Ensuring the Integrity of Patient Data for the Nation’s Largest Integrated Health System

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Ensuring the Integrity of Patient Data for the Nation’s Largest Integrated Health System

Posted on 03.22.24

Resolving data differences between VA and DoD

VA has partnered with the Department of Defense (DoD) to share a single Electronic Health Record Management System (EHRM) based on the Oracle Millennium product for providing care to both DoD and VA patients. EHRM uses the DoD Defense Enrollment Eligibility Reporting System (DEERS) as the authoritative source of identity information in Oracle Millennium, and the DoD Electronic Data Interchange Person Identifier (EDIPI) as the unique identifier for the shared system. There are major differences in the identity data between VA and DoD that must be addressed before data migration. Data accuracy is essential for ensuring patients are properly identified, clinical records are linked and care is delivered to Veterans.

Although significant progress has been made in reducing the number of identity issues shared between VA and DoD, tremendous numbers of anomalies remain that will likely require manual analysis, which are beyond the ability of the existing HC IdM team to successfully resolve according to schedule.


VHA partnered with Aptive HTG to help reduce the risk of delaying EHRM migration activities and mitigate potential patient safety issues reported during the initial deployment at Spokane, Washington, which are tracked by the VA Patient Safety Team.

The Aptive team addresses inconsistencies in data elements between VHA and DoD records and errors created by integrating with DoD into a single EHR. For example, including DoD and VHA providers in the provider list has resulted in VHA Message Center orders being sent to DoD providers (e.g., Dr. John J. Smith) rather than the appropriate VHA provider (e.g., Dr. John B. Smith), risking patient safety unless erroneous orders are identified and correctly redirected. Rectifying these errors requires audit procedures to identify current system errors; detailed tracking of data message redirection and corrections; workflow redesign to halt future, potential errors; detailed reporting; and systematic tracking of the initial data errors and corrections as required by statute. Aptive actively supports all aspects of error identification, resolution, reporting and workflow redesign.

Comprehensive Program Management

We provide comprehensive program management for the VHA National Councils and Council Management Team (CMT), which work to resolve data discrepancies. Aptive Council Administrators (CAs) facilitate intra- and inter-Council activities and coordinate with the EHRM Integration Office (EHRM-IO) to ensure an accurate, reliable, efficient and effective EHR and validated data.

In support of the VHA National Councils, Aptive CAs facilitate the partnership with Council co-chairs, Oracle Cerner, Chief Medical Information Office (CMIO) Process Reengineering, Council Control and local sites — and collaborate with EHRM-IO Solution Advisors/Solution Management Administrators — to address data integrity concerns.

This work includes identifying and resolving data discrepancies and duplicate records across functional areas, developing audit procedures to identify current system errors, supporting detailed data tracking of corrections and redesigning workflows to prevent future errors. The Aptive team helps manage deadlines, milestones and priorities and delivers weekly and monthly performance data based on agreed-upon key performance indicators (KPIs), which include statistical workload metrics in a variety of reporting formats.

Data Integrity

In addition to facilitating Council partnerships, the Aptive team actively supports the Client Portfolio Management Operations (CPMO) Issue Management Team (IMT) with developing the future state, end-to-end EHRM issue resolution process. Our team facilitates working sessions between field users, including VA Medical Centers (VAMCs) and Veterans Integrated Services Networks (VISNs), Councils and the IMT to:

  • Identify critical requirements for associating and elevating issues with people, processes and technology
  • Define the process for resolving issues at the local and enterprise levels
  • Present solutions for decisions to EHRM decision-making bodies for approval and implementation

This work requires identifying gaps in the current issue resolution process, designing and documenting new issue resolution processes, defining data requirements and creating a new set of standard operating procedures (SOPs) and processes.


The Aptive team creates interoperability management planning, develops outcome-oriented metrics and monitors and reports on overall EHRM activities and issues. We establish and maintain consistent communications, develop support processes and enterprise standards and lead reporting to VA leadership via weekly EHRM executive committee briefing slides.

Our team coordinates with other teams to present reports about patient safety incidents, issues and events; progress on new service requests; and the status of high-priority projects and initiatives. We also track and manage deadlines and priorities and deliver weekly and monthly performance data based on agreed upon KPIs.

In addition, the Aptive team is supporting the development of a new tool to report the status of EHRM-related issues. Currently, these issues are tracked manually via multiple shared Excel spreadsheets, leading to inconsistent tracking and understanding of status across stakeholders due to the lack of a single source of record, schedule of spreadsheet updates and access limitations. The new tool will centralize EHRM issue status reporting and ensure the same information is captured, maintained and consistently reported for each individual issue.

Technical Writing

As Councils develop revised workflows and reengineer processes, and the IMT helps resolve outstanding issues, Aptive provides direct support to ensure thorough technical documentation of proposed EHR changes, rationale for decision making and overall progress of EHRM efforts.

We also develop, coordinate and deliver comprehensive reporting to track identified issues and improvement progress through multiple reports and summary formats. Our staff use systematic procedures to ensure documents receive thorough quality checks for content accuracy and readability (e.g., design, layout, wording, 508 compliance), and we ensure complex technical information is explained using plain language.


Remedying thousands of anomalies

Data Anomalies

The Aptive team expects to resolve a significant quantity of multiple types of data anomalies with the motivation of ensuring positive quality of life changes for Veterans who have had their medical care significantly impacted by these anomalies. The types of anomalies the team is focused on in the first year of this multi-year contract include remedying 6,000 duplicate ICNs, 6,000 duplicate EDIPI, 6,000 EDIPI to ICN crossovers and another 6,000 separate identify trait verifications. Simultaneously, we are working on 10,400 missing EDIPIs and another 14,400 EDIPIs for non-enumerated patients.

To date the Aptive team has remedied over 7,223 separate anomalies.

Technical Writing

Using the products Aptive creates through refining current processes and procedures, VA will be able to streamline current training and operations. This will hasten both the preparation time for remedying complex data anomalies and the operation of the remediation itself — which, in turn, will affect Veterans at an exponentially greater rate than current capabilities allow.

Aptive technical writing has also been instrumental in helping VA document and plan meeting agendas while creating a record system for reference. This process helps our client with continuous forward momentum with the same motivation of Veteran health success.

Results at a Glance

  • Remedied over 7,223 anomalies
  • Streamlining current processes and procedures
  • Created a record system for reference