Key Issues > Duplication & Cost Savings > GAO's Action Tracker > DOD and VA Electronic Health Records Systems
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Health: DOD and VA Electronic Health Records Systems

Opportunities exist for the Department of Defense and the Department of Veterans Affairs to jointly modernize their electronic health record systems.

Action:

The Secretaries of Defense and Veterans Affairs should revise the departments joint strategic plan to include information discussing their electronic health record system modernization efforts and how those efforts will address the departments common health care business needs.

Progress:

As a result of actions taken by the Departments of Defense (DOD) and Veterans Affairs (VA), GAO is no longer assessing this action, which GAO recommended in February 2011. DOD and VA released their joint strategic plan for fiscal years 2013 through 2015 in March 2013. The plan described the departments' intentions to pursue a single electronic health record system. However, 1 month earlier, the departments had abandoned the single-system approach and, as a result, the plan's discussion of the single-system effort is no longer relevant. Specifically, in February 2013, the secretaries cited challenges in the cost and schedule for developing the single, integrated system and announced that each department would focus instead on building or acquiring similar core sets of electronic health record capabilities, then ensuring interoperability between them. As GAO reported in February 2014, the departments have decided to focus on developing or acquiring separate systems in lieu of a single, integrated system, and they have committed resources to developing these separate systems. Given these changes to the departments’ approach, GAO is no longer assessing this action. Instead, GAO will assess the departments’ progress in implementing GAO’s February 2014 recommendations, which were added to GAO’s Action Tracker in 2015 as Actions 4, 5, and 6 under this area (Health: DOD and VA Electronic Health Records). GAO’s February 2014 recommendations focus on (1) the cost-effectiveness and timeliness of the departments’ current approach, (2) the departments’ efforts to develop a plan for achieving an interoperable health record, and (3) the effectiveness of the departments’ collaborative efforts.

Implementing Entity:

Department of Defense, Department of Veterans Affairs

Action:

The Secretaries of Defense and Veterans Affairs should further develop the departments joint health architecture to include their planned future state and transition plan from their current state to the next generation of electronic health record capabilities

Progress:

As a result of actions taken by the Departments of Defense (DOD) and Veterans Affairs (VA), GAO is no longer assessing this action, which GAO recommended in February 2011. In January 2013, the DOD/VA Interagency Program Office developed an Enterprise Architecture Management Plan to provide guidance for developing joint architecture products, identify architecture governance bodies and stakeholder responsibilities, and propose high-level timelines for architecture-related activities. However, as GAO reported in February 2014, the departments have decided not to pursue a joint health architecture and instead to focus on developing or acquiring separate systems in lieu of the single, integrated system, and they have committed resources to developing these separate systems. Specifically, in February 2013, the secretaries cited challenges in the cost and schedule for developing the single, integrated system and announced that each department would focus instead on either building or acquiring similar core sets of electronic health record capabilities, then ensuring interoperability between them. According to officials from the Departments of Defense and Veterans Affairs, the joint enterprise architecture plan is no longer operative because it does not reflect the departments' decision to pursue separate electronic health record system modernization efforts. Given the current focus on each department’s respective approach and the departments’ intended focus on coordination through national health data standards, GAO is no longer assessing this action. Instead, GAO will assess the departments’ progress in implementing GAO’s February 2014 recommendations, which were added to GAO’s Action Tracker in 2015 as Actions 4, 5, and 6 under this area (Health: DOD and VA Electronic Health Records). GAO’s February 2014 recommendations focus on (1) the cost-effectiveness and timeliness of the departments’ current approach, (2) the departments’ efforts to develop a plan for achieving an interoperable health record, and (3) the effectiveness of the departments’ collaborative efforts.

Implementing Entity:

Department of Defense, Department of Veterans Affairs

Action:

The Secretaries of Defense and Veterans Affairs should define and implement a process, including criteria that consider costs, benefits, schedule, and risks, for identifying and selecting joint information technology (IT) investments to meet the departments common health care business needs.

