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Appl Clin Inform 2017; 08(01): 235-249
DOI: 10.4338/ACI-2016-10-RA-0184
Research Article
Schattauer GmbH

Medication Use among Veterans across Health Care Systems

Khoa A. Nguyen
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
2   College of Pharmacy, Purdue University, West Lafayette, IN, USA
,
David A. Haggstrom
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
4   Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
5   Regenstrief Institute, Inc., Indianapolis, IN, USA
,
Susan Ofner
3   Department of Biostatistics, School of Medicine, Indiana University, IN, USA
,
Susan M. Perkins
3   Department of Biostatistics, School of Medicine, Indiana University, IN, USA
,
Dustin D. French
6   Department of Ophthalmology and the Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, and the Veterans Affairs Health Services Research and Development Service, in Chicago, IL, USA
,
Laura J. Myers
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
,
Marc Rosenman
8   Department of Pediatrics, Children’s Health Services Research, Indiana University, Regenstrief Institute, Inc.
,
Michael Weiner
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
5   Regenstrief Institute, Inc., Indianapolis, IN, USA
7   Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN, USA
,
Brian E. Dixon
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
4   Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
5   Regenstrief Institute, Inc., Indianapolis, IN, USA
,
Alan J. Zillich
1   Center for Health Information and Communication, Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service (CIN 13-416), Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
2   College of Pharmacy, Purdue University, West Lafayette, IN, USA
› Institutsangaben
Funding This project was supported by the U.S. Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service, grant number IIR 11-058, Evaluation of VLER Indiana Health Information Exchange Demonstration Project. This work was further supported by VA HSR&D grant CIN 13-416 at the Richard L Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana. Dr. Weiner is Chief of Health Services Research and Development at the Richard L Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana.
Weitere Informationen

Correspondence to:

Khoa A Nguyen, Pharm.D
Medical Informatics Postdoctoral Fellow
VA HSR&D-CHIC, D6004-2
1481 West 10th Street, Indianapolis, IN 46202, USA
Telefon: (317) 988-4409   

Publikationsverlauf

Received: 26. Oktober 2016

Accepted: 06. Januar 2017

Publikationsdatum:
20. Dezember 2017 (online)

 
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Summary

Introduction: Dual healthcare system use can create gaps and fragments of information for patient care. The Department of Veteran Affairs is implementing a health information exchange (HIE) program called the Virtual Lifetime Electronic Record (VLER), which allows providers to access and share information across healthcare systems. HIE has the potential to improve the safety of medication use. However, data regarding the pattern of outpatient medication use across systems of care is largely unknown. Therefore, the objective of this study is to describe the prevalence of medication dispensing across VA and non-VA health care systems among a cohort Veteran population Methods: This study included all Veterans who had two outpatient visits or one inpatient visit at the Indianapolis VA during a 1-year period prior to VLER enrollment. Source of medication data was assessed at the subject level, and categorized as VA, INPC (non-VA), or both. The primary target was identification of sources for medication data. Then, we compared the mean number of prescriptions, as well as overall and pairwise differences in medication dispensing.

Results: Out of 52,444 Veterans, 17.4% of subjects had medication data available in a regional HIE. On average, 40 prescriptions per year were prescribed for Veterans who used both sources compared to 29 prescriptions per year from VA only and 25 prescriptions per year from INPC only sources. The annualized prescription rate of Veterans in the dual use group was 36% higher than those who had only VA data available and 61% higher than those who had only INPC data available.

Conclusions: Our data demonstrated that 17.4% of subjects had medication use identified from non-VA sources, including prescriptions for antibiotics, antineoplastics, and anticoagulants. These data support the need for HIE programs to improve coordination of information, with the potential to reduce adverse medication interactions and improve medication safety.


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Keywords

Medication use - health information exchange - medication safety - dual health care systems

 


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Conflicts of interest

There are no conflicts of interest in the research.

