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The VHA Has an Opportunity to Get Patient Matching Right

Thought Leadership

As the largest Integrated Health System in the United States, the Veterans Health Administration (VHA) gets a lot of attention for every step it might make. Its $65B annual budget and 300,000 employees dwarfs our nation’s largest Integrated Delivery Networks and as such, it is watched closely by pundits and advocates alike. The VHA’s mission is to honor American Veterans by providing exceptional healthcare. And from what I gathered, it does a great job. Ranked highly by physicians and patients for its quality of care, the VHA is no longer a last resort for care. Especially with programs like Veterans Choice, which provides service at community Providers and is paid for by the VHA when it is unable to fulfill an appointment within 30 days or within 40 miles of the patient’s residence.

With roots dating back over 150 years, the VHA was elevated to a cabinet level position with the United States government back in 1988 under then president Ronald Regan. It has been said that all publicity is good publicity, but that may not be entirely true for the VHA. Reforms in the 1990s led to transformations that permitted the tracking of a number of performance indicators including quality of care measures and accountability for management to improve those measures. More recently, there was a scheduling scandal that an investigation found resulted in six Veterans dying due to clinically significant delays while on a waiting list for treatment. Secret waiting lists, poor patient care, millions of dollars intended for care that went unspent, and big bonuses paid to management for results that were the result of covered-up statistics did not help its image.

Perhaps most promising is the VHA’s effort to modernize a legacy electronic health record, VistA. Born in the 1970s, the VHA has often been praised for its efforts in developing the low cost open source EHR. But now, the VHA intends to spend at least $16B and replace VistA with Cerner®, the same EHR vendor that is overhauling the US Department of Defense. But with the transition of leadership still in question, the promises of a transformed VHA seem increasingly challenged. This is certainly no referendum on or analysis of the controversial decision to pick an EHR vendor. Rome wasn’t built in a day. If it were, we all would have hired them as contractors.

Innovations from healthcare technology don’t need to reform entire landscapes to be impactful. Considerable time and money has been spent to solve the challenge of identity matching. Despite promises and mandates, innovation has suffered. Interoperability platforms have provided further evidence of this unsolved challenge. Can we afford to wait? Probably not. We also shouldn’t expect DOD and VHA to line up nicely. The two agencies don’t even follow the same schedule when updating medication information every month. As a result, providers will continue to manually check data for accuracy. Patient matching is the underbelly that supports many of the VHA’s strategic initiatives.

The future of healthcare will involve extensive coordination across the full continuum of care. The ability to access patient information is the cornerstone of that coordination. Resolving patient identities across disparate systems is critical to accessing information. Existing MPI technologies cannot resolve patient identities well enough to support VHA. But our new patient identity resolution technology, the Verato Universal MPI, could support the new needs as a highly accurate patient identity resolution service. And only by using such a technology — that leverages both the power of Referential Matching and the cloud — can the VHA get patient matching right.

The demand for interoperability and information exchange has begun to increase and will continue increasing even more rapidly. This is caused by regulatory changes and by natural business drivers within the healthcare industry. As a result, there has been an incredibly fast pace of technology change that offers the possibility to transform healthcare — via advanced analytics, precision medicine, remote monitoring, mobile technologies, consumer engagement apps, et cetera. These new technologies will only be effective if they can access the right data for every patient. Each one of these new technologies represents yet another stakeholder that will require accurate, complete patient records.

The complexity of interoperability requirements is increasing as rapidly as the demand. This is in part because new technologies have new requirements and need access to different data in different ways. But these technologies also have the capacity to operate effectively on a much wider array of data, and in fact often require multiple, large sources of data to achieve their objectives. So, in addition to having more consumers of interoperability, the scope of patient data that each of these systems are using is only increasing.

While there are many challenges that must be overcome to support these increasing demands (e.g. adoption of modern application programming interface [API] standards or rationalization of structured documents vs. unstructured content), accurate patient record matching is currently one of the leading blockers to effective information exchange. Failure to locate useful information on a patient, especially if that information is known to exist, is a surefire way to discourage adoption of health information sharing platforms.