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United States Government Accountability Office: 
GAO: 

Testimony: 

Before the Subcommittee on Oversight and Investigations, House 
Veterans’ Affairs Committee: 

For Release on Delivery: 
Expected at 10:00 a.m. EDT: 
Tuesday, July 14, 2009: 

Electronic Health Records: 

Program Office Improvements Needed to Strengthen Management of VA and 
DOD Efforts to Achieve Full Interoperability: 

Statement of Valerie C. Melvin, Director: 
Information Management and 
Human Capital Issues: 

GAO-09-895T: 

GAO Highlights:

Highlights of GAO-09-895T, a testimony to Subcommittee on Oversight and 
Investigations; House Committee on Veterans' Affairs. 

Why GAO Did This Study:

For over a decade, the Department of Veterans Affairs (VA) and the 
Department of Defense (DOD) have been working on initiatives to share 
electronic health information. To expedite their efforts, Congress 
mandated in the National Defense Authorization Act for Fiscal Year 2008 
that VA and DOD establish a joint interagency program office to act as 
a single point of accountability in the development of electronic 
health records systems or capabilities that allow for full 
interoperability (generally, the ability of systems to exchange data) 
by September 30, 2009. 

In this statement, GAO summarizes findings from its upcoming report, 
focusing on progress in setting up the interagency program office and 
the departments’ actions to achieve fully interoperable capabilities by 
September 30, 2009. To do so, GAO analyzed agency documentation on 
project status and conducted interviews with agency officials. 

What GAO Found:

VA and DOD have made progress in setting up the interagency program 
office; however, the office is not yet effectively positioned to be 
accountable for the departments' efforts to achieve fully interoperable 
electronic health record systems or capabilities. The departments have 
taken the important steps of completing personnel descriptions and 
hiring necessary staff to perform the office's functions, but key 
leadership positions (for the Director and Deputy Director) continue to 
be filled on an interim basis. In addition, the office has established 
a charter and begun to demonstrate responsibilities outlined within 
this document. Nonetheless, the office is not yet fulfilling key 
information technology management responsibilities in the areas of 
performance measurement, project planning, and scheduling--all of which 
are essential to establishing the office as a single point of 
accountability for the departments' interoperability efforts.

VA and DOD continue to take steps toward achieving full 
interoperability by the September deadline. In this regard, the 
departments have achieved planned capabilities for three of six 
interoperability objectives (see table) that they identified to meet 
their data sharing needs--refine social history data, share physical 
exam data, and demonstrate initial network gateway operation. For the 
remaining three objectives--expand questionnaires and self assessment 
tools, expand DOD inpatient medical records system, and demonstrate 
initial document scanning--the departments have partially achieved 
planned capabilities, with additional work needed to fully meet 
clinicians' needs for health information.

Table: Description of VA and DOD Interoperability Objectives: 

Objective: Refine social history data; 
Description: DOD will begin sharing with VA social history data 
currently captured in the DOD electronic health record. Such data 
describe, for example, patients’ involvement in hazardous activities 
and tobacco and alcohol use. 
 
Objective: Share physical exam data; 
Description: DOD will provide an initial capability to share with VA 
its electronic health record information that supports the physical 
exam process when a service member separates from active military duty. 

Objective: Demonstrate initial network gateway operation; Description: 
DOD and VA will demonstrate the operation of secure network gateways 
that provide expanded bandwidth to support information sharing between 
DOD and VA healthcare facilities. 

Objective: Expand questionnaires and self assessment tools; 
Description: DOD will provide all periodic health assessment data 
stored in its electronic health record to the VA such that 
questionnaire responses are viewable with the questions that elicited 
them. 

Objective: Expand DOD inpatient medical records system; 
Description: DOD will expand its inpatient medical records system to at 
least one additional site in each military medical department (one 
Army, one Air Force, and one Navy for a total of three sites). 

Objective: Demonstrate initial document scanning; 
Description: DOD will demonstrate an initial capability for scanning 
service members’ medical documents into its electronic health record 
and sharing the documents electronically with the VA. 

Source: GAO based on VA and DOD data. 

[End of table] 

What GAO Recommends:

GAO’s draft report recommends that the Secretaries of Defense and 
Veterans Affairs emphasize the interagency program office’s 
establishment of a project plan and integrated master schedule to guide 
their interoperability activities. 

View [hyperlink, http://www.gao.gov/products/GAO-09-895T] or key 
components. For more information, contact Valerie Melvin at (202) 512-
6304 or melvinv@gao.gov. 

