Computer-Based Patient Records:

Better Planning and Oversight By VA, DOD, and IHS Would Enhance Health Data Sharing

GAO-01-459: Published: Apr 30, 2001. Publicly Released: Apr 30, 2001.

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In November 1997, the President called for the Department of Veterans Affairs (VA) and the Department of Defense (DOD) to create an interface that would allow the two agencies to share patient health information. By allowing health care providers to electronically share comprehensive patient information, computer-based patient record's (GCPR) should help VA, DOD, and the Indian Health Service (IHS) to improve the quality of care for their beneficiaries. But without a lead entity, a clear mission, and detailed planning to achieve that mission, it is difficult to monitor progress, identify project risks, and develop appropriate contingency plans to keep the project moving forward and on track. Critical project decisions were not made, and the agencies were not bound by those that were made. The VA and DOD Chief Information Officers' (CIO) action to focus on short-term deliverables and to capitalize on existing technologies is warranted and a step in the right direction. However, until problems with the two agencies' existing systems and issues regarding planning, management, and accountability are resolved, project costs will likely continue to increase and implementation of the larger GCPR effort--and its expected benefits--will continue to be delayed.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: Decisions about the broader, long-term GCPR project should be reassessed, based on the results of the interim effort. If the Secretaries of VA and DOD and the Director of IHS decide to continue with the broader effort, they should direct their health CIOs to apply the principles of sound project management delineated in GAO's recommendations for the interim effort.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: DOD, VA, and IHS have reassessed the long-term future of Government Computer-based Patient Record (GCPR) project, and the goal of sharing patient health information via a virtual electronic record. As a result, work on the overall goal will be done as three objectives, achieving the goal of agencies sharing access to their electronic health records in 2005. VA is the lead agency on these objectives. In May 2002, VA and DOD finalized a memorandum of agreement on three objectives for the project. The first two objectives are formally called the Federal Health Information Exchange (FHIE), and consist of a one-way transfer of data from DOD to VA. The first objective is to set up capability to exchange information and to begin exchanging basic data. The second is to evaluate additional information to exchange, and include it as necessary. The third objective is known as HealthePeople, and will enable bi-directional sharing of patient health information among participating agencies by 2005. Under a memorandum of agreement in October 2002, IHS will be included in the project. FHIE became operational in July 2002, and allows VA physicians and other authorized users, via a secure database, access to selected health information provided by DOD on military personnel who have separated from active duty. Additional details of the project plan are included in a September 2002 report. Performance goals for the project are included in VA's fiscal year 2004 Departmental Performance Plan, completed in March 2003.

    Recommendation: Decisions about the broader, long-term GCPR project should be reassessed, based on the results of the interim effort. If the Secretaries of VA and DOD and the Director of IHS decide to continue with the broader effort, they should direct their health CIOs to apply the principles of sound project management delineated in GAO's recommendations for the interim effort.

    Agency Affected: Department of Health and Human Services: Health Services Administration: Indian Health Service

    Status: Closed - Implemented

    Comments: DOD, VA, and IHS have reassessed the long-term future of Government Computer-based Patient Record (GCPR) project, and the goal of sharing patient health information via a virtual electronic record. As a result, work on the overall goal will be done as three objectives, achieving the goal of agencies sharing access to their electronic health records in 2005. VA is the lead agency on these objectives. In May 2002, VA and DOD finalized a memorandum of agreement on three objectives for the project. The first two objectives are formally called the Federal Health Information Exchange (FHIE), and consist of a one-way transfer of data from DOD to VA. The first objective is to set up capability to exchange information and to begin exchanging basic data. The second is to evaluate additional information to exchange, and include it as necessary. The third objective is known as HealthePeople, and will enable bi-directional sharing of patient health information among participating agencies by 2005. Under a memorandum of agreement in October 2002, IHS will be included in the project. FHIE became operational in July 2002, and allows VA physicians and other authorized users, via a secure database, access to selected health information provided by DOD on military personnel who have separated from active duty. Additional details of the project plan are included in a September 2002 report. Performance goals for the project are included in VA's fiscal year 2004 Departmental Performance Plan, completed in March 2003.

