November 28, 2011
10 lessons learned from linking VLER to private health orgs

The research on coordinated care is clear: Patients experience better outcomes when medical teams operate within a connected healthcare ecosystem. Access to the patient’s complete medical history helps physicians make better decisions, reduces medical errors and eliminates duplicate diagnostic testing.

During the past several years, the US government has undertaken a number of initiatives to encourage healthcare practitioners to adopt and use electronic medical records (EMRs). One such project was the development of the Virtual Lifetime Electronic Record (VLER) program, a joint effort between the Departments of Defense (DoD) and Veterans Affairs (VA) to develop and implement an electronic health record system to allow secure sharing of data between civilian and military healthcare organizations.

There’s an urgent need for a way to share data since up to 60 percent of healthcare received by active duty personnel and 40 percent of veterans’ healthcare is delivered by civilian medical professionals. While numerous stakeholders are working collaboratively to ensure the success of VLER, optimal results can only be achieved if private practices support the initiative by filling both data-supplier and user roles. Quite simply, the program relies on active participation from all parties, including private practices.

Numerous challenges and opportunities have arisen from the introduction of VLER to private health organizations, and many lessons can be gleaned from the experience of enabling VLER portal access to providers:

  1. Requiring the veterans to “opt-in” to the program takes up-front planning from the VA perspective, as well as lead time to enroll enough veterans to obtain a critical mass.
  2. Coordination between the various partners proves challenging at times and requires a coordinated effort and regular communication – via frequent phone conferences and face-to-face quarterly meetings – from all entities to ensure changes are made in a timely and cost-effective manner and that everyone is in the loop on issues, best practices etc.
  3. Patience is key in the early stages of the VLER program. The utility and value derived from VLER closely parallel the amount of data available – as the amount of data and number of users grow, so too will the value. It will take time to accumulate data and onboard users, however, so patience and diligence are important as the adoption of the programs continues to gain more acceptance and a larger number of patients agree to share their information electronically.
  4. There is no question that VLER is a beneficial initiative for both veterans and providers, but providers need to consider office workflow changes that may occur.
  5. Discussing realistic expectations with providers is important to reduce frustration if patients are not found in the system, and the designation of a VLER “champion” or leader within a practice can help rally interest in the initiative and encourage practice staff to utilize the portal.
  6. Efforts need to be made to ensure that all users within a practice are given proper training and background on VLER. There is often a disconnect and subsequent decline in usage when senior leaders do not convey the value of Health Information Exchange (HIE) and VLER to their staff. For this reason, early stakeholder engagement – from end users to operational staff to project sponsors – is a critical element for success.
  7. Specifications are great guidelines for integration but can be subject to interpretation by the corresponding organizations. Having the ability to identify and handle the nuances is important, as is involvement of the clinical staff when determining the scope, details and format of the medical records content that will be viewed by providers.
  8. Make sure your onboarding process provides a way for multiple stakeholders to influence and shape the program.
  9. Continuous improvement is a key element of the process. Once an organization has been through onboarding, an ongoing continuous improvement effort will be necessary to achieve the best results.
  10. Partnerships are the foundation to a successful engagement. A strong project management office with a solid governance structure supported by experienced technical resources are mandatory for ongoing success.

The pilot VLER program has demonstrated how the vision of improving care with secure, universal access to medical data can become a reality. We’ve seen the potential for a wider application that can allow providers nationwide to deliver better outcomes through seamlessly coordinated care.