[End of section] 

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here today to discuss the Departments of Veterans 
Affairs' (VA) and Defense's (DOD) interagency program office and 
efforts toward advancing the use of health information technology to 
achieve interoperable electronic health records. As you know, VA and 
DOD have been working for over a decade on initiatives to share data 
between their health information systems; yet, while they have made 
progress in a number of areas, questions have persisted concerning when 
and to what extent the intended electronic sharing capabilities of the 
two departments will be fully achieved. To expedite their efforts, the 
National Defense Authorization Act for Fiscal Year 2008[Footnote 1] 
included provisions directing VA and DOD to jointly develop and 
implement, by September 30, 2009, fully interoperable electronic health 
record systems or capabilities that are compliant with applicable 
federal interoperability[Footnote 2] standards. It further established 
an interagency program office to be a single point of accountability 
for the departments' efforts.

Also, the act directed us to report semiannually on VA's and DOD's 
progress in implementing their electronic health record systems. In 
this regard, we have previously issued two reports (in July 2008 and 
January 2009). We plan to issue a third report near the end of this 
month--a draft of which is currently with the departments for their 
review and comments. At your request, my testimony today summarizes 
findings from this latest draft report, focusing on the departments' 
progress in setting up the interagency program office as a point of 
accountability for the implementation of interoperable electronic 
health records, and actions being taken to achieve these capabilities 
by September 30, 2009.

In developing this testimony, we relied on our previous work supporting 
the draft report. We conducted our work from April 2009 through July 
2009, in the Washington, D.C. metropolitan area. All work on which this 
testimony is based was performed in accordance with generally accepted 
government auditing standards. Those standards require that we plan and 
perform the audit to obtain sufficient, appropriate evidence to provide 
a reasonable basis for our findings and conclusions based on our audit 
objectives. We believe that the evidence obtained provides a reasonable 
basis for our findings and conclusions based on our audit objectives.

Background:

The use of information technology (IT) to electronically collect, 
store, retrieve, and transfer clinical, administrative, and financial 
health information has great potential to help improve the quality and 
efficiency of health care and is important to improving the performance 
of the U.S. health care system. Historically, patient health 
information has been scattered across paper records kept by many 
different caregivers in many different locations, making it difficult 
for a clinician to access all of a patient's health information at the 
time of care. Lacking access to these critical data, a clinician may be 
challenged to make the most informed decisions on treatment options, 
potentially putting the patient's health at greater risk. The use of 
electronic health records can help provide this access and improve 
clinical decisions.[Footnote 3]

Key to making health care information electronically available is 
interoperability--that is, the ability to share data among health care 
providers. Interoperability enables different information systems or 
components to exchange information and to use the information that has 
been exchanged. This capability is important because it allows 
patients' electronic health information to move with them from provider 
to provider, regardless of where the information originated. If 
electronic health records conform to interoperability standards, they 
can be created, managed, and consulted by authorized clinicians and 
staff across more than one health care organization, thus providing 
patients and their caregivers the necessary information required for 
optimal care. In the health IT field, standards may govern areas 
ranging from technical issues, such as file types and interchange 
systems, to content issues, such as medical terminology. Unlike paper- 
based documents, electronic health records can also provide automatic 
alerts about a particular patient's health, or other advantages of 
automation.

In prior reports, we have discussed the different levels of 
interoperability that agencies can achieve.[Footnote 4] At the highest 
level, electronic data are computable (that is, in a format that a 
computer can understand and act on to, for example, provide alerts to 
clinicians on drug allergies). At a lower level, electronic data are 
structured and viewable, but not computable. At still a lower level, 
electronic data are unstructured and viewable, but not computable. With 
unstructured electronic data, a user would have to find needed or 
relevant information by searching uncategorized data. Beyond these, 
paper records also can be considered interoperable (at the lowest 
level) because they allow data to be shared, read, and interpreted by 
human beings. According to VA and DOD officials, not all data require 
the same level of interoperability, nor is interoperability at the 
highest level achievable in all cases. For example, unstructured, 
viewable data may be sufficient for such narrative information as 
clinical notes.

VA and DOD Are Required by Law to Establish an Interagency Program 
Office and Achieve Full Interoperability:

As previously noted, the National Defense Authorization Act for Fiscal 
Year 2008[Footnote 5] called for VA and DOD to jointly develop and 
implement fully interoperable electronic health record systems or 
capabilities by September 30, 2009, and established an interagency 
program office to be accountable for the departments' efforts in this 
regard. The departments have been working to set up this office since 
April 2008. In January 2009, the office completed its charter, 
articulating, among other things, its mission and functions with 
respect to attaining interoperable electronic health data. The charter 
further identified the office's responsibilities in carrying out its 
mission, in areas such as oversight and management, stakeholder 
communication, and decision-making.