  • References

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    CrossrefPubMedGoogle Scholar
  • 5 Gandhi TK, Burstin HR, Cook EF, Puopolo AL, Haas JS, Brennan TA, Bates DW. Drug complications in outpatients. Journal of general internal medicine 2000; 15 (Suppl. 03) 149-154. PubMed PMID: 10718894; PubMed Central PMCID: PMC1495358.
    CrossrefPubMedGoogle Scholar
  • 6 U.S. Food and Drug Administration.. Medication error reports: FDA. 2009 [updated 03/05/2009; cited 2016 06/06]. Available from: http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/ucm080629.htm.
    PubMedGoogle Scholar
  • 7 Johnson A, Guirguis E, Grace Y. Preventing medication errors in transitions of care: A patient case approach. Journal of the American Pharmacists Association: JAPhA 2015; 55 (Suppl. 02) e264-e274 quiz e75-e76. doi: 10.1331/JAPhA.2015.15509. PubMed PMID: 25749270.
    PubMedGoogle Scholar
  • 8 Hincapie A, Warholak T. The impact of health information exchange on health outcomes. Applied clinical informatics 2011; 2 (Suppl. 04) 499-507. doi: 10.4338/ACI-2011-05-R-0027. PubMed PMID: 23616891; PubMed Central PMCID: PMC3612997.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Vest JR, Kern LM, Silver MD, Kaushal R. investigators H. The potential for community-based health information exchange systems to reduce hospital readmissions. Journal of the American Medical Informatics Association: JAMIA. 2015; 22 (Suppl. 02) 435-442. doi: 10.1136/amiajnl-2014-002760. PubMed PMID: 25100447.
    CrossrefPubMedGoogle Scholar
  • 10 Gellad WF, Zhao X, Thorpe CT, Mor MK, Good CB, Fine MJ. Dual use of Department of Veterans Affairs and medicare benefits and use of test strips in veterans with type 2 diabetes mellitus. JAMA internal medicine 2015; 175 (Suppl. 01) 26-34. doi: 10.1001/jamainternmed.2014.5405. PubMed PMID: 25383920.
    CrossrefPubMedGoogle Scholar
  • 11 Fontaine P, Ross SE, Zink T, Schilling LM. Systematic review of health information exchange in primary care practices. Journal of the American Board of Family Medicine: JABFM 2010; 23 (Suppl. 05) 655-670. doi: 10.3122/jabfm.2010.05.090192. PubMed PMID: 20823361.
    CrossrefPubMedGoogle Scholar
  • 12 Vest JR, Kaushal R, Silver MD, Hentel K, Kern LM. Health information exchange and the frequency of repeat medical imaging. The American journal of managed care. 2014; 20 11 Spec No. 17 eSP16-eSP24. PubMed PMID: 25811815.
    PubMedGoogle Scholar
  • 13 French DD, Dixon BE, Perkins SM, Myers LJ, Weiner M, Zillich AJ, Haggstrom DA. Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article. Medicine 2016; 95 (Suppl. 02) e2481. doi: 10.1097/MD.0000000000002481. PubMed PMID: 26765453; PubMed Central PMCID: PMC4718279.
    CrossrefPubMedGoogle Scholar
  • 14 Rahurkar S, Vest JR, Menachemi N. Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care. Health affairs 2015; 34 (Suppl. 03) 477-483. doi: 10.1377/hlthaff.2014.0729. PubMed PMID: 25732499.
    CrossrefPubMedGoogle Scholar
  • 15 Hersh WR, Totten AM, Eden KB, Devine B, Gorman P, Kassakian SZ, Woods SS, Daeges M, Pappas M, McDonagh MS. Outcomes From Health Information Exchange: Systematic Review and Future Research Needs. JMIR medical informatics 2015; 3 (Suppl. 04) e39. doi: 10.2196/medinform.5215. PubMed PMID: 26678413; PubMed Central PMCID: PMC4704923.
    CrossrefPubMedGoogle Scholar
  • 16 Biondich PG, Grannis SJ. The Indiana network for patient care: an integrated clinical information system informed by over thirty years of experience. J Public Health Manag Pract 2004; (Suppl.) S81-S86. Epub 2005/01/12. doi: 00124784-200411001–00013 [pii]. PubMed PMID: 15643364.
    PubMedGoogle Scholar