    Recommendation: To help strengthen management and oversight of GCPR, the Secretaries of VA and DOD and the Director of IHS should direct their health CIOs to create comprehensive and coordinated plans--which include an agreed upon mission, clear goals, objectives, and performance measures and capitalize on existing medical information technology capabilities--to ensure that the agencies' can share comprehensive, accurate, and secure patient health data.

    Agency Affected: Department of Health and Human Services: Health Services Administration: Indian Health Service

    Status: Closed - Implemented

    Comments: Major changes have been made to the electronic health record project, formerly known as the Government Computer-based Patient Record project. In May 2002, VA and DOD finalized a memorandum of agreement on three objectives for the project. The first two objectives are formally called the Federal Health Information Exchange (FHIE), and consist of a one-way transfer of data from DOD to VA. The first objective is to set up capability to exchange information and to begin exchanging basic data. The second is to evaluate additional information to exchange, and include it as necessary. The third objective is known as HealthePeople, and will enable bi-directional sharing of patient health information among participating agencies by 2005. Under a memorandum of agreement in October 2002, IHS will be included in the project. FHIE became operational in July 2002, and allows VA physicians and other authorized users, via a secure database, access to selected health information provided by DOD on military personnel who have separated from active duty. Additional details of the project plan are included in a September 2002 report. Performance goals for the project are included in VA's fiscal year 2004 Departmental Performance Plan, completed in March 2003.

    Recommendation: To help strengthen management and oversight of GCPR, the Secretaries of VA and DOD and the Director of IHS should direct their health CIOs to create comprehensive and coordinated plans--which include an agreed upon mission, clear goals, objectives, and performance measures and capitalize on existing medical information technology capabilities--to ensure that the agencies' can share comprehensive, accurate, and secure patient health data.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: Major changes have been made to the electronic health record project, formerly known as the Government Computer-based Patient Record project. In May 2002, VA and DOD finalized a memorandum of agreement on three objectives for the project. The first two objectives are formally called the Federal Health Information Exchange (FHIE), and consist of a one-way transfer of data from DOD to VA. The first objective is to set up capability to exchange information and to begin exchanging basic data. The second is to evaluate additional information to exchange, and include it as necessary. The third objective is known as HealthePeople, and will enable bi-directional sharing of patient health information among participating agencies by 2005. Under a memorandum of agreement in October 2002, IHS will be included in the project. FHIE became operational in July 2002, and allows VA physicians and other authorized users, via a secure database, access to selected health information provided by DOD on military personnel who have separated from active duty. Additional details of the project plan are included in a September 2002 report. Performance goals for the project are included in VA's fiscal year 2004 Departmental Performance Plan, completed in March 2003.

    Recommendation: To help strengthen management and oversight of GCPR, the Secretaries of VA and DOD and the Director of IHS should direct their health CIOs to create comprehensive and coordinated plans--which include an agreed upon mission, clear goals, objectives, and performance measures and capitalize on existing medical information technology capabilities--to ensure that the agencies' can share comprehensive, accurate, and secure patient health data.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: Major changes have been made to the electronic health record project, formerly known as the Government Computer-based Patient Record project. In May 2002, VA and DOD finalized a memorandum of agreement on three objectives for the project. The first two objectives are formally called the Federal Health Information Exchange (FHIE), and consist of a one-way transfer of data from DOD to VA. The first objective is to set up capability to exchange information and to begin exchanging basic data. The second is to evaluate additional information to exchange, and include it as necessary. The third objective is known as HealthePeople, and will enable bi-directional sharing of patient health information among participating agencies by 2005. Under a memorandum of agreement in October 2002, IHS will be included in the project. FHIE became operational in July 2002, and allows VA physicians and other authorized users, via a secure database, access to selected health information provided by DOD on military personnel who have separated from active duty. Additional details of the project plan are included in a September 2002 report. Performance goals for the project are included in VA's fiscal year 2004 Departmental Performance Plan, completed in March 2003.

