VA management is requesting solutions intended to mitigate the risk of fragmentation of care and low utilization levels of health records (e.g., consult reports)exchanged between Department of Veterans Affairs (VA) and non-VA providers, for example: community hospitals, Third Party Administrators (TPA), vendors, and individual non-VA providers. The Veterans Access, Choice, and Accountability Act of 2014 (VACAA) (Public Law 113-146) Section 101 required VA to establish a temporary program (“the Choice Program”) to improve Veterans’ access to health care by allowing eligible Veterans to use eligible health care providers outside of the VA system (non-VA care). The launch of the Choice Program places heightened importance and responsibility on VA to more efficiently and effectively receive, store, and utilize returning consult reports and Veteran Electronic Health Record (EHR) data from non-VA providers. Regular growth of Non-VA Medical Care (NVC) over the last ten years, coupled with VACAA’s expansion in Veteran eligibility for non-VA care, demands seamless communication between all parties rendering care for our Nation’s Veterans, irrespective of whether care was rendered internal or external to VA’s provider network. In order to meet the demands of the Choice Program, solutions are needed to provide:

• VA providers with access to patient information and/or health data received from non- VA providers;

• non-VA providers the ability to send medical documents and/or data to VA; and

• non-VA providers the ability to access Veterans’ EHR as authorized by the patient and on a “need to know” basis, to review existing consults/referrals, orders and/or progress reports, or other relevant health record data (e.g., Joint Legacy Viewer [JLV]).

Currently, the majority of Veterans’ administrative (e.g., NVC authorization and non-VA provider correspondence) and/or clinical documentation (e.g., NVC consult/referral radiology reports, health summaries, operative reports) exchanged between VA and non-VA providers for both NVC (purchased) and self-selected care are faxed, mailed, sent via courier, or manually uploaded and downloaded via a web portal (e.g., Patient-Centered Community Care [PC3]/TPA). When the documentation is received at VA, it is manually sorted, reviewed, uploaded, and scanned (Chief Business Office Purchased Care [CBOPC] or Health Information Management [HIM] owners) into the “Scanned Medical Record” (SMR) system of the Computerized Patient Record System (CPRS). Due to the fragmentation of the current system (multiple system interfaces needed such as the Veterans Health Information Systems Technology Architecture [VistA], Fee Basis Claims System [FBCS], CPRS, VistA Imaging, etc.) and storage/retrieval issues, the scanned clinical documentation is not readily available to the VA providers. Even though the clinical documentation is made available and the VA provider is electronically alerted, the VA provider is, at times, not aware of the existence of SMR due to a lack of standardized processing of this incoming documentation and/or the abundance of clinical view alerts sent to the VA provider.

By providing solutions to enable automated mechanisms and secure data exchange supported by standardized policies and governance over what data is shared and when, Veterans’ EHR data could be more effectively utilized by both VA and non-VA providers for improved care coordination and continuity of care.