title: The Veteran-Initiated Electronic Care Coordination: A Multisite Initiative to Promote and Evaluate Consumer-Mediated Health Information Exchange.
abstract: Information continuity is critical to person-centered care when patients receive care from multiple healthcare systems. Patients can access their electronic health record data through patient portals to facilitate information exchange. This pilot was developed to improve care continuity for rural Veterans by (1) promoting the use of the Department of Veterans Affairs (VA) patient portal to share health information with non-VA providers, and (2) evaluating the impact of health information sharing at a community appointment.
  
  
  
  Veterans from nine VA healthcare systems were trained to access and share their VA Continuity of Care Document (CCD) with their non-VA providers. Patients and non-VA providers completed surveys on their experiences.
  
  
  
  Participants (n = 620) were primarily older, white, and Vietnam era Veterans. After training, 78% reported the CCD would help them be more involved in their healthcare and 86% planned to share it regularly with non-VA providers. Veterans (n = 256) then attended 277 community appointments. Provider responses from these appointments (n = 133) indicated they were confident in the accuracy of the information (97%) and wanted to continue to receive the CCD (96%). Ninety percent of providers reported the CCD improved their ability to have an accurate medication list and helped them make medication treatment decisions. Fifty percent reported they did not order a laboratory test or another procedure because of information available in the CCD.
  
  
  
  This pilot demonstrates feasibility and value of patient access to a CCD to facilitate information sharing between VA and non-VA providers. Outreach and targeted education are needed to promote consumer-mediated health information exchange.
authors.affiliation: 1 Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center , Iowa City, Iowa.|2 Department of Psychiatry, The University of Iowa Carver College of Medicine , Iowa City, Iowa.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Klein
authors.affiliation: 1 Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center , Iowa City, Iowa.
authors.forename: Kassi
authors.initials: K
authors.lastname: Pham
authors.affiliation: 3 Department of Health and Human Services, Office of the National Coordinator , Washington, District of Columbia.
authors.forename: Leila
authors.initials: L
authors.lastname: Samy
authors.affiliation: 4 Department of Veterans Affairs, Office of Rural Health , Washington, District of Columbia.
authors.forename: Adam
authors.initials: A
authors.lastname: Bluth
authors.affiliation: 5 Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration , Washington, District of Columbia.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Nazi
authors.affiliation: 6 Department of Pharmacy Practice and Science, The University of Iowa College of Pharmacy , Iowa City, Iowa.
authors.forename: Matthew
authors.initials: M
authors.lastname: Witry
authors.affiliation: 7 Iowa City VA Health Care System, Pathology and Laboratory Medicine , Iowa City, Iowa.|8 Department of Pathology, The University of Iowa Carver College of Medicine , Iowa City, Iowa.
authors.forename: J Stacey
authors.initials: JS
authors.lastname: Klutts
authors.affiliation: 9 VA Nebraska Western Iowa Health Care System, Substance Use Disorders Treatment Program , Omaha, Nebraska.|10 Department of Internal Medicine, University of Nebraska Medical Center , Omaha, Nebraska.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Grant
authors.affiliation: 11 VA Salt Lake City Health Care System , Salt Lake City, Utah.|12 University of Utah School of Medicine , Salt Lake City, Utah.
authors.forename: Adi V
authors.initials: AV
authors.lastname: Gundlapalli
authors.affiliation: 13 Canandaigua VA Medical Center , Geriatrics and Extended Care, Canandaigua, New York.
authors.forename: Gary
authors.initials: G
authors.lastname: Kochersberger
authors.affiliation: 14 Robert J. Dole VA Medical Center , Wichita, Kansas.
authors.forename: Laurie
authors.initials: L
authors.lastname: Pfeiffer
authors.affiliation: 15 North Florida/South Georgia Veterans Health System, Center of Innovation on Disability and Rehabilitation Research , Gainesville, Florida.|16 Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida , Gainesville, Florida.
authors.forename: Sergio
authors.initials: S
authors.lastname: Romero
authors.affiliation: 17 St. Cloud VA Health Care System , St. Cloud, Minnesota.
authors.forename: Brian
authors.initials: B
authors.lastname: Vetter
authors.affiliation: 1 Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center , Iowa City, Iowa.|2 Department of Psychiatry, The University of Iowa Carver College of Medicine , Iowa City, Iowa.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Turvey
mesh_terms: D022126:Access to Information; D000368:Aged; D003200:Computer User Training / Q000379:methods; D003266:Continuity of Patient Care / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration; D005260:Female; D066275:Health Information Exchange; D006801:Humans; D008297:Male; D059065:Medication Reconciliation; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods; D017060:Patient Satisfaction; D012424:Rural Population; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014728:Veterans
keywords: continuity of care; e-health; education; information management; medical records; personal health records; telehealth; telemedicine