Virtual Lifetime Electronic Record Fosters Health Information Sharing

The goal of the Virtual Lifetime Electronic Record (VLER) program is simple enough—to improve the care coordination and delivery for the approximately 22 million veterans that the Department of Veterans Affairs (VA) currently serves. But traversing the road towards the effective exchange of health information has required careful planning and proficient management of challenges.

Development of the VLER is an important step in improving healthcare delivery for veterans, according to a presentation on the VLER initiative’s progress over the past year delivered Tuesday by Jennifer Teal, MS, RHIA, CPC, health information management specialist for the Veterans Health Administration (VHA) Health Information Management Program Office, and Peggy Pugh, RN, CIPP/G, CPC, CPC-H, CCP, privacy specialist for the VHA Privacy Program Office.

No “I” in Exchange

The VLER program supports health information sharing between the VA, Department of Defense, and private providers via the secure Nationwide Health Information Network (NwHIN). In order to eliminate the need for point-to-point agreements with so many diverse participants, the Data Use and Reciprocal Support Agreement (DURSA) was developed in coordination with the Office of the National Coordinator and the Department of Health and Human Services.

“Many different entities came to the table to get this process underway,” Pugh said. The DURSA creates a standardized, common set of rules and expectations in the form of an enforceable legal framework. Eliminating the need for individual authorizations from each participating organization streamlines the process.

Teamwork is key to the exchange process, and health information management (HIM) professionals are at the core of the processes vital to the success of this exchange process, Pugh said. HIM professionals must keep track of applicable laws, policies, and standards regarding the release and exchange of information, patient requests to authorize or restrict disclosure, and valid authorization for all exchange requests.

Challenges Mean Lessons Learned

Patient enrollment recruitment efforts for the program have taken multiple shapes. Mixing targeted, open, and mail-in recruitment strategies works best, Teal said. As of July 25, that program has had 50,886 patients opt in. The opt-in option has also been added to certain specially authorized accounts on the VA’s eBenefits website.

Authorized and correlated patients can expect benefits such as the availability of real-time, accurate updates to health information for their providers, creating a centralized and reliable location for a full picture of medical history.

Issues in the patient authorization process are still being identified and addressed, as are best practices for aligning the workflows of separate entities and improving patient matching and data exchange.

“Implementation strategy and scalability concerns will need to be addressed” as the program moves forward, Teal said.

In addition to the VA’s NwHIN Exchange efforts for VLER, the office will also begin implementing The Direct Project (a supplement to NwHIN) message pilots in six communities, leveraging the secure messaging platform for the exchange of orders and results.


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