  • 17 Zafar A, Dixon BE. Pulling back the covers: technical lessons of a real-world health information exchange. Studies in health technology and informatics 2007; 129 Pt 1 488-492. Epub 2007/10/04. PubMed PMID: 17911765.
    PubMedGoogle Scholar
  • 18 Barnes M. Lessons learned from the implementation of clinical messaging systems. AMIA Annu Symp Proc 2007; 36-40. Epub 2008/08/13. PubMed PMID: 18693793.
    PubMedGoogle Scholar
  • 19 Dixon BE, Siegel JA, Oemig TV, Grannis SJ. Electronic health information quality challenges and interventions to improve public health surveillance data and practice. Public Health Rep 2013; 128 (Suppl. 06) 546-553. Epub 2013/11/02. PubMed PMID: 24179266; PubMed Central PMCID: PMC3804098.
    CrossrefPubMedGoogle Scholar
  • 20 Dixon BE, Grannis SJ, Revere D. Measuring the impact of a health information exchange intervention on provider-based notifiable disease reporting using mixed methods: a study protocol. BMC Med Inform Decis Mak 2013; 13 (Suppl. 01) 121. Epub 2013/11/01. doi: 10.1186/1472-6947-13-121. PubMed PMID: 24171799; PubMed Central PMCID: PMC3819468.
    CrossrefPubMedGoogle Scholar
  • 21 Indiana Health Information Exchange.. ADT Alerts for Reducing ED Admissions: A Case Study Indianapolis. Indiana: Indiana Health Information Exchange; 2013. [cited 2015 May 15]. Available from: http://www.ihie.org/aco-services.
    Google Scholar
  • 22 Stroupe KT, Smith BM, Hogan TP, St Andre JR, Gellad WF, Weiner S, Lee TA, Burk M, Cunningham F, Piette JD, Rogers TJ, Huo Z, Weaver FM. Medication acquisition across systems of care and patient-provider communication among older veterans. American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 2013; 70 (Suppl. 09) 804-813. doi: 10.2146/ajhp120222. PubMed PMID: 23592363.
    PubMedGoogle Scholar
  • 23 Hildreth CJ, Burke AE, Glass RM. JAMA patient page. Inappropriate use of antibiotics. Jama 2009; 302 (Suppl. 07) 816. doi: 10.1001/jama.302.7.816. PubMed PMID: 19690318.
    PubMedGoogle Scholar
  • 24 Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. Jama 2016; 316 (Suppl. 20) 2115-2125. doi: 10.1001/jama.2016.16201. PubMed PMID: 27893129.
    CrossrefPubMedGoogle Scholar
  • 25 Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug safety 2007; 30 (Suppl. 10) 911-918. Epub 2007/09/18. PubMed PMID: 17867728.
    CrossrefPubMedGoogle Scholar
  • 26 Cooper AL, Jiang L, Yoon J, Charlton ME, Wilson IB, Mor V, Kizer KW, Trivedi AN. Dual-System Use and Intermediate Health Outcomes among Veterans Enrolled in Medicare Advantage Plans.. Health services research 2015 doi: 10.1111/1475-6773.12303. PubMed PMID: 25845818.
    PubMedGoogle Scholar
  • 27 Gaglioti A, Cozad A, Wittrock S, Stewart K, Lampman M, Ono S, Reisinger HS, Charlton ME. Non-VA primary care providers’ perspectives on comanagement for rural veterans. Military medicine 2014; 179 (Suppl. 11) 1236-1243. doi: 10.7205/MILMED-D-13-00342. PubMed PMID: 25373047.
    CrossrefPubMedGoogle Scholar
  • 28 Byrne CM, Mercincavage LM, Bouhaddou O, Bennett JR, Pan EC, Botts NE, Olinger LM, Hunolt E, Banty KH, Cromwell T. 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. International journal of medical informatics 2014; 83 (Suppl. 08) 537-547. doi: 10.1016/j.ijmedinf.2014.04.005. PubMed PMID: 24845146.
    CrossrefPubMedGoogle Scholar
  • 29 Lyle J, Bouhaddou O, Botts N, Swall M, Pan E, Cullen T, Donahue M, Hsing N. Veterans Health Administration Experience with Data Quality Surveillance of Continuity of Care Documents: Interoperability Challenges for eHealth Exchange Participants. AMIA Annual Symposium proceedings / AMIA Symposium AMIA Symposium 2015; 2015: 870-879. PubMed PMID: 26958223; PubMed Central PMCID: PMC4765662
    PubMedGoogle Scholar

