Which veterans enroll in a VA health information exchange program?
To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions.



Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients' sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records.



Among 57 072 patients, 6627 (12%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50-64, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment.



Enrollment in HIE is complex, with several factors involved in a patient's decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation.
Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN bedixon@iupui.edu.|Richard M. Fairbanks School of Public Health, Indiana University.|Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN.
Brian E
BE
Dixon
Department of Biostatistics, School of Medicine, Indiana University.
Susan
S
Ofner
Richard M. Fairbanks School of Public Health, Indiana University.|Department of Biostatistics, School of Medicine, Indiana University.
Susan M
SM
Perkins
Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.|Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University.
Laura J
LJ
Myers
Department of Pediatrics, Children's Health Services Research, Indiana University.|Center for Health Services Research, Regenstrief Institute, Indianapolis, IN.
Marc B
MB
Rosenman
Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.|Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN.
Alan J
AJ
Zillich
Department of Ophthalmology and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.|Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.
Dustin D
DD
French
Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.|Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University.|Center for Health Services Research, Regenstrief Institute, Indianapolis, IN.
Michael
M
Weiner
Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.|Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University.|Center for Health Services Research, Regenstrief Institute, Indianapolis, IN.
David A
DA
Haggstrom
D000328:Adult; D000368:Aged; D005260:Female; D066275:Health Information Exchange / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
computerized; health information exchange; matched-pair analysis; medical records systems; veterans health