Why your community care records don't reach the VA

The short version

Two civilian practices that both use Epic can usually see each other's notes. The software shares them. People assume community care works the same way, and it doesn't.

Your community care records only get to the VA if someone at the practice you saw sends them. They have to upload the notes. If they don't, nothing catches it later. The record simply isn't there when your VA provider goes looking.

Two things people mix up

The VA does share records with civilian health systems, which is probably where the confusion starts. There are two separate things happening, and only one of them is about your community care paperwork.

Record sharing between systems

The VA is connected to national record-sharing networks, and since 2024 it has offered an interoperability API to health systems running Epic or Oracle Health. Where that connection is set up, a VA clinician can look up records from an outside system.

Two things limit how much this helps you. You have to have authorized the sharing, because it works on an opt-in basis. And it lets a clinician go find records if they think to look for them. It doesn't put the specialist's note into your chart.

Community care documentation

This is the paperwork from the visit the VA authorized and paid for: the consult note, the operative report, the imaging results. It gets back to the VA a different way. The practice uploads it to HealthShare Referral Manager, or HSRM, which is the system the VA uses to run community care referrals.

What the practice is required to do

Sending records back isn't a courtesy. It's part of what a practice agrees to when it joins the Community Care Network, and there are deadlines attached:

• Initial documentation for outpatient care, within 30 days of your first appointment.
• Final documentation, within 30 days of the end of the authorized care.

Your authorization covers a set of services over a set period, which the VA calls a standardized episode of care. The practice owes a closing summary at the end of that period, not just notes along the way.

You can ask the practice whether they've sent your records and when. It's a reasonable question and their staff should be able to answer it.

Why it goes wrong

Usually it's a paperwork problem rather than a medical one. The practice treats you like any other patient, and the extra step of logging into a VA portal they don't use often and uploading a file is easy to skip. Staff change. Someone is out. A referral closes and nobody goes back to it.

What makes it worse is that nobody is checking. The VA's community care office has said it can't tell, across the system, whether documentation is actually coming back, and there's a bill in Congress aimed at that specific problem. About three quarters of veterans return to a VA facility for follow-up after being seen in the community. So when a note is missing, the VA provider seeing you next doesn't know what the specialist found or recommended.

Often you find out in the appointment itself, when your VA provider asks what the specialist said.

What you can do

You can't make a practice file its paperwork. You can make sure you have the information yourself.

• Ask for a copy before you leave. Request the visit summary and any results at the appointment. They're your records and you're entitled to them, and the rules behind that are worth knowing. Getting a copy there is much easier than calling for one a month later.
• Ask whether they've submitted the documentation to the VA, and when. Asking makes it more likely somebody follows through.
• Keep your own notes on what was said. If the paperwork is late or never shows up, you still have the substance of the visit.
• Take your copy to your VA appointment. Then it doesn't matter much whether the note arrived.
• Tell your VA care team if something is missing. The community care staff at your VA medical center can follow up on the referral.

It shouldn't fall to you. In practice it often does, and it's a lot easier to handle at the visit than to reconstruct six weeks later.