Correspondence to:

Khoa A Nguyen, Pharm.D
Medical Informatics Postdoctoral Fellow
VA HSR&D-CHIC, D6004-2
1481 West 10th Street, Indianapolis, IN 46202, USA
Telefon: (317) 988-4409   

  • References

  • 1 Humensky J, Carretta H, de Groot K, Brown MM, Tarlov E, Hynes DM. Service utilization of veterans dually eligible for VA and Medicare fee-for-service: 1999-2004.. Medicare & medicaid research review 2012 2. 03 doi: 10.5600/mmrr.002.03.a06. PubMed PMID: 24800148; PubMed Central PMCID: PMC4006386.
    PubMedGoogle Scholar
  • 2 Wolinsky FD, Miller TR, An H, Brezinski PR, Vaughn TE, Rosenthal GE. Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?. BMC health services research 2006; 6: 131. doi: 10.1186/1472-6963-6-131. PubMed PMID: 17029643; PubMed Central PMCID: PMC1617101.
    CrossrefPubMedGoogle Scholar
  • 3 VLER Health: VA Health Care. [cited 2015 10/28]. Available from: http://www.va.gov/VLER/about-vlerhealth.asp#what-is-vler-health.
    PubMedGoogle Scholar
  • 4 Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, Seger DL, Shu K, Federico F, Leape LL, Bates DW. Adverse drug events in ambulatory care. The New England journal of medicine 2003; 348 (Suppl. 16) 1556-1564. doi: 10.1056/NEJMsa020703. PubMed PMID: 12700376.
    CrossrefPubMedGoogle Scholar
  • 5 Gandhi TK, Burstin HR, Cook EF, Puopolo AL, Haas JS, Brennan TA, Bates DW. Drug complications in outpatients. Journal of general internal medicine 2000; 15 (Suppl. 03) 149-154. PubMed PMID: 10718894; PubMed Central PMCID: PMC1495358.
    CrossrefPubMedGoogle Scholar
  • 6 U.S. Food and Drug Administration.. Medication error reports: FDA. 2009 [updated 03/05/2009; cited 2016 06/06]. Available from: http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/ucm080629.htm.
    PubMedGoogle Scholar
  • 7 Johnson A, Guirguis E, Grace Y. Preventing medication errors in transitions of care: A patient case approach. Journal of the American Pharmacists Association: JAPhA 2015; 55 (Suppl. 02) e264-e274 quiz e75-e76. doi: 10.1331/JAPhA.2015.15509. PubMed PMID: 25749270.
    PubMedGoogle Scholar
  • 8 Hincapie A, Warholak T. The impact of health information exchange on health outcomes. Applied clinical informatics 2011; 2 (Suppl. 04) 499-507. doi: 10.4338/ACI-2011-05-R-0027. PubMed PMID: 23616891; PubMed Central PMCID: PMC3612997.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Vest JR, Kern LM, Silver MD, Kaushal R. investigators H. The potential for community-based health information exchange systems to reduce hospital readmissions. Journal of the American Medical Informatics Association: JAMIA. 2015; 22 (Suppl. 02) 435-442. doi: 10.1136/amiajnl-2014-002760. PubMed PMID: 25100447.
    CrossrefPubMedGoogle Scholar
  • 10 Gellad WF, Zhao X, Thorpe CT, Mor MK, Good CB, Fine MJ. Dual use of Department of Veterans Affairs and medicare benefits and use of test strips in veterans with type 2 diabetes mellitus. JAMA internal medicine 2015; 175 (Suppl. 01) 26-34. doi: 10.1001/jamainternmed.2014.5405. PubMed PMID: 25383920.
    CrossrefPubMedGoogle Scholar
  • 11 Fontaine P, Ross SE, Zink T, Schilling LM. Systematic review of health information exchange in primary care practices. Journal of the American Board of Family Medicine: JABFM 2010; 23 (Suppl. 05) 655-670. doi: 10.3122/jabfm.2010.05.090192. PubMed PMID: 20823361.
    CrossrefPubMedGoogle Scholar
  • 12 Vest JR, Kaushal R, Silver MD, Hentel K, Kern LM. Health information exchange and the frequency of repeat medical imaging. The American journal of managed care. 2014; 20 11 Spec No. 17 eSP16-eSP24. PubMed PMID: 25811815.
    PubMedGoogle Scholar
  • 13 French DD, Dixon BE, Perkins SM, Myers LJ, Weiner M, Zillich AJ, Haggstrom DA. Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article. Medicine 2016; 95 (Suppl. 02) e2481. doi: 10.1097/MD.0000000000002481. PubMed PMID: 26765453; PubMed Central PMCID: PMC4718279.
    CrossrefPubMedGoogle Scholar
  • 14 Rahurkar S, Vest JR, Menachemi N. Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care. Health affairs 2015; 34 (Suppl. 03) 477-483. doi: 10.1377/hlthaff.2014.0729. PubMed PMID: 25732499.
    CrossrefPubMedGoogle Scholar
