OBJECTIVE:This study aimed to explore the association between demographic variables, such as race and gender, and patient consent policy preferences for health information exchange as well as self-report by VHA enrollees of information continuity between Veterans Health Administration (VHA) and community non-VHA heath care providers. MATERIALS AND METHODS:Data were collected between March 25, 2016 and August 22, 2016 in an online survey of 19 567 veterans. Three questions from the 2016 Commonwealth Fund International Health Policy Survey, which addressed care continuity, were included. The survey also included questions about consent policy preference regarding opt-out, opt-in, and "break the glass" consent policies. RESULTS:VHA enrollees had comparable proportions of unnecessary laboratory testing and conflicting information from providers when compared with the United States sample in the Commonwealth Survey. However, they endorsed medical record information being unavailable between organizations more highly. Demographic variables were associated with gaps in care continuity as well as consent policy preferences, with 56.8% of Whites preferring an opt-out policy as compared with 40.3% of Blacks, 44.9% of Hispanic Latinos, 48.3% of Asian/Pacific Islanders, and 38.3% of Native Americans (P < .001). DISCUSSION:Observed large differences by race and ethnicity in privacy preferences for electronic health information exchange should inform implementation of these programs to ensure cultural sensitivity. Veterans experienced care continuity comparable to a general United States sample, except for less effective exchange of health records between heath care organizations. VHA followed an opt-in consent policy at the time of this survey which may underlie this gap.

The Department of Veterans Affairs (VA) Veterans Health Information Exchange (VHIE), formerly known as the Virtual Lifetime Electronic Record (VLER) Health Program, is a Veteran-focused portfolio of programs that gives VA and authorized Community Care Partners secure access to certain parts of a Veteran’s electronic health record for the purpose of care coordination across the health care continuum. VHIE established a technological platform to securely exchange health information between VA and the community, both at an organizational level (VA Exchange) and at the personal provider level (VA Direct Messaging). VHIE connects the Department of Veteran Affairs with care organizations through national networks (e.g., eHealth Exchange). Today, VA is connected to more than 314 eHealth Exchange members and will expand community provider access to Veterans health information by joining the CommonWell Health Alliance and Carequality national networks.

Health Information Exchange (HIE) between organizations is necessary to have more complete information and coordinate care. Given its nationwide footprint, the Department of Veterans Affairs (VA) connects and exchanges health information with a large number of organizations and consequently has a unique opportunity to experience most issues affecting clinical interoperability. The Veterans HIE Program manages these exchanges by focusing on patient engagement, provider adoption, partner relationship, technology platform, and performance. This paper analyzes the success and challenges of this program over the last five years, and offers valuable metrics and insights. Although significant progress has been made, nationwide interoperability remains fragmented and laborious, requiring multiple agreements and exchange methods. A future nationwide interoperability would embrace a single "on-ramp" to connect to everyone.

The U.S. Department of Veterans Affairs (VA) Veteran Health Information Exchange (VHIE, formerly Virtual Lifetime Electronic Record, or VLER) Retail Immunization Coordination Project established a partnership between VA and Walgreens to empower Veterans to elect to receive their immunizations at a local Walgreens, which might be located closer to their home than their nearest VA facility. Analysis of Veterans immunized at Walgreens between September 2014 and January 2015 showed that 64% of study Veterans now traveled <5 miles to receive their immunization, 12% of study Veterans traveled between 5 to 10 miles, and 24% of study Veterans traveled more than 10 miles. In addition, we note that 93% of Veterans traveled less than 54 miles, the average distance rural Veterans traveled to the nearest VA facility. We conclude that the VHIE Retail Immunization Coordination Project improved Veteran access to healthcare and discuss future directions of this effort.

The U.S. Department of Veterans Affairs (VA) Veteran Health Information Exchange (VHIE, formerly Virtual Lifetime Electronic Record, or VLER) had been deployed at all VA sites and used to exchange clinical information with private sector healthcare partners nationally. This paper examined VHIE's effect on allergy documentation. Review of all inbound VHIE transactions in FY14 showed that VHIE use was associated with a nearly eight-fold increase in allergy documentation rate. Preliminary manual document review further showed that VA and partners had shared knowledge of only 38% ofpatient allergies, while VA had exclusive knowledge of another 58% ofpatient allergies, and partners had exclusive knowledge of the last 5% of patient allergies. To our knowledge, this is the first study that examined the effect of HIE on allergy documentation.

As part of ongoing data quality efforts authors monitored health information retrieved through the United States Department of Veterans Affairs' (VA) Virtual Lifetime Electronic Record (VLER) Health operation. Health data exchanged through the eHealth Exchange (managed by Healtheway, Inc.) between VA and external care providers was evaluated in order to test methods of data quality surveillance and to identify key quality concerns. Testing evaluated transition of care data from 20 VLER Health partners. Findings indicated operational monitoring discovers issues not addressed during onboarding testing, that many issues result from specification ambiguity, and that many issues require human review. We make recommendations to address these issues, specifically to embed automated testing tools within information exchange transactions and to continuously monitor and improve data quality, which will facilitate adoption and use.