Electronic Health Records:

Outcome-Oriented Metrics and Goals Needed to Gauge DOD's and VA's Progress in Achieving Interoperability

GAO-15-530: Published: Aug 13, 2015. Publicly Released: Aug 13, 2015.

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What GAO Found

The Departments of Defense (DOD) and Veterans Affairs (VA), with guidance from the Interagency Program Office (IPO) that is tasked with facilitating the departments' efforts to share health information, have taken actions to increase interoperability between their electronic health record systems. Among other things, DOD and VA have initiated work focused on near-term objectives, including standardizing their existing health data and making them viewable by both departments' clinicians in an integrated format. The departments also have developed longer-term plans to modernize their respective electronic health record systems. For its part, the IPO has issued guidance outlining the technical approach for achieving interoperability between the departments' systems.

Even with the actions taken, DOD and VA did not, by the October 1, 2014, deadline established in the National Defense Authorization Act (NDAA) for Fiscal Year 2014 for compliance with national data standards, certify that all health care data in their systems complied with national standards and were computable in real time. Both departments stated that they intend to do so later in calendar year 2015. Further, the departments' system modernization plans identify a number of key activities to be implemented beyond December 31, 2016—the deadline established in the NDAA for the two departments to deploy modernized electronic health record software to support clinicians while ensuring full standards-based interoperability. Specifically, DOD has issued plans and announced the contract award for acquiring a modernized system to include interoperability capabilities across military operations. In addition, VA has issued plans describing an incremental approach to modernizing its existing electronic health records system. These plans—if implemented as currently described—indicate that deployment of the new systems with interoperability capabilities will not be completed across the departments until after 2018.

The IPO has taken steps to develop process metrics intended to monitor progress related to the data standardization and exchange of health information consistent with its responsibilities. For example, it has issued guidance that calls for tracking metrics, such as the percentage of data domains within the departments' current health information systems that are mapped to national standards. However, the office has not yet specified outcome-oriented metrics and established related goals that are important to gauging the impact that interoperability capabilities have on improving health care services for shared patients. IPO officials said this work is ongoing and that a team is working with DOD, VA, and subject matter experts to identify metrics that would provide more meaningful measures of the impact of increased interoperability. However, the IPO has not identified a time frame for when this team will report its results and when the IPO plans to incorporate these metrics and goals into its guidance. Without ensuring that outcome-oriented metrics and related goals are defined and incorporated into the current approach, the departments and the IPO will not be positioned to assess and report on the status of interoperability-related activities and determine areas that need improvement.

Why GAO Did This Study

DOD and VA operate two of the nation's largest health care systems, serving approximately 16 million veterans and active duty service members and their beneficiaries, at a cost of more than $100 billion a year. For almost two decades, the departments have been engaged in various efforts to advance DOD and VA electronic health record interoperability. Among their most recent efforts, the DOD and VA Secretaries have committed the departments to achieving interoperability between their separate electronic health record systems.

The Consolidated Appropriations Act , 2014, and accompanying Joint Explanatory Statement, included a provision for GAO to review the departments' efforts. GAO evaluated the actions taken by DOD, VA, and the IPO to plan for and measure the progress toward achieving interoperability between the departments' electronic health record systems. GAO reviewed relevant program documents and interviewed agency officials.

What GAO Recommends

GAO recommends that DOD and VA, working with the IPO, establish a time frame for identifying outcome-oriented metrics; define related goals to provide a basis for assessing and reporting on the status of interoperability; and update IPO guidance to reflect the metrics and goals identified. DOD and VA concurred with GAO's recommendations.

For more information, contact Valerie C. Melvin at (202) 512-6304 or Melvinv@gao.gov.

Recommendations for Executive Action

  1. Status: Open

    Comments: According to the Department of Defense (DOD), the Interagency Program Office (IPO) continues to lead a collaborative effort with the department and VA to set outcome-oriented interoperability metrics, using its Joint Interoperability Plan as a framework. Specifically, they were to convene a summit to identify preliminary metrics, with initial assessments and reporting expected by the end of fiscal year 2016. GAO continues to monitor the progress of this effort.

    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should establish a time frame for identifying outcome-oriented metrics.

    Agency Affected: Department of Defense

  2. Status: Open

    Comments: According to the Department of Veterans Affairs (VA), it has identified the fourth quarter of fiscal year 2016 as the target for producing its first baseline for outcome-based interoperability metrics. GAO continues to monitor the progress of the department's efforts.

    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should establish a time frame for identifying outcome-oriented metrics.

    Agency Affected: Department of Veterans Affairs

  3. Status: Open

    Comments: According to the Department of Defense (DOD), the Interagency Program Office (IPO) continues to lead a collaborative effort with the department and the Department of Veterans Affairs (VA) to set outcome-oriented interoperability metrics using its Joint Interoperability Plan as a framework. Specifically, they were to convene a summit to identify preliminary metrics, with initial assessments and reporting expected by the end of fiscal year 2016. GAO continues to monitor the progress of this effort.

    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should ensure related goals are defined to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems.

    Agency Affected: Department of Defense

  4. Status: Open

    Comments: According to the Department of Veterans Affairs (VA), the department is working with the Interagency Program Office (IPO) and the Office of the National Coordinator for Health Information Technology to identify clinical goals, outcomes, and program metrics. The department stated that further work needs to be done to shift existing process metrics to more outcome-oriented metrics, and that it intends to establish baseline measures by the beginning of fiscal year 2017. GAO continues to monitor the progress of these ongoing efforts.

    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should ensure related goals are defined to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems.

    Agency Affected: Department of Veterans Affairs

  5. Status: Open

    Comments: The Interagency Program Office has not yet taken steps to update its guidance to reflect the metrics and goals identified. Specifically, the Joint Interoperability Plan, version 3, dated July 15, 2015, describes seven use cases that helped identify scenarios where near-term interoperability would be most useful to the departments. However, it has not identified specific and measurable goals and outcome metrics for these use cases or described how outcome-oriented goals and metrics will be used by the office to communicate progress made on interoperability and improving health services delivery, or improving health results for veterans. GAO continues to monitor the guidance of the office for relevant updates.

    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should update IPO guidance to reflect the metrics and goals identified.

    Agency Affected: Department of Defense

  6. Status: Open

    Comments: The Interagency Program Office has not yet taken steps to update its guidance to reflect the metrics and goals identified. Specifically, the Joint Interoperability Plan, version 3, dated July 15, 2015, describes seven use cases that helped identify scenarios where near-term interoperability would be most useful to the departments. However, it has not identified specific and measurable goals and outcome metrics for these use cases or described how outcome-oriented goals and metrics will be used by the office to communicate progress made on interoperability and improving health services delivery, or improving health results for veterans. GAO continues to monitor the guidance of the office for relevant updates.

    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should update IPO guidance to reflect the metrics and goals identified.

    Agency Affected: Department of Veterans Affairs

 

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