  • 15 Hersh WR, Totten AM, Eden KB, Devine B, Gorman P, Kassakian SZ, Woods SS, Daeges M, Pappas M, McDonagh MS. Outcomes From Health Information Exchange: Systematic Review and Future Research Needs. JMIR medical informatics 2015; 3 (Suppl. 04) e39. doi: 10.2196/medinform.5215. PubMed PMID: 26678413; PubMed Central PMCID: PMC4704923.
    CrossrefPubMedGoogle Scholar
  • 16 Biondich PG, Grannis SJ. The Indiana network for patient care: an integrated clinical information system informed by over thirty years of experience. J Public Health Manag Pract 2004; (Suppl.) S81-S86. Epub 2005/01/12. doi: 00124784-200411001–00013 [pii]. PubMed PMID: 15643364.
    PubMedGoogle Scholar
  • 17 Zafar A, Dixon BE. Pulling back the covers: technical lessons of a real-world health information exchange. Studies in health technology and informatics 2007; 129 Pt 1 488-492. Epub 2007/10/04. PubMed PMID: 17911765.
    PubMedGoogle Scholar
  • 18 Barnes M. Lessons learned from the implementation of clinical messaging systems. AMIA Annu Symp Proc 2007; 36-40. Epub 2008/08/13. PubMed PMID: 18693793.
    PubMedGoogle Scholar
  • 19 Dixon BE, Siegel JA, Oemig TV, Grannis SJ. Electronic health information quality challenges and interventions to improve public health surveillance data and practice. Public Health Rep 2013; 128 (Suppl. 06) 546-553. Epub 2013/11/02. PubMed PMID: 24179266; PubMed Central PMCID: PMC3804098.
    CrossrefPubMedGoogle Scholar
  • 20 Dixon BE, Grannis SJ, Revere D. Measuring the impact of a health information exchange intervention on provider-based notifiable disease reporting using mixed methods: a study protocol. BMC Med Inform Decis Mak 2013; 13 (Suppl. 01) 121. Epub 2013/11/01. doi: 10.1186/1472-6947-13-121. PubMed PMID: 24171799; PubMed Central PMCID: PMC3819468.
    CrossrefPubMedGoogle Scholar
  • 21 Indiana Health Information Exchange.. ADT Alerts for Reducing ED Admissions: A Case Study Indianapolis. Indiana: Indiana Health Information Exchange; 2013. [cited 2015 May 15]. Available from: http://www.ihie.org/aco-services.
    Google Scholar
  • 22 Stroupe KT, Smith BM, Hogan TP, St Andre JR, Gellad WF, Weiner S, Lee TA, Burk M, Cunningham F, Piette JD, Rogers TJ, Huo Z, Weaver FM. Medication acquisition across systems of care and patient-provider communication among older veterans. American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 2013; 70 (Suppl. 09) 804-813. doi: 10.2146/ajhp120222. PubMed PMID: 23592363.
    PubMedGoogle Scholar
  • 23 Hildreth CJ, Burke AE, Glass RM. JAMA patient page. Inappropriate use of antibiotics. Jama 2009; 302 (Suppl. 07) 816. doi: 10.1001/jama.302.7.816. PubMed PMID: 19690318.
    PubMedGoogle Scholar
  • 24 Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. Jama 2016; 316 (Suppl. 20) 2115-2125. doi: 10.1001/jama.2016.16201. PubMed PMID: 27893129.
    CrossrefPubMedGoogle Scholar
  • 25 Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug safety 2007; 30 (Suppl. 10) 911-918. Epub 2007/09/18. PubMed PMID: 17867728.
    CrossrefPubMedGoogle Scholar
  • 26 Cooper AL, Jiang L, Yoon J, Charlton ME, Wilson IB, Mor V, Kizer KW, Trivedi AN. Dual-System Use and Intermediate Health Outcomes among Veterans Enrolled in Medicare Advantage Plans.. Health services research 2015 doi: 10.1111/1475-6773.12303. PubMed PMID: 25845818.
    PubMedGoogle Scholar
  • 27 Gaglioti A, Cozad A, Wittrock S, Stewart K, Lampman M, Ono S, Reisinger HS, Charlton ME. Non-VA primary care providers’ perspectives on comanagement for rural veterans. Military medicine 2014; 179 (Suppl. 11) 1236-1243. doi: 10.7205/MILMED-D-13-00342. PubMed PMID: 25373047.
    CrossrefPubMedGoogle Scholar
  • 28 Byrne CM, Mercincavage LM, Bouhaddou O, Bennett JR, Pan EC, Botts NE, Olinger LM, Hunolt E, Banty KH, Cromwell T. 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. International journal of medical informatics 2014; 83 (Suppl. 08) 537-547. doi: 10.1016/j.ijmedinf.2014.04.005. PubMed PMID: 24845146.
    CrossrefPubMedGoogle Scholar
  • 29 Lyle J, Bouhaddou O, Botts N, Swall M, Pan E, Cullen T, Donahue M, Hsing N. Veterans Health Administration Experience with Data Quality Surveillance of Continuity of Care Documents: Interoperability Challenges for eHealth Exchange Participants. AMIA Annual Symposium proceedings / AMIA Symposium AMIA Symposium 2015; 2015: 870-879. PubMed PMID: 26958223; PubMed Central PMCID: PMC4765662
    PubMedGoogle Scholar

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