Electronic Health Records:

DOD and VA Have Increased Their Sharing of Health Information, but More Work Remains

GAO-08-954: Published: Jul 28, 2008. Publicly Released: Jul 28, 2008.

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Under the National Defense Authorization Act for Fiscal Year 2008, the Department of Defense (DOD) and the Department of Veterans Affairs (VA) are required to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for full interoperability (generally, the ability of systems to use data that are exchanged) and that are compliant with federal standards. The act also established a joint interagency program office to act as a single point of accountability for the effort, whose function is to implement such systems or capabilities by September 30, 2009. Further, the act required that GAO semi-annually report on the progress made in achieving these goals. For this first report, GAO describes the departments' progress to date in sharing electronic health information, developing electronic health records that comply with federal standards, and setting up the joint interagency program office. To do so, GAO reviewed its past work, analyzed agency documentation, and conducted interviews with agency officials.

DOD and VA are sharing some, but not all, electronic health information at different levels of interoperability. Specifically, pharmacy and drug allergy data on about 18,300 patients who receive care from both departments are exchanged at the highest level of interoperability--that is, in computable form; at this level, the data are in a standardized format that a computer application can act on (for example, to provide alerts to clinicians of drug allergies). In other cases, data can be viewed only--a lower level of interoperability that still provides clinicians with important information. However, not all electronic health information is yet shared, and information is still captured on paper at many DOD medical facilities. According to the departments, a DOD/VA Information Interoperability Plan (targeted for approval in August 2008) is to address these and other issues and define tasks required to guide the development and implementation of an interoperable electronic health record capability. If properly developed and implemented, the plan could help the departments achieve the goal of seamless sharing of health information. DOD and VA have agreed upon numerous common standards that allow them to share health data, which include standards that are part of current and emerging federal interoperability specifications. This collaboration provided the essential foundation for the departments to begin sharing computable health data. The departments are currently participating in recent initiatives led by the Office of the National Coordinator for Health Information Technology (within the Department of Health and Human Services) that are aimed at promoting the adoption of federal standards and broader use of electronic health records. These initiatives include identifying relevant existing standards, identifying and addressing overlaps and gaps in the standards, and developing interoperability specifications and certification criteria based on these standards. The involvement of the departments in these activities is an important mechanism for aligning their electronic health records with emerging federal standards. In establishing the joint interagency program office, Congress directed the departments to develop an implementation plan for setting up the office and carrying out related activities (such as validating and establishing requirements for interoperable health capabilities). The departments' effort to set up the program office is still in its early stages. Leadership positions in the office are not yet permanently filled, staffing is not complete, and facilities to house the office have not been designated. Further, the implementation plan is currently in draft, and although it includes schedules and milestones, dates for several activities have not yet been determined (such as implementing a capability to share immunization records), even though all capabilities are to be achieved by September 2009. Without a fully established program office and a finalized implementation plan with set milestones, the departments may be challenged in meeting the required date for achieving interoperable electronic health records and capabilities.

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: To better ensure that the effort by DOD and VA to achieve fully interoperable electronic health record systems or capabilities is accelerated, the Secretaries of Defense and Veterans Affairs should give priority to fully establishing the Joint Interagency Program Office by expediting efforts to (1) put in place permanent leadership, staff, and facilities and (2) make the necessary decisions to finalize the draft implementation plan.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: DOD and VA had substantially addressed this recommendation as of early 2010. Specifically, DOD appointed a permanent director to lead the Interagency Program Office (IPO), effective in October 2009, and VA filled the permanent deputy director position, effective in January 2010. At that time, the departments had filled 13 of 14 government staff positions. Regarding the departments' implementation plan for the IPO, the departments produced the DOD/VA Information Interoperability Plan (Version 1.0) in September 2008, which included schedules for establishing the interagency program office; establishing requirements for electronic health record systems; and acquiring, testing, and implementing electronic health record systems.

    Recommendation: To better ensure that the effort by DOD and VA to achieve fully interoperable electronic health record systems or capabilities is accelerated, the Secretaries of Defense and Veterans Affairs should give priority to fully establishing the Joint Interagency Program Office by expediting efforts to (1) put in place permanent leadership, staff, and facilities and (2) make the necessary decisions to finalize the draft implementation plan.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: DOD and VA had substantially addressed this recommendation as of early 2010. Specifically, DOD appointed a permanent director to lead the Interagency Program Office (IPO), effective in October 2009, and VA filled the permanent deputy director position, effective in January 2010. At that time, the departments had filled 13 of 14 government staff positions. Regarding the departments' implementation plan for the IPO, the departments produced the DOD/VA Information Interoperability Plan (Version 1.0) in September 2008, which included schedules for establishing the interagency program office; establishing requirements for electronic health record systems; and acquiring, testing, and implementing electronic health record systems.

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