The Department of Veterans Affairs' (VA) implementation of the Virtual Lifetime Electronic Record (VLER): findings and lessons learned from Health Information Exchange at 12 sites.

PURPOSE: We describe the Department of Veterans Affairs' (VA) Virtual Lifetime Health Electronic Record (VLER) pilot phase in 12 communities to exchange health information with private sector health care organizations and the Department of Defense (DoD), key findings, lessons, and implications for advancing Health Information Exchanges (HIE), nationally. METHODS: A mixed methods approach was used to monitor and evaluate the status of VLER Health Exchange pilot phase implementation from December 2009 through October 2012. Selected accomplishments, contributions, challenges, and early lessons that are relevant to the growth of nationwide HIE are discussed. RESULTS: Veteran patient and provider acceptance, trust, and perceived value of VLER Health Exchange are found to be high, and usage by providers is steadily growing. Challenges and opportunities to improve provider use are identified, such as better data quality and integration with workflow. Key findings and lessons for advancing HIE are identified. CONCLUSIONS: VLER Health Exchange has made great strides in advancing HIE nationally by addressing important technical and policy issues that have impeded scalability, and by increasing trust and confidence in the value and accuracy of HIE among users. VLER Health Exchange has advanced HIE interoperability standards and patient consent policies nationally. Policy, programmatic, technology, and health Information Technology (IT) standards implications to advance HIE for improved delivery and coordination of health care are discussed. The pilot phase success led to VA-wide deployment of this data sharing capability in 2013.

Organizational framework for health information technology.

PURPOSE: We do not yet know how best to design, implement, and use health information technology (IT). A comprehensive framework that captures knowledge on the implementation, use, and optimization of health IT will help guide more effective approaches in the future. METHODS: The authors conducted a targeted review of existing literature on health IT implementation and use, including health IT-related theories and models. By crosswalking elements of current theories and models, the authors identified five major facets of an organizational framework that provides a structure to organize and capture information on the implementation and use of health IT. RESULTS: The authors propose a novel organizational framework for health IT implementation and use with five major facets: technology, use, environment, outcomes, and temporality. Each major facet is described in detail along with associated categories and measures. CONCLUSION: The proposed framework is an essential first step toward ensuring a more consistent and comprehensive understanding of health IT implementation and use and a more rigorous approach to data collection, measurement development, and theory building.

Applying an organizational framework for health information technology to alerts.

We are far from understanding how best to design, implement, and use health information technology (IT). A comprehensive framework, developed by Rippen et al to capture and organize knowledge on the implementation, use, and optimization of health IT, may guide and inform more effective health IT deployment. This study applied Rippen's framework to a focused type of health IT - alerts - through clinical decision support (CDS), an area with a substantial evidence base around many facets of implementation, including the technology, use, and outcomes. We report results from applying this framework for capturing, organizing and standardizing knowledge and related measures around alerts. It is clear there are gaps in information shared and that measures across studies vary significantly. Insights identified using the framework highlight areas for further study and development, directed toward a shared conceptualization and representation of knowledge, and ultimately, a more comprehensive and deeper understanding of health IT.

The value from investments in health information technology at the U.S. Department of Veterans Affairs.

We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA's health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs. This study serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.

Assessing the value of laboratory electronic data interchange in the department of veterans affairs.

We modeled the adoption, costs and monetezied benefits of the Department of Veterans Affairs' (VA's) internally developed Laboratory Electronic Data Interchange (LEDI) application from 2001-2007. LEDI provides standards-based electronic exchange of laboratory data and secure transmission of laboratory test orders and results. Once the initial development and installation costs were accounted for, LEDI likely produced value for the VA in savings of laboratory staff time for test ordering and results processing. We estimate that the VA needed to realize 20 percent of projected labor saving to recover its investment in LEDI.