The Department of Veterans Affairs' (VA) implementation of the Virtual Lifetime Electronic Record (VLER): findings and lessons learned from Health Information Exchange at 12 sites.
OBJECTIVE
We describe the Department of Veterans Affairs' (VA) Virtual Lifetime Health Electronic Record (VLER) pilot phase in 12 communities to exchange health information with private sector health care organizations and the Department of Defense (DoD), key findings, lessons, and implications for advancing Health Information Exchanges (HIE), nationally.


METHODS
A mixed methods approach was used to monitor and evaluate the status of VLER Health Exchange pilot phase implementation from December 2009 through October 2012. Selected accomplishments, contributions, challenges, and early lessons that are relevant to the growth of nationwide HIE are discussed.


RESULTS
Veteran patient and provider acceptance, trust, and perceived value of VLER Health Exchange are found to be high, and usage by providers is steadily growing. Challenges and opportunities to improve provider use are identified, such as better data quality and integration with workflow. Key findings and lessons for advancing HIE are identified.


CONCLUSIONS
VLER Health Exchange has made great strides in advancing HIE nationally by addressing important technical and policy issues that have impeded scalability, and by increasing trust and confidence in the value and accuracy of HIE among users. VLER Health Exchange has advanced HIE interoperability standards and patient consent policies nationally. Policy, programmatic, technology, and health Information Technology (IT) standards implications to advance HIE for improved delivery and coordination of health care are discussed. The pilot phase success led to VA-wide deployment of this data sharing capability in 2013.
Westat, Center for Health IT, Cambridge, MA, USA.
Colene M
CM
Byrne
Westat, Center for Health IT, Cambridge, MA, USA.
Lauren M
LM
Mercincavage
Hewlett-Packard, San Diego, CA, USA.
Omar
O
Bouhaddou
Department of Veterans Affairs (VA), VLER Health Program, Washington, DC, USA.
Jamie R
JR
Bennett
Westat, Center for Health IT, Rockville, MD, USA. Electronic address: EricPan@Westat.com.
Eric C
EC
Pan
Westat, Center for Health IT, Cambridge, MA, USA.
Nathan E
NE
Botts
Westat, Center for Health IT, Cambridge, MA, USA.
Lois M
LM
Olinger
Department of Veterans Affairs (VA), VLER Health Program, Washington, DC, USA.
Elaine
E
Hunolt
Westat, Center for Health IT, Cambridge, MA, USA.
Karl H
KH
Banty
Department of Veterans Affairs (VA), VLER Health Program, Washington, DC, USA.
Tim
T
Cromwell
D057286:Electronic Health Records / Q000458:organization & administration* / Q000706:statistics & numerical data*; D063025:Health Information Management / Q000458:organization & administration; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs; D014584:User-Computer Interface
Electronic Health Record; Health Information Exchange; Health informatics; Information technology; Interoperability; Veterans Health; eHealth Exchange