3134 — Barriers and Facilitators to VA Providers' Use of a Regional Health Information Exchange Tool to Access non-VA Patient Health Information

Boockvar KS, James J Peters VAMC, Bronx, NY; Kushniruk AW, University of Victoria, Canada; Borycki EM, University of Victoria, Canada; Monkman H, University of Victoria, Canada;

Objectives:
VA providers have growing access to non-VA health information through the VA's national Virtual Lifetime Electronic Record program and through individual VAMC's linkages with non-VA providers and with regional health information exchange (HIE) organizations. The objective of this qualitative study was to identify system and provider factors that impede and facilitate use of HIE by VA providers.

Methods:
With patients' and providers' consent we observed JJP VAMC providers access veterans' non-VA health information using the Bronx Regional Health Information Organization (RHIO) virtual health record while preparing for a VA encounter. Participants were asked to "think aloud" as they used CPRS and RHIO systems. Two observers recorded mouseclicks and screen navigation. Sessions were audiotaped and transcribed. Using close readings, investigators generated a transcript coding scheme. Recurrent themes were identified.

Results:
Participants consisted of 8 primary care physicians, 2 specialists, 1 pharmacist, and 1 physician assistant. Seven had prior experience using the RHIO and 5 were naïve users. Many participants wished for more comprehensive non-VA data in the RHIO (e.g. outpatient medications; discharge summaries) to justify the time for using it. Some participants wished for improved integration between the current entirely separate CPRS and RHIO interfaces. Some participants suggested usability improvements to the RHIO health record itself, including permitting formatted cutting and pasting into CPRS. Some participants indicated that misremembered RHIO passwords prevented regular use. Some participants indicated barriers outweighed usefulness and would not use the RHIO routinely for care. Others felt that the non-VA information in the RHIO was important and would use it despite the barriers.

Implications:
Barriers to VA providers' use of the Bronx RHIO were common and impeded use. To improve use, HIE tools should minimize steps for access and viewing, optimize integration with CPRS, and maximize capture of non-VA data to justify providers' viewing time.

Impacts:
HIE has the potential to benefit veterans whose care is fragmented between VA and non-VA systems. This study's findings support findings from other studies that show low provider use of HIE even when made available. VA dual care policies should be updated to provide guidance about VA providers' access and viewing of non-VA health information available in HIEs.