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Expanding Veterans’ Options Highlights Need for Data Exchange in San Diego

SAN DIEGO — Congress is working to expand veterans’ access to medical services in response to revelations about falsified appointment records that concealed long wait times at veterans’ hospitals.

Although the VA San Diego Healthcare System is not on the list of facilities under investigation, this bill could have implications for the nearly quarter million veterans living in the region. 

Members of the House and Senate are working on merging two bills that would require the Department of Veterans Affairs to pay for medical care delivered by health care providers in the private sector in order to reduce wait times for those seeking care.

Exactly how this reform will be funded has not yet been established and that remains the primary issue under debate in Congress. Local VA facilities are waiting to learn how new requirements will affect their facility’s operations and the veterans they serve.

“It’s a little unclear still how this is going to affect an individual VA, and in particular what it’s going to look like in terms of funding or resources that the VA might have,” said Robert Smith, chief of staff at VA San Diego.

Outside Referrals Not New But About to Increase Significantly

Referring veterans for care delivered outside of the VA system is not a new process. The San Diego VA has existing relationships with UC-San Diego, Balboa Naval Center and Tri-City of Alvarado, among other facilities in the private sector. However, Smith said, as a result of the action Congress may be taking, VA San Diego likely will increase the number of outside referrals it makes for the nearly 80,000 veterans it serves.  

“It will impact us in part because a significant number of patients are not being seen within the 30-day timeframe Congress is focusing on,” Smith said.

Potential Impact for San Diego Vets

Today, the average wait time for a new patient at the San Diego VA to receive a primary care appointment is 45 days, except for patients who have requested and received same- or next-day appointments, Smith said. 

Certain types of specialty care appointments, however, may have longer wait times. Veterans in need of elective orthopedic surgery, dermatology and certain elective ophthalmology services, for example, are likely to be sent to private facilities throughout the San Diego region in the near future. That’s already the case for those currently in need of radiology and chemotherapy, as well women in need of obstetric and labor and delivery services.

Smith sees a number of challenges in meeting the requirements Congress is considering. For example, he said the current discussion doesn’t account for the fact that veterans tend to prefer staying within the VA system to being seen by outside providers. That’s true even if wait times are long, he said.

“If I don’t have the resources to improve access to care internally, I’m not clear how I’m going to meet the mandates that I’m given if only a modest percentage of the veterans I serve … will accept” referrals to outside providers, he said.

There’s another challenge experts point to: making sure veterans’ medical records are able to travel with them to ensure continuity of care.

San Diego Ahead of Most in Electronic Exchange of Medical Information

The VA’s My HealtheVet provides veterans and their dependents online access to their medical records, secure messaging with health care providers, and in some cases, access to clinical notes recorded by health care providers during outpatient visits and hospital stays.

According to the San Diego VA, 70% of local veterans are enrolled in MyHealtheVet and 30% have signed up to receive secure messages.

But that access alone doesn’t allow veterans to take their medical records with them to outside providers. The VA is at work on a separate system called the Veterans Lifetime Electronic Record, or VLER, which allows for the electronic exchange of records between the VA and other health care entities, including the Department of Defense. However, those systems are not fully linked.

The San Diego region does have a well-established health information exchange in place through San Diego Health Connect — formerly the San Diego Beacon project — that could prove helpful if more veterans seek care outside the VA system.

“There already exists a high degree of interconnectivity between the VA and the community,” said James Killeen, clinical professor of emergency medicine at UC-San Diego Health Sciences. Most major health care entities in San Diego participate in the San Diego Health Connect exchange, according to Killeen.

The greater challenge is gaining patient consent to allow their medical records to be shared electronically from one health care system to another. The VA is hard at work to increase the number of veterans who consent to this exchange. Current participation, however, is modest, Smith said.

Let the Patient Take it With Him

Even if more veterans consent to the sharing of their health records, that doesn’t mean veterans will necessarily be able to incorporate all of their medical records in one place. Systems at DOD and the VA currently do not communicate with one another, meaning that there are higher chances of fragmentation for veterans with medical records housed with DOD, the VA and private health care providers.

The San Diego-based information technology firm Humetrix has developed a mobile tool — iBlueButton — to address the problem. The iBlueButton app works with the government’s Blue Button initiative, which enables patients to download their medical records electronically from the VA and Medicare to their computer. iBlueButton is said to be the only application able to absorb and coordinate records housed at DOD, the VA and Medicare for older vets and securely load them onto a mobile device such as a tablet or smartphone.

“The key use of this technology is to get information to flow and ease patient/physician communication and bring critical health information to any given physician at the point of care,” said Bettina Experton, CEO of Humetrix.

Plans to expand care for veterans outside of the VA system, Experton said, “highlight the need for patients to be in the information loop.”

Enabling patients to easily compile and carry their records with them also helps to eliminate one primary flaw when electronic medical record exchange happens between health care systems and providers rather than via the patient: confirming the patient’s identity. When the patient sits at the center of the information exchange, the likelihood of records matching up correctly, experts say, is higher.

“Outfitting patients with a personal health record … can be a practical means for information exchange,” Experton said.

As technology solutions continue to evolve, the most important point is that veterans’ medical information should be able to follow them if they are able to increasingly go outside the VA system, UCSD’s Killeen said.

“That’s the whole goal of health information exchange,” he said. “We just hope the vets can get the best care that they need no matter where they go.”

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