Further, to help meet the intent of the act, the Interagency Clinical 
Informatics Board,[Footnote 6] made up of senior clinical leaders from 
both departments who represent the user community, began establishing 
priorities for health data sharing between VA and DOD. The board 
subsequently identified six interoperability objectives for meeting the 
departments' data sharing needs, as reflected in table 1.

Table 1: Description of VA and DOD Interoperability Objectives:

Objective: Refine social history data; 
Description: DOD will begin sharing with VA the social history data 
that is currently captured in the DOD electronic health record. Such 
data describe, for example, patients' involvement in hazardous 
activities and tobacco and alcohol use; 
Associated interoperability level: Structured, viewable electronic data.

Objective: Share physical exam data; 
Description: DOD will provide an initial capability to share with VA 
its electronic health record information that supports the physical 
exam process when a service member separates from active military duty; 
Associated interoperability level: Structured, viewable electronic data.

Objective: Demonstrate initial network gateway operation; 
Description: VA and DOD will demonstrate the operation of the secure 
network gateways[A] to support joint DOD-VA health information sharing; 
Associated interoperability level: There is no interoperability level 
associated with this objective. 

Objective: Expand questionnaires and self assessment tools; 
Description: DOD will provide all periodic health assessment data 
stored in its electronic health record to the VA in such a fashion that 
questionnaire responses are viewable with the questions that elicited 
them; 
Associated interoperability level: Structured, viewable electronic data.

Objective: Expand DOD inpatient medical records system; 
Description: DOD will expand its inpatient medical records system 
(CliniComp's Essentris[B] product suite), also called the clinical 
information system, to at least one additional site in each military 
medical department (one Army, one Air Force, and one Navy for a total 
of three sites); 
Associated interoperability level: Unstructured, viewable electronic 
data.

Objective: Demonstrate initial document scanning; 
Description: DOD will demonstrate an initial capability for scanning 
service members' medical documents into its electronic health record 
and sharing the documents electronically with the VA; 
Associated interoperability level: Unstructured, viewable electronic 
data.

Source: GAO Analysis of VA and DOD data.

[A] Secure network gateways provide expanded bandwidth to support 
information sharing and ensure secure and reliable data communications 
between VA and DOD health care facilities.

[B] Essentris is a commercial health information system customized to 
support inpatient treatment at military medical facilities. 

[End of table]

According to the former acting director of the interagency program 
office, VA and DOD consider achievement of these six objectives, in 
conjunction with data sharing capabilities previously achieved (e.g., 
the Federal Health Information Exchange ([Footnote 7]FHIE), the 
Bidirectional Health Information Exchange [Footnote 8](BHIE), and the 
interface between DOD's Clinical Data Repository (CDR) and VA's Health 
Data Repository (HDR), known a[Footnote 9]s CHDR), to be sufficient to 
satisfy the requirement for full interoperability by September 2009.

DOD/VA Interagency Program Office Has Made Progress in Becoming 
Operational, but Is Not Fully Functioning as a Single Point of 
Accountability:

As our report later this month will note, VA and DOD have taken 
important steps to make the interagency program office operational. 
However, more work is needed to solidify its leadership and management 
capabilities if the office is to effectively function as a single point 
of accountability for achieving interoperable electronic health data.

In particular, the departments have completed personnel descriptions 
and recruited and hired staff for government positions and obtained 
necessary contractor staff to perform the office's functions. As of 
early July, the departments reported that they had selected staff 
members for 10 of 14 government positions and that recruitment efforts 
were underway to fill the remaining 4 positions by late September 2009. 
Further, all of the 16 designated contractor positions had been filled.

Nonetheless, VA and DOD continue to fill the office's key leadership 
positions--that of director and deputy director--on an interim basis. 
To their credit, the departments have taken steps to hire a full-time 
permanent director and a deputy director to lead the office. Earlier 
this month, DOD selected a candidate for the director position, VA 
concurred with the selection, and the candidate's application was sent 
to the Office of Personnel Management for approval. In the meantime, 
the departments requested and received an extension of the interim 
director's appointment until September 30, 2009, or until a permanent 
official is hired. Further, as of late June, interagency program 
officials stated that actions were underway to fill the deputy director 
position and that VA was interviewing candidates for this position. The 
interim director stated that the departments anticipate making a 
selection for the deputy director position by the end of this month.

