to identify those shared patients while safeguarding privacy.

An answer is now evolving with a new Web based personal health record portion of VHA's system—called MyHealtheVet—that could serve as a conduit for improved communication between VHA and non VHA providers, the report noted.

Similarly, other PHRs have that same potential to help secure storage and exchange of health information have been emerging. The Department of Defense, for instance, has been developing its own PHR system, MiCare, by partnering with Microsoft and Google. VHA could benefit from analyzing the development of these other PHRs to make sure that information exchange information occurs—for all our veterans that need it.