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2019 HSR&D/QUERI National Conference Abstract

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1131 — Health Information Sharing Among Veterans with Multiple System Use

Lead/Presenter: Bridget Smith,  COIN - Hines
All Authors: Smith BM (Center of Innovation for Complex Chronic Healthcare (CINCCH), Northwestern University), Hogan TP (Center for Healthcare Organization and Implementation Research, University of Massachusetts Medical School), Martinez RM (Center of Innovation for Complex Chronic Healthcare) Tarlov E (Center of Innovation for Complex Chronic Healthcare, University of Illinois Chicago) Silva A (Center of Innovation for Complex Chronic Healthcare, Loyola University Chicago) Fischer M (Center of Innovation for Complex Chronic Healthcare, University of Illinois Chicago) French D ((Center of Innovation for Complex Chronic Healthcare, Northwestern University) Stroupe KT (Center of Innovation for Complex Chronic Healthcare, Loyola University Chicago)

Objectives:
The Affordable Care Act (ACA) created new insurance options for Veterans, including increased opportunities to seek healthcare services outside VA; however, little is known about how Veterans share information with providers across healthcare systems. We describe attitudes about sharing health information among Veterans who use multiple healthcare systems, and examine their use of different information exchange tools including Blue Button, a feature in VA's patient portal, and VA's Virtual Lifetime Electronic Record (VLER).

Methods:
In 2016, surveys were mailed to 21,000 VA users in the Midwestern United States who were under age 65. The response rate was 24%. After excluding Veterans who reported no use of multiple healthcare systems, 1,349 Veterans constituted the final analytic cohort. Descriptive statistics were used to characterize Veteran perspectives about information sharing, and multiple logistic regression models were estimated to examine associations between Veteran characteristics and use of information exchange tools. Analyses were weighted to account for the sampling design.

Results:
The majority (90%) of Veterans indicated that sharing health information with both VA and non-VA providers was extremely or very important. When asked who was mainly responsible for information sharing, 45% indicated the patient had some or all responsibility. Sixty percent discussed care received at VA with non-VA providers while 72% discussed non-VA care with VA providers. When asked about information exchange tools, 24% had used Blue Button and 9% had signed up for VLER. Hispanic ethnicity (OR = 0.3, p < 0.05) was negatively associated with Blue Button use, while being married (OR = 1.5, p < 0.05) was positively associated with use. Veterans with enrollment priority categories indicating high levels of disability had higher odds of using VLER (3.78, p < 0.01) compared to other Veterans

Implications:
Although almost all Veterans in this analysis agree that sharing information is important, many do not share information about their care in one healthcare system with providers in other systems, nor do they use VLER or Blue Button to share information.

Impacts:
Sharing health information can increase efficiency and improve outcomes by facilitating care coordination. Developing strategies to increase use of currently available information exchange tools is critical as options for Veterans to use community services increase.