Beyond the need to appoint these key permanent leaders, the office 
needs to fulfill a number of responsibilities identified in its January 
2009 charter that are critical to its effectiveness. To this end, the 
office has taken several steps. For example, it submitted its first 
annual report to Congress that summarized the departments' efforts 
toward achieving full interoperability and the status of key activities 
completed to set up the office. Further, the office developed 11 
standard operating procedures in areas such as program management 
oversight, strategic communications, and process improvement.

However, the office has not yet carried out other key responsibilities 
identified in its charter that are fundamental to effective IT program 
management and that would be essential to effectively serving as the 
single point of accountability. For example, the office has not yet 
established results-oriented (i.e., objective, quantifiable, and 
measurable) goals and performance measures for all six of the 
interoperability objectives discussed previously.

In particular, early development and use of results-oriented metrics is 
an important IT program management activity. Performance goals and 
measures, if effectively implemented, can provide a meaningful baseline 
against which to measure the progress of a program and the outcomes 
associated with its implementation. VA and DOD agreed with our previous 
recommendation calling for the development of such goals and measures. 
[Footnote 10] Further, the interagency program office charter 
identified the development of metrics to monitor the departments' 
performance against interoperability objectives as a responsibility of 
the office. Nevertheless, the office has developed performance goals 
for only one of the six identified interoperability objectives--the 
expansion of DOD's medical records system (Essentris) to share 
inpatient discharge summaries with VA. Department officials have stated 
that results-oriented goals and measures for the other five 
interoperability objectives will be included in the next version of the 
DOD/VA Joint Executive Council Joint Strategic Plan, expected to be 
completed by December 2009. To the extent that the departments 
establish and effectively use results-oriented goals and measures for 
their interoperability objectives, they will be better positioned to 
gauge their progress toward achieving fully interoperable capabilities 
and improving veterans' health care.

Further, development of an integrated master schedule is a key IT 
program management activity, especially given the magnitude and 
complexity of the departments' efforts to achieve full 
interoperability. According to DOD guidance,[Footnote 11] an integrated 
master schedule should identify detailed project tasks and the 
associated start, completion, and interim milestone dates; resource 
needs; and relationships (e.g., sequence and dependencies) between 
tasks.

While the program office has begun to develop an integrated master 
schedule as required by its charter, the current version does not 
include the attributes of an effective schedule. For example, the 
schedule included limited information--only the name of the objective 
and a completion date of September 30, 2009--for three of the six 
interoperability objectives (i.e., refine social history data, share 
physical exam data, and expand questionnaires and self assessment 
tools). The schedule did not include information on tasks to be 
performed to meet the objectives, nor start dates, resource needs, or 
relationships between tasks for any of the six objectives. Without a 
complete and detailed integrated master schedule, the departments are 
devoid of critical information that could be vital to their ability to 
appropriately respond to project needs and guide project efforts. 
Similarly, development of a project plan is an important activity for 
IT program management. Industry best practices and IT program 
management principles stress the importance of sound planning for any 
project. Inherent in such planning is the development and use of a 
project management plan that describes, among other things, the 
project's scope, resource needs, and key milestones. The interagency 
program office charter identified the need to develop a project plan 
but, as of late June, the office had not yet done so. As we have noted 
in our prior work,[Footnote 12] without a project plan, the departments 
lack a key tool that could be used to guide their efforts in achieving 
full interoperability.

In discussing these activities, the interagency program office's 
interim director and former acting director cited three reasons for why 
performance measurement, scheduling, and project planning 
responsibilities had not been accomplished. First, they stated that 
because it has taken longer than anticipated to hire staff, the office 
has not been able to perform all of its responsibilities. Second, the 
office's interim leadership and staff have focused their efforts on 
providing interested parties (e.g., federal agencies and military 
organizations) with briefings, presentations, and status information on 
activities the office is undertaking to achieve interoperability, in 
addition to participating in efforts to develop a strategy for 
implementation of the Virtual Lifetime Electronic Record, which the 
President announced in April 2009. Finally, according to the officials, 
the office waited until June to begin the process of developing 
performance metrics so that it could do so in conjunction with the 
departments' annual update to the Joint Strategic Plan that is 
scheduled for completion in December 2009.

