University of Pittsburgh Medical Center (UPMC) and several other regional hospitals could soon be swapping patient records with the U.S. Department of Veterans Affairs, part of an ongoing VA effort to share medical charts with community hospitals.

Even among those veterans who receive free or subsidized care at the nation's VA hospitals -- about 40 percent of the nation's 22 million veterans get VA care -- it's common for them to seek care outside of the VA system. Many veterans have private insurance, while veterans who are old enough often carry Medicare coverage.

"Over half of [the] veterans that use us have other forms of insurance," said David S. Macpherson, a medical professor at the University of Pittsburgh and the chief medical officer of the VA's regional network office, which is headquartered in Pittsburgh and supervises 10 hospitals and 45 outpatient clinics in Pennsylvania, Delaware, New Jersey and West Virginia.

The number of vets who carry supplemental insurance and seek care out of the VA network is "significant enough that I think there's a lot of value in this," Dr. Macpherson said. Linking the data networks fits into the VA's larger goal of giving each veteran a "virtual lifetime electronic record," a 3-year-old campaign to make veterans' health records more portable.

The portability campaign, and the proposed data link between community hospitals and the VA, are both part of a sweeping federal initiative to connect hospitals, clinicians, insurers, pharmacies and government health plans, allowing them to trade patient records electronically with partners of their choosing -- and to eventually trade data with any health system in the country.

As for the local effort, there are about 325,000 veterans served by the facilities in the multistate regional VA network. Of those, about 100,000 live in the western half. Those would be most likely to benefit from a data exchange with UPMC and other area hospitals.

That exchange would take place by linking the VA's expansive health database with the regional database led by UPMC, called ClinicalConnect.

The point of widespread patient data-sharing is to improve triage decision-making, cut down on duplicate procedures, and generally make health care more efficient when patients move from provider to provider.

"If the veteran says, 'I already had a back MRI at UPMC,' we're not going to repeat it at the VA," Dr. Macpherson said. "We can just go in and look at the results."

Patients also are relieved of the responsibility of arranging for their records to be mailed or faxed from doctor to doctor -- or, even more cumbersome, being asked to retrieve them.

On occasion, Dr. Macpherson has asked a patient, " 'Can you pick up copies of your records and bring them to me at your next appointment?' It's really a pain in the butt," he said.

UPMC is the lead system at ClinicalConnect, a health information exchange that already trades patient data among several regional hospitals.

In all, the exchange partnership has 10 participating venues and health networks: UPMC, Butler Health System, Armstrong County Memorial Hospital, Excela Health, Heritage Valley Health System, St. Clair Hospital, Washington Health System, Presbyterian SeniorCare, the Pediatric Alliance, and The Children's Institute of Pittsburgh.

Of those, five are already submitting patient health data to the exchange (UPMC, ACMH, Butler, Heritage Valley and The Children's Institute) while all but two are able to retrieve and view the data (Excela and Presbyterian SeniorCare).

By the end of this year, all of the hospitals should be both viewing and submitting patient data.

When ClinicalConnect is linked with the VA system, any veteran who visited one of the hospitals submitting data could have those charts viewed at the VA, and vice versa.

That could happen by January 2015, Dr. Macpherson said.

Chris Carmody, vice president of the information services division at UPMC and president of ClinicalConnect, said the next step for ClinicalConnect is certification by the federal government to participate in the eHealth Exchange, a collective of federal agencies, state agencies, private health information exchanges and several hospital networks (the VA is a participant).

It is, essentially, a "network of networks." It began as a government-managed project, but now it's being run by a nonprofit public-private consortium called HealtheWay.

"We see it as an opportunity" to better serve Western Pennsylvania veterans, Mr. Carmody said. Once ClinicalConnect is certified by HealtheWay, it will take several more months to connect the systems via the eHealth Exchange, and make sure that the data sent on one end can be viewed properly on the other.

Being part of the federal records exchange does not mean ClinicalConnect gains access to all other exchange partners, however.

"Organizations must connect to one another, and create a peer-to-peer network to exchange information," Mr. Carmody said.

The VA is a pioneer in electronic medical records. Design of what's now known as its VistA -- Veterans Health Information System and Technology Architecture -- system began in the 1970s. A veteran's medical records can be viewed at VA hospitals and clinics nationwide.

Over at ClinicalConnect, 11,000 users have traded more than 118,000 charts and moved more than 1.25 million individual records since the system went live in 2012. Some 2.1 million patients have agreed to be part of the exchange thus far.

When swapping data between ClinicalConnect and the VA system, security is the No. 1 issue, said Wendell Sherman, chief health informatics officer at the VA regional offices. ClinicalConnect is doing much of the heavy lifting on the security and technology issues, mostly by the design of the eHealth Exchange accreditation procedure.

"For us to partner with a clinical provider like UPMC, they have a back-breaking process to go through," Mr. Sherman said. ClinicalConnect and "UPMC [have] really done a whole lot of work to make sure that this is going to happened."

It's already happening elsewhere in the region on a more limited basis -- Conemaugh Health System, based in Johnstown, interfaces with the VA hospital in Altoona and the eHealth Exchange. That data swap has been in place since late 2012. Geisinger Health System, in northern Pennsylvania, is also a member of the eHealth Exchange.

Current membership in the eHealth Exchange is at 41 partners, a collection that includes 800 hospitals, 6,000 medical groups, 800 dialysis centers and 850 retail pharmacies. The number of partners is expected to hit 100 this year, as ClinicalConnect and dozens of other groups are now in the application, accreditation or testing stages.

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