Progress:

As a result of actions taken by the Departments of Defense (DOD) and Veterans Affairs (VA), GAO is no longer assessing this action, which GAO recommended in February 2011. As GAO reported in February 2014, the departments have decided to focus on developing or acquiring separate systems in lieu of the single, integrated system, and they have committed resources to developing these separate systems.  Specifically, in February 2013, the secretaries cited challenges in the cost and schedule for developing the single, integrated system and announced that each department would focus instead on either building or acquiring similar core sets of electronic health record capabilities, then ensuring interoperability between them. VA noted in its September 2014 recommendation status update that, given these commitments, the departments’ respective solutions should yield interoperable information exchanges without the need to invest in other joint technologies. Further, as a result of the departments’ strategy to implement “separate but interoperable systems,” VA asserts that the concept of a joint IT investment approach is no longer practical. Given the changes to the departments’ approach, GAO is no longer assessing this action. Instead, GAO will assess the departments’ progress in implementing GAO’s February 2014 recommendations, which were added to GAO’s Action Tracker in 2015 as Actions 4, 5, and 6 under this area (Health: DOD and VA Electronic Health Records). GAO’s February 2014 recommendations focus on (1) the cost-effectiveness and timeliness of the departments’ current approach, (2) the departments’ efforts to develop a plan for achieving an interoperable health record, and (3) the effectiveness of the departments’ collaborative efforts.

Implementing Entity:

Department of Defense, Department of Veterans Affairs

Action:

To bring transparency and credibility to the Secretaries of Veterans Affairs' and Defense’s assertion that the Department of Veterans Affairs’ (VA) and the Department of Defense’s (DOD) current approach to achieving an interoperable electronic health record will cost less and take less time than the previous single-system approach, the secretaries should (1) develop a cost and schedule estimate for their current approach, from the perspective of both departments, that includes the estimated cost and schedule of VA's VistA Evolution program, DOD Healthcare Management System Modernization (DHMSM) program, and the joint efforts to achieve interoperability between the two systems; then, (2) compare the cost and schedule estimates of the departments' current and previous (i.e., single-system) approaches. If the results of the comparison indicate that the departments' current approach is estimated to cost more and/or take longer than the single-system approach, the secretaries should (1) provide a rationale for pursuing the current approach despite its higher cost and/or longer schedule and (2) report the cost and schedule estimates of the current and previous approaches, results of the comparison of the estimates, and reasons (if applicable) for pursuing a more costly or time-consuming approach to VA's and DOD's congressional authorizing and appropriations committees.

This action was identified in GAO’s February 2014 report, Electronic Health Records: VA and DOD Need to Support Cost and Schedule Claims, Develop Interoperability Plans, and Improve Collaboration (GAO-14-302) and was added to the Action Tracker in April 2015.

Progress:

VA and DOD concurred with GAO's February 2014 recommendation and agreed that they should compare the cost and schedule of their current efforts against those of the previous (i.e., single-system) approach. As of March 2017, the departments had made progress in addressing the recommendation to develop separate cost and schedule estimates for their modernization efforts, although they had not provided a comparison between the current and previous estimates. However, VA and DOD now plan to use the same commercially available electronic health record system as a result of the Secretary of VA’s June 2017 decision that his department will acquire the same system that DOD is currently implementing. In light of this decision, GAO believes the steps VA and DOD have taken are sufficient to address this action. Further, as a result of the departments’ actions, they are better positioned to achieve an interoperable electronic health record.

Implementing Entity:

Department of Defense, Department of Veterans Affairs

Action:

To better position the Departments of Veterans Affairs (VA) and Defense (DOD) to achieve an interoperable electronic health record, the Secretaries of Veterans Affairs and Defense should develop a plan that, at a minimum, describes (1) the clinical domains that the interoperable electronic health record will address; (2) a schedule for implementing the interoperable record at each VA and DOD location; (3) the estimated cost of each major component (i.e., VistA Evolution, DHMSM, etc.) and the total cost of the departments’ interoperability efforts; (4) the organizations within VA and DOD that are involved in acquiring, developing, and implementing the record, as well as the roles and responsibilities of these organizations; (5) major risks to the departments’ interoperability efforts and mitigation plans for those risks; and (6) the departments’ approach to defining, measuring, tracking, and reporting progress toward achieving expected performance (i.e., benefits and results) of the interoperable record.

