Which veterans enroll in a VA health information exchange program?

Abstract

Objective: To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions.

Materials and methods: Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients' sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records.

Results: Among 57 072 patients, 6627 (12%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50-64, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment.

Discussion and conclusion: Enrollment in HIE is complex, with several factors involved in a patient's decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation.

Keywords: computerized; health information exchange; matched-pair analysis; medical records systems; veterans health.

Published by Oxford University Press on behalf of the American Medical Informatics Association 2016. This work is written by US Government employees and is in the public domain in the United States.

Figures

Figure 1.

Screenshots from the VistA Web application as used in educational material from the Veterans Health Administration explaining to providers how they can access information available from non-VA providers.

Figure 2.

Theoretical model depicting the determinants of enrollment in health information exchange. Adapted from Phillips et al.

Figure 3.

Model of the study population depicting inclusion and exclusion criteria as well as proportion of the population that enrolled in health information exchange.