    Recommendation: To help strengthen management and oversight of GCPR, the Secretaries of VA and DOD and the Director of IHS should direct their health CIOs to designate a lead entity with final decisionmaking authority and establish a clear line of authority.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: Following GAO's April 2001 report, DOD, VA, and the Indian Health Service (IHS) have restructured the overall project and scaled back and renamed the initial effort. As a result, VA is now the designated lead agency, and was given overall responsibility for leading the project, which has been scaled back to focus on providing authorized VA physicians and others access to selected DOD health information from DOD's Composite Health Care System (CHCS) I. Moreover, the overall effort to create an electronic health record accessible by authorized users from multiple agencies is being divided into three projects (IHS will not be involved in the Federal Health Information Exchange (FHIE), as the initial effort is now called, but will be involved in the future efforts). As a result of designation of a lead agent, the establishment of clear lines of authority, and refocused efforts, in July 2002, authorized VA physicians and others have gained access to DOD data on military personnel separated from active duty, in addition to access to VA information on these personnel.

    Recommendation: To help strengthen management and oversight of GCPR, the Secretaries of VA and DOD and the Director of IHS should direct their health CIOs to designate a lead entity with final decisionmaking authority and establish a clear line of authority.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: Following GAO's April 2001 report, DOD, VA, and the Indian Health Service (IHS) have restructured the overall project, and scaled back and renamed the initial effort. As a result, VA is now the designated lead agency, and was given overall responsibility for leading the project, which has been scaled back to focus on providing authorized VA physicians and others access to selected DOD health information from DOD's Composite Health Care System (CHCS) I. Moreover, the overall effort to create an electronic health record accessible by authorized users from multiple agencies is being divided into three projects (IHS will not be involved in the Federal Health Information Exchange (FHIE), as the initial effort is now called, but will be involved in the future efforts). As a result of designation of a lead agent, the establishment of clear lines of authority, and refocused efforts, in July 2002, authorized VA physicians and others have gained access to DOD data on military personnel separated from active duty, in addition to access to VA information on these personnel.

    Recommendation: To help strengthen management and oversight of GCPR, the Secretaries of VA and DOD and the Director of IHS should direct their health CIOs to designate a lead entity with final decisionmaking authority and establish a clear line of authority.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: Following GAO's April 2001 report, DOD, VA, and the Indian Health Service (IHS) have restructured the overall project and scaled back and renamed the initial effort. As a result, VA is now the designated lead agency, and was given overall responsibility for leading the project, which has been scaled back to focus on providing authorized VA physicians, and others, access to selected DOD health information from DOD's Composite Health Care System (CHCS) I. Moreover, the overall effort to create an electronic health record accessible by authorized users from multiple agencies is being divided into three projects (IHS will not be involved in the Federal Health Information Exchange (FHIE), as the initial effort is now called, but will be involved in the future efforts). As a result of designation of a lead agent, the establishment of clear lines of authority, and refocused efforts, in July 2002, authorized VA physicians and others have gained access to DOD data on military personnel separated from active duty, in addition to access to VA information on these personnel.

    Recommendation: Decisions about the broader, long-term GCPR project should be reassessed, based on the results of the interim effort. If the Secretaries of VA and DOD and the Director of IHS decide to continue with the broader effort, they should direct their health CIOs to apply the principles of sound project management delineated in GAO's recommendations for the interim effort.

    Agency Affected: Department of Health and Human Services: Health Services Administration: Indian Health Service

    Status: Closed - Implemented

    Comments: DOD, VA, and IHS have reassessed the long-term future of Government Computer-based Patient Record (GCPR) project, and the goal of sharing patient health information via a virtual electronic record. As a result, work on the overall goal will be done as three objectives, achieving the goal of agencies sharing access to their electronic health records in 2005. VA is the lead agency on these objectives. In May 2002, VA and DOD finalized a memorandum of agreement on three objectives for the project. The first two objectives are formally called the Federal Health Information Exchange (FHIE), and consist of a one-way transfer of data from DOD to VA. The first objective is to set up capability to exchange information and to begin exchanging basic data. The second is to evaluate additional information to exchange, and include it as necessary. The third objective is known as HealthePeople, and will enable bi-directional sharing of patient health information among participating agencies by 2005. Under a memorandum of agreement in October 2002, IHS will be included in the project. FHIE became operational in July 2002, and allows VA physicians and other authorized users, via a secure database, access to selected health information provided by DOD on military personnel who have separated from active duty. Additional details of the project plan are included in a September 2002 report. Performance goals for the project are included in VA's fiscal year 2004 Departmental Performance Plan, completed in March 2003.

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