JMIR Publications

ABSTRACT

Background:

The U.S. Department of Veterans Affairs (VA) seeks to achieve interoperability with other organizations, including other integrated delivery networks, via its Virtual Lifetime Electronic Record (VLER) program.

Objective:

While prior research has examined the adoption and use of VA health information exchange (HIE) among providers, this study sought to understand the implementation of VA-HIE by a wider range of organizational leaders.

Methods:

Operational, clinical, and health informatics leaders at the VA facility and its external community HIE partner were interviewed. Respondents discussed their experiences with HIE including barriers and facilitators to implementation. Qualitative analyses utilized a hybrid method that combined inductive and deductive approaches.

Results:

VA leaders considered training and preparation to be key success factors when implementing HIE and employed a wide array of strategies to prepare medical staff. During recruitment, a “high-touch approach” was successfully used to enlist patients in-person. Operational and clinical leaders described at least two potential barriers to HIE use: (1) the time and effort to use the system and (2) a fear of disappointment among medical staff and leadership. Overall enthusiasm was consistently high regarding the potential value of data sharing in improving care coordination and patient health outcomes.

Conclusions:

The major management challenge was coordination of the complex interrelationships among entities within and outside the VA. A model that captures the interconnected web of information systems and human teams is helpful to visualize and describe HIE implementation. This model can be applied by other national and regional networks that seek to achieve interoperability goals across health care delivery systems. Clinical Trial: n/a