The following letter was issued in response to concerns DirectTrust expressed about being misrepresented in a report from the VA OIG.

RE :  Improving VA and Select Community Care Health Information Exchanges, August 6, 2020

Ms. Wickenhauser,

The report, Improving VA and Select Community Care Health Information Exchanges, addresses VA’s use of Health Information Exchanges and DirectTrust to share medical information.  The report makes four recommendations to VA with the goal of improving medical information sharing.

I received your memo, “DirectTrust VA OIG Report Concerns 08142020”, which offers 12 suggested changes to the report, on September 10, 2020.  The relevant source material for this report derived from interviews with VA leaders, a questionnaire to VA facility directors, VA documents and your website. The draft report was provided to VA prior to publication for their review and comment. Upon receipt  of your memo, I met with the authors of the report, the report editors, and this report’s quality review team to address the issues raised in your September 10 memo.  As a result of that review, I find four errors in the report that I plan to correct.  The post publication edits to the report will recognize that: DirectTrust does not facilitate training for VA, community providers are not required to be members of DirectTrust to exchange information with VA, and the term “associate member” has no meaning. In addition, footnote 35 was inartful in the way it addresses  accreditation  and will be deleted.

The additional issues raised in your memo, upon review, do not require post publication edits.  The comparison of the medical information sharing system to email is reasonable given the technical sophistication of the intended audience for this report, the ease of understanding the “like email” comparison, and the fact that VA used this comparison in our discussions on this topic.  The map demonstrates nation-wide impact of DirectTrust services and was sourced from the DirectTrust website. The fees paid by VA are reasonably stated. The heading, “Costs Associated with HIEs and DirectTrust” is reasonable and is not intended to single out DirectTrust in a negative way. The statements “Some of the smaller facilities in rural locations reported costs prevented community partners from joining an HIE or DirectTrust” and “Some facilities wanted to use VA Exchange or VA Direct but had no community partners with whom information could be shared” were made by VA staff in interviews with OHI staff, and will not be changed in the report.

Changes will be made to the report on our website shortly. There was no intention to make inaccurate statements about DirectTrust, and the team went to great lengths to insure the data in the report was accurate.  I hope you find these changes address your concerns.


(original signed)

John D. Daigh, Jr, MD

Assistant Inspector General for Healthcare Inspections

See the Updated Report