Electronic Health Records:

DOD and VA Efforts to Achieve Full Interoperability Are Ongoing; Program Office Management Needs Improvement

GAO-09-775: Published: Jul 28, 2009. Publicly Released: Jul 28, 2009.

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The National Defense Authorization Act for Fiscal Year 2008 required the Department of Defense (DOD) and the Department of Veterans Affairs (VA) to accelerate their exchange of health information and to develop systems or capabilities that allow for interoperability (generally, the ability of systems to exchange data) by September 30, 2009. It also required compliance with federal standards and the establishment of a joint interagency program office to function as a single point of accountability for the effort. Further, the act directed GAO to semiannually report on the progress made in achieving these requirements. For this third report, GAO evaluated (1) the departments' progress and plans toward sharing fully interoperable electronic health information that comply with federal standards and (2) whether the interagency program office is positioned to function as a single point of accountability. To do so, GAO analyzed agency documentation on project status and conducted interviews with agency officials.

DOD and VA have taken steps to meet six objectives that they identifiedforachieving full interoperability in compliance with applicable standards (see table) by September 30, 2009. Specifically, 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. For the remaining three objectives, the departments have partially achieved planned capabilities, with additional work needed to fully meet the objectives. Regarding the objective to expand questionnaires and self-assessment tools, this additional work is intended to be completed by the deadline. The departments' officials have stated that they intend to meet the objectives to expand DOD's inpatient medical records system and demonstrate initial document scanning; however, additional work will be required beyond September to perform all the activities necessary to meet clinicians' needs for health information. The DOD/VA Interagency Program Office is not yet effectively positioned to function as a single point of accountability for the implementation of fully interoperable electronic health record systems or capabilities between DOD and VA. While the departments have made progress in setting up the office by hiring additional staff, they continue to fill key leadership positions on an interim basis. Further, while the office has begun to demonstrate responsibilities outlined in its charter, it is not yet fulfilling key information technology management responsibilities in the areas of performance measurement (as GAO previously recommended), project planning, and scheduling, which are essential to establishing the office as a single point of accountability for the departments' interoperability efforts.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: VA agreed with our recommendation and in early 2010 the department took steps to develop a program plan and an integrated master schedule to support the health data interoperability activities that it was pursuing with DOD. In this regard, we reported in January 2010 that VA and DOD had begun to develop an integrated master schedule that included information about the departments' ongoing interoperability activities; however, this schedule was not complete and did not include information about all of the tasks, resource needs, or relationships between tasks. The departments subsequently changed their approach to achieving fully interoperable electronic health care systems in March 2011 when the VA and DOD Secretaries committed to developing a new, single integrated electronic health record (iEHR) system. In support of this effort, the DOD/VA Interagency Program Office began preparing a program plan and an integrated master schedule. However, the program plan and schedule were not completed before the Secretaries of VA and DOD announced another change of course in February 2013. According to this new approach to achieving fully interoperable electronic health record systems, VA intends to modernize its existing VistA system, DOD now plans to acquire a commercially available system, and the departments intend to achieve interoperability between their two systems. However, the departments have not yet articulated project plans or schedules that reflect their current approach. Without plans and schedules for this new approach to achieving fully interoperable electronic health record systems, the departments are not positioned to effectively manage their efforts.

    Recommendation: To better improve management of DOD's and VA's efforts to achieve fully interoperable electronic health record systems, including satisfaction of the departments' interoperability objectives, the Secretaries of Defense and Veterans Affairs should direct the Director of the DOD/VA Interagency Program Office to establish a project plan and a complete and detailed integrated master schedule.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Not Implemented

    Comments: DOD agreed with our recommendation and in early 2010 the department took steps to develop a program plan and an integrated master schedule to support the interoperable electronic health record activities that it was pursuing with VA. In this regard, we reported in January 2010 that DOD and VA had begun to develop an integrated master schedule that included information about the departments' ongoing interoperability activities; however, this schedule was not complete and did not include information about all of the tasks, resource needs, or relationships between tasks. The departments subsequently changed their approach to achieving fully interoperable electronic health care systems in March 2011 when the DOD and VA Secretaries committed to developing a new, single integrated electronic health record (iEHR) system. In support of this effort, the DOD/VA Interagency Program Office began preparing a program plan and an integrated master schedule. However, the program plan and schedule were not completed before the Secretaries of DOD and VA announced another change of course in February 2013. According to this new approach to achieving fully interoperable electronic health record systems, DOD now plans to acquire a commercially available system, VA intends to modernize its existing VistA system, and the departments intend to achieve interoperability between their two systems. However, the departments have not yet articulated project plans or schedules that reflect their current approach. Without plans and schedules for this new approach to achieving fully interoperable electronic health record systems, the departments are not positioned to effectively manage their efforts.

    Recommendation: To better improve management of DOD's and VA's efforts to achieve fully interoperable electronic health record systems, including satisfaction of the departments' interoperability objectives, the Secretaries of Defense and Veterans Affairs should direct the Director of the DOD/VA Interagency Program Office to establish a project plan and a complete and detailed integrated master schedule.

    Agency Affected: Department of Defense

 

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