Why Veteran Health Records Are the Hardest Data Problem in Medicine
The VA health system serves 9 million enrolled veterans. Their records span VA systems, DoD military health, and civilian EHRs from community care. The problem is not a shortage of data. It is a shortage of trust metadata.
The VA health system serves 9 million enrolled veterans. Their records span three distinct environments: VA VistA and VHIE systems, DoD military health records, and civilian EHR systems from community care visits under the Mission Act and Choice Act.
The data problem is not a shortage of information. It is a shortage of trust metadata.
The provenance gap
Provenance means: where did this record come from, and how do we know? VA VistA has well-documented chain-of-custody standards. Civilian EHRs do not share those standards. When a record enters the VA system from a community care provider, there is no score attached to it that says: this data was verified at source, transcribed from paper, or generated algorithmically.
The result is that clinicians and care coordinators make decisions on data with unknown reliability. They cannot see the difference between a lab result with a documented chain of custody and a medication list transcribed from paper during a transition of care.
The audit trail problem
Federal health IT systems are subject to FISMA, OIG oversight, and VA oversight requirements. These require systems to demonstrate data integrity, not just data availability.
Most VA health IT programs can show what data they have. They cannot show a timestamped, source-attributed audit trail for how that data was verified.
This gap becomes critical during OIG audits, appeals, and benefits determinations. The data exists. The documentation of its trustworthiness does not.
The Mission Act created access rights but not a trust framework
The VA Mission Act of 2018 expanded veteran access to community care. It solved the access problem without solving the data trust problem.
Every community care visit now generates records in civilian systems. Those records flow back into VA infrastructure. But there is no standard for scoring the reliability of those records at ingestion. The VA system receives data from hundreds of different community providers with different documentation practices, different EHR systems, and different data quality standards.
What a trust layer does
A trust layer does not move data. It scores it. For every record in the VA system, a trust score attaches provenance metadata: where this record came from, when it was verified, what modality produced it, and how current it is right now.
When a VA clinician sees a medication list, they see not just the list but its Trust Score. A record from a VA facility with a documented VHIE chain of custody scores differently than a record transcribed from paper at a community care site. When records disagree, the system flags the discordance with attribution.
That is the infrastructure federal health programs need. Not more data. Scored data.
Jason Alan Snyder
Co-founder of SuperTruth and Artists & Robots, and an inventor on the Data Trust Index patents. Twenty-plus years building technology inside Interpublic Group. He writes here nearly every day on data trust, provenance, and what AI should be allowed to act on, and publishes essays on his Substack.
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