This action was identified in GAO’s February 2014 report, Electronic Health Records: VA and DOD Need to Support Cost and Schedule Claims, Develop Interoperability Plans, and Improve Collaboration (GAO-14-302) and was added to the Action Tracker in April 2015.

Progress:

As of March 2017, VA and DOD have taken actions to address GAO’s February 2014 recommendation that they develop a plan for achieving an interoperable electronic health record. For example, VA and DOD developed a Joint Interoperability Plan that refers to the Interagency Program Office’s Healthcare Information Interoperability Technical Package, which identifies a list of clinical domains that are to be included in the interoperable electronic health record. The plan also includes expected dates for key interoperability activities, as well as high-level risks that may challenge the departments’ efforts to promote interoperability, and mitigation plans for those risks. The plan, together with the Health Data Interoperability Management Plan, describes the organizations within VA and DOD that are to be involved in acquiring, developing, and implementing the electronic health record. Additionally, the Joint Interoperability Plan, along with VA’s Interoperability Milestones and Metrics document, includes high-level descriptions of monitoring and performance testing and specific goals and metrics related to defining, measuring, tracking, and reporting progress toward achieving expected performance of interoperable records. Lastly, VA and DOD have performed multiple iterations of cost estimates for their respective system modernizations. As a result of the actions taken to address this recommendation, the departments are better positioned to achieve an interoperable health record between their electronic health record systems.

Implementing Entity:

Department of Defense, Department of Veterans Affairs

Action:

To better position the Interagency Program Office (IPO) for effective collaboration between the Departments of Veterans Affairs (VA) and Defense (DOD) and to efficiently and effectively fulfill the office's stated purpose of functioning as the single point of accountability for achieving interoperability between the departments' electronic health record systems, the Secretaries of Veterans Affairs and Defense should ensure that the IPO has authority (1) over dedicated resources (e.g., budget and staff), (2) to develop interagency processes, and (3) to make decisions over the departments’ interoperability efforts.

This action was identified in GAO’s February 2014 report, Electronic Health Records: VA and DOD Need to Support Cost and Schedule Claims, Develop Interoperability Plans, and Improve Collaboration (GAO-14-302) and was added to the Action Tracker in April 2015.

Progress:

No executive action taken as of March 2017. VA and DOD concurred with GAO’s February 2014 recommendation and asserted that the IPO, which was re-chartered in December 2013, remained the single point of accountability for achieving interoperability between the departments’ electronic health record systems. However, since GAO made its recommendation in February 2014, the departments have pursued separate approaches to modernizing their respective electronic health record systems and have established governance structures that are independent of the IPO to manage their efforts. Specifically, DOD has established the Program Executive Office for Defense Health Management Systems, which manages multiple programs related to the department’s interoperability efforts, including DOD’s acquisition of a new electronic health record system. VA has established the Executive Triad of VA officials under the Chief Information Officer to oversee modernizing its electronic health record system, which is managed jointly by the Office of Information and Technology and the Veterans Health Administration.

Additionally, the IPO was again re-chartered in May 2016 with a new purpose—to jointly oversee and monitor, and be the single point of accountability, the efforts of the departments in implementing national health data standards for interoperability. This new purpose does not refer to the IPO’s previous responsibility as the single point of accountability for achieving interoperability between the departments’ electronic health record systems. Thus, the IPO’s role as a vehicle for promoting effective collaboration between the departments is diminished and GAO is no longer assessing this action.

Implementing Entity:

Department of Defense, Department of Veterans Affairs
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    • Valerie C. Melvin
    • Director, Information Technology
    • melvinv@gao.gov
    • (202) 512-6304