In the absence of sufficient metrics to monitor progress, a complete 
integrated master schedule, and a project plan, the interagency program 
office's ability to effectively provide oversight and management, 
including meaningful reporting on the progress and delivery of 
interoperable capabilities, is jeopardized. As importantly, the absence 
of these critical management tools calls into question the 
effectiveness of this office in functioning as the single point of 
accountability for achieving full interoperability, and the 
departments' overall success in meeting this goal.

VA and DOD Are Taking Steps to Meet their Objectives, but Activities to 
Meet Clinicians' Needs Are Expected to Remain After the Deadline for 
Achieving Full Interoperability:

VA and DOD continue to take steps toward achieving full 
interoperability by September 30, 2009. In this regard, the departments 
have achieved planned capabilities for three of the objectives--refine 
social history data, share physical exam data, and demonstrate initial 
network gateway operation. Specifically, with regard to these 
objectives, the departments have accomplished the following 
capabilities:

* The sharing of viewable social history data captured in DOD's 
electronic health record, thus providing VA with additional clinical 
information on shared patients that clinicians could not previously 
view. These data describe, for example, patients' involvement in 
hazardous activities and tobacco and alcohol use.

* The sharing of physical exam data, allowing VA to view DOD's medical 
exam data through the BHIE interface, which supports the physical exam 
process when a service member separates from active military duty. VA 
clinicians are able to view outpatient treatment records, pre-and post-
deployment health assessments, and post deployment health reassessments.

* The operation of secure network gateways to support health 
information sharing between the departments, thus facilitating future 
growth in data sharing. As of early July, the departments reported that 
five network gateways were operational and that data migration to two 
of the operational gateways had begun.[Footnote 13] The departments 
believed these five gateways satisfy the intent of the objective and 
will provide sufficient capacity to support health information sharing 
between VA and DOD as of September 2009.

For the remaining three objectives--expand questionnaires and self 
assessment tools, expand Essentris in DOD, and demonstrate initial 
document scanning--the departments have partially achieved planned 
capabilities, with additional work needed to fully meet clinicians' 
needs.

Specifically, for the objective to expand questionnaires and self 
assessment tools, the departments intend to provide all periodic health 
assessment data stored in the DOD electronic health record to VA in a 
format that associates questions with responses. Health assessment data 
is collected from two sources: questionnaires administered at military 
treatment facilities and a DOD health assessment reporting tool that 
enables patients to answer questions about their health upon entry into 
the military. Questions relate to a wide range of personal health 
information, such as dietary habits, physical exercise, and tobacco and 
alcohol use. While the departments have established the capability for 
VA to view questions and answers from the questionnaires collected by 
DOD at military treatment facilities, they have not yet established the 
additional capability for VA to view information from DOD's health 
assessment reporting tool. Department officials stated that they intend 
to provide this capability by September 2009.

However, the other two objectives--expand Essentris in DOD and 
demonstrate initial document scanning--are expected to require 
substantial additional work beyond September to meet clinicians' needs. 
By September 30, DOD intends to expand its Essentris system to at least 
one additional site for each military medical service and to increase 
the percentage of inpatient discharge summaries that it shares 
electronically with VA to 70 percent. According to the interim director 
of the interagency program office, as of late June 2009, the 
departments had expanded the system to two Army sites (but not yet to 
an Air Force or Navy site) and were sharing 58 percent of inpatient 
discharge summaries. The interim director stated that the departments 
expect to share 70 percent of inpatient discharge summaries and expand 
the system to an Air Force and a Navy site by the September deadline. 
Nevertheless, the official added that to better meet clinicians' needs, 
DOD will need to further expand the inpatient medical records system. 
In this regard, the department has established a future goal of making 
the inpatient system operational for 92 percent of DOD's inpatient beds 
by September 2010.

The departments also expect to demonstrate an initial capability to 
scan service members' medical documents into the DOD electronic health 
record and share the documents electronically with VA by September 
2009. According to the program office interim director, the departments 
were in the process of setting up an interagency test environment to 
test the initial capability to query medical documents associated with 
specific patients as of late June 2009. He stated that the departments 
expect to begin user testing at up to nine sites by September 2009. 
According to this official, these activities are expected to 
demonstrate an initial document scanning capability. However, after 
September 2009, the departments anticipate needing to perform 
additional work to expand their initial document scanning capability 
(e.g., completion of user testing and establishment of the scanning 
capability at all DOD sites).

