This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans' access to healthcare by establishing a bi-directional connection between Maine's statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.
Despite significant challenges, the Maine Rural Veterans Health Access Program (MeRVHAP) successfully established bi-directional connections with Maine's statewide health information exchange (HIE), allowing for the exchange of clinical health information among U.S. Department of Veterans Affairs (VA) and non-VA providers. Key factors that contributed to success include:
- A strong business case;
- Strong political and organizational commitment and leadership;
- Project champions in the VA with enough seniority to overcome bureaucratic and technical hurdles;
- Highly structured and detailed design and implementation plan;
- Technical flexibility and capacity to adjust strategy mid-stream;
- Collaboration and communication strategies developed by the stakeholders in the course of implementing this project which built a strong foundation for sustainability and replicability.