Which veterans enroll in a VA health information exchange program?

Brian E. Dixon*, Susan Ofner, Susan M. Perkins, Laura J. Myers, Marc B. Rosenman, Alan J. Zillich, Dustin D. French, Michael Weiner, David A. Haggstrom

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions. Materials and Methods: Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients' sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records. Results: Among 57 072 patients, 6627 (12%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50-64, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment. Discussion and Conclusion: Enrollment in HIE is complex, with several factors involved in a patient's decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation.

Original languageEnglish (US)
Pages (from-to)96-105
Number of pages10
JournalJournal of the American Medical Informatics Association
Issue number1
StatePublished - Jan 2017


  • Computerized
  • Health information exchange
  • Matched-pair analysis
  • Medical records systems
  • Veterans health

ASJC Scopus subject areas

  • Health Informatics

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