In conclusion, VA and DOD have continued to increase electronic health 
information interoperability, and have taken steps to meet the six 
objectives that they identified as necessary to achieve full 
interoperability by September 30, 2009. However, for two of the six 
interoperability objectives, the departments subsequently plan to 
perform significant additional activities that are necessary to meet 
clinicians' needs. Further, the departments' lack of progress in 
establishing fundamental IT management capabilities that are the 
specific responsibilities of the interagency program office contributes 
to uncertainty about the extent to which they will achieve full 
interoperability by the deadline. Although the departments have 
generally made progress toward making the program office operational, 
the absence of performance metrics, and a complete integrated master 
schedule and a project plan, limits the office's ability to effectively 
manage and provide meaningful progress reporting on the delivery of 
interoperable capabilities that are deemed critical to improving the 
quality of health care for our nation's veterans.

To better improve the management of VA's and DOD's efforts to achieve 
fully interoperable electronic health record systems, our draft report 
recommends that the Secretaries of Defense and Veterans Affairs 
emphasize the interagency program office's establishment of a project 
plan and a complete and detailed integrated master schedule.

Mr. Chairman, this concludes my prepared statement. I would be pleased 
to respond to any questions that you or other members of the 
subcommittee may have.

Contact and Acknowledgments:

If you have any questions on matters discussed in this testimony, 
please contact Valerie C. Melvin, Director, Information Management and 
Human Capital Issues, at (202) 512-6304 or melvinv@gao.gov. Other 
individuals who made key contributions to this testimony are Mark Bird, 
Assistant Director; Rebecca Eyler; Michael Redfern; J. Michael Resser; 
Kelly Shaw; Eric Trout; and Merry Woo. 

[End of section] 

Footnotes: 

[1] Pub. L. No. 110-181, § 1635 (2008).

[2] Interoperability is the ability of two or more systems or 
components to exchange information and to use the information that has 
been exchanged. Further discussion of levels of interoperability is 
provided later in this testimony.

[3] An electronic health record is a collection of information about 
the health of an individual or the care provided, including patient 
demographics, progress notes, problems, medications, vital signs, past 
medical history, immunizations, laboratory data, and radiology reports. 

[4] These levels were identified by the Center for Information 
Technology Leadership, which was chartered in 2002 as a research 
organization to help guide the health care community in making more 
informed strategic IT investment decisions. According to VA and DOD, 
the different levels of interoperability have been accepted for use by 
the Office of the National Coordinator for Health Information 
Technology. 

[5] Pub. L. No. 110-181, § 1635 (2008). 

[6] This board was originally named the Joint Clinical Information 
Board. 

[7] FHIE, enhanced through its completion in 2004, provides a one-way 
transfer of data that enables DOD to electronically transfer service 
members' electronic health information to VA when the members leave 
active duty. 

[8] BHIE, established in 2004, was aimed at allowing clinicians at both 
departments viewable access to records on shared patients--that is, 
those who receive care from both departments. For example, veterans may 
receive outpatient care from VA clinicians and be hospitalized at a 
military treatment facility. To create BHIE, the departments drew on 
the architecture and framework of the information transfer system 
established by the FHIE project. Unlike FHIE, BHIE is a two-way 
interface that allows clinicians in both departments to view, in real 
time, limited health data (in text form) from the departments' existing 
health information systems. The interface also allows DOD sites to see 
previously inaccessible data at other DOD sites. 

[9] Combining the names of the two repositories, the Clinical Data 
Repository/Health Data Repository (CHDR) interface, pronounced 
"cheddar," implemented in September 2006, linked the department's 
separate repositories of standardized data to enable a two-way exchange 
of computable health information. These repositories are a part of the 
modernized health information systems that the departments have been 
developing--DOD's AHLTA and VA's HealtheVet. 

[10] GAO, Electronic Health Records: DOD's and VA's Sharing of 
Information Could Benefit from Improved Management, [hyperlink, 
http://www.gao.gov/products/GAO-09-268] (Washington, D.C.: Jan. 28, 
2009).

[11] DOD Integrated Master Plan and Integrated Master Schedule 
Preparation and Use Guide, Version 0.9, October 21, 2005.

[12] GAO, Computer-Based Patient Records: VA and DOD Efforts to 
Exchange Health Data Could Benefit from Improved Planning and Project 
Management, [hyperlink, http://www.gao.gov/products/GAO-04-687] 
(Washington, D.C.: June 7, 2004).

[13] The five operational gateways are located in Dallas, Texas; 
Reston, Virginia; Kansas City, Missouri; North Chicago, Illinois; and 
Santa Clara, California. 

[End of section] 

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