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Health Data' which was released on March 17, 2004.

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United States General Accounting Office:

GAO:

Testimony before the Subcommittee on Oversight and Investigations, 
Committee on Veterans' Affairs, House of Representatives:

For Release on Delivery:

Expected at 10:00 a.m. EST Wednesday, March 17, 2004:

COMPUTER-BASED PATIENT RECORDS:

Sound Planning and Project Management Are Needed to Achieve a Two-Way 
Exchange of VA and DOD Health Data:

Statement of Linda D. Koontz:

Director, Information Management Issues:

GAO-04-402T:

GAO Highlights:

Highlights of GAO-04-402T, testimony before the Subcommittee on 
Oversight and Investigations, House Committee on Veterans' Affairs:

Why GAO Did This Study:

A critical component of the Department of Veterans Affairs' (VA) 
information technology program is its ongoing work with the Department 
of Defense (DOD) to achieve the ability to exchange patient health care 
data and create electronic records for use by veterans, active military 
personnel, and their health care providers.

GAO testified before the Subcommittee last November that one-way 
sharing of data, from DOD to VA medical facilities, had been realized. 
At the Subcommittee's request, GAO assessed, among other matters, VA's 
and DOD's progress since that time toward defining a detailed strategy 
for and developing the capability of a two-way exchange of patient 
health information.

What GAO Found:

Since November, VA and DOD have made little progress in determining 
their approach for achieving the two-way exchange of patient health 
data. Department officials recognize the importance of an architecture 
to articulate how they will electronically interface their health 
systems, but continue to rely on a nonspecific, high-level strategy--in 
place since September 2002--to guide their development and 
implementation of this capability (see figure).

High-Level Strategy Intended To Allow Two-Way Exchange of Health Data:

[See PDF for image]

Source: VA and DOD:

[End of figure]

VA officials stated that an initiative begun this month to satisfy a 
mandate of the Bob Stump National Defense Authorization Act for Fiscal 
Year 2003 will be used to better define the electronic interface needed 
to exchange patient health data. However, this project is at an early 
stage, and the departments have not yet fully identified the approach 
or requirements for this undertaking. Given these uncertainties, there 
is little evidence of how this project will contribute to defining a 
specific architecture and technological solution for achieving the two-
way health data exchange.

These uncertainties are further complicated by the absence of sound 
project management to guide the departments' actions. At present, 
neither department has the authority to make final decisions binding on 
the other, and day-to-day oversight of the joint initiative to develop 
an electronic interface is limited. Progress toward defining data 
standards continues, but delays have occurred in the development and 
deployment of the agencies' individual health information systems.

www.gao.gov/cgi-bin/getrpt?GAO-04-402T.

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Linda D. Koontz at 
(202) 512-6240 or koontzl@gao.gov.

[End of section]

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here today to participate in continuing discussions 
of the Department of Veterans Affairs' (VA) information technology 
program. My testimony focuses on a critical aspect of that program--
VA's work with the Department of Defense (DOD) to achieve the ability 
to exchange patient health care data and create an electronic medical 
record for veterans and active duty military personnel. As you are well 
aware, having readily accessible medical data on these individuals--
many of whom are highly mobile and may have health records at multiple 
medical facilities within and outside of the United States--is 
important to providing high-quality health care to them and to 
adjudicating any disability claims that they may have. VA and DOD have 
been pursuing ways to share data in their health information systems 
and create electronic records since 1998, yet accomplishing a two-way 
health data exchange has been elusive.

When we testified on this initiative last November,[Footnote 1] VA and 
DOD had achieved a measure of success in sharing data through the one-
way transfer of health information from DOD to VA health care 
facilities.[Footnote 2] Yet VA and DOD faced significant challenges and 
were far from realizing a longer term objective: providing a virtual 
medical record based on the two-way exchange of data, as part of their 
HealthePeople (Federal) initiative. The departments had not clearly 
articulated a common health information architecture, and lacked the 
details and specificity essential to determining how they would achieve 
this capability.

At your request, my testimony will discuss our review of VA's and DOD's 
actions since November toward defining a detailed strategy and 
developing the capability for a two-way exchange of patient health 
information. In addition, I will provide an update on actions that the 
departments have taken to address recommendations resulting from prior 
reviews of their efforts to share medical data,[Footnote 3] including 
those articulated in the May 2003 report of the President's task force 
on the development of electronic medical records.[Footnote 4]

In conducting this work, we analyzed key documentation supporting VA's 
and DOD's strategy for developing and implementing the two-way 
electronic exchange of health data, including deployment and conversion 
plans, project schedules, and status reports for their individual 
health information systems. In addition, we reviewed documentation to 
identify the costs incurred by VA and DOD in developing technology to 
support the sharing of health data, including costs associated with the 
government computer-based patient record and federal health information 
exchange initiatives, and with VA's and DOD's ongoing projects to 
develop new health information systems. We supplemented our analyses 
with interviews of VA and DOD officials responsible for key decisions 
and actions on the initiatives. Further, we analyzed documentation and 
interviewed relevant VA and DOD officials to determine actions that 
have been taken to address our previous recommendations related to the 
government computer-based patient record initiative and those contained 
in the President's task force report. We did not verify the 
departments' reported actions in response to the President's task force 
recommendations. We performed our work in accordance with generally 
accepted government auditing standards, from December 2003 through 
March of this year.

RESULTS IN BRIEF:

Since November, VA and DOD have made little progress toward defining 
how they intend to achieve the two-way exchange of patient health data 
under the HealthePeople (Federal) initiative. Although VA officials 
recognize the importance of having an architecture to describe in 
detail how they plan to develop an electronic interface between their 
health information systems, they acknowledged that the departments' 
actions are continuing to be driven by a less-specific, high-level 
strategy that has been in place since September 2002. VA and DOD 
officials stated that they intend to rely on an initiative being 
undertaken this month to satisfy a mandate of the Bob Stump National 
Defense Authorization Act for Fiscal Year 2003[Footnote 5] to better 
define the electronic interface needed to exchange patient health 
information. However, this project is at an early stage, and the 
departments have not yet fully determined the approach or requirements 
for this undertaking. Given these uncertainties, there is little 
evidence as to whether and how this project will contribute to defining 
an explicit architecture and technological solution for achieving the 
two-way exchange of patient health information.

Adding to the challenge and uncertainties of developing the electronic 
interface is that VA and DOD have not fully established a project 
management structure to ensure the necessary day-to-day guidance of and 
accountability for the departments' investment in and implementation of 
this capability. Although maintaining that they are collaborating on 
this initiative through a joint working group and receiving oversight 
from executive-level councils, neither department has had the authority 
to make final project decisions binding on the other. Further, the 
departments are operating without a project management plan describing 
the specific responsibilities of VA and DOD in developing, testing, and 
deploying the interface. In the absence of an explicit architecture and 
critical project management, VA and DOD are progressing slowly in their 
development of this important technology. The departments have 
continued to define data standards that are essential to facilitating 
the exchange of data, but have experienced delays in key milestones 
associated with the development and deployment of their individual 
health information systems. Such delays call into question the 
departments' ability to meet their target date for beginning to 
exchange patient health information in 2005.

Both the President's task force and we have made multiple 
recommendations aimed at improving VA's and DOD's success in 
undertaking projects intended to achieve the electronic exchange of 
patient health records. For example, the task force recommended 
developing and deploying, by fiscal year 2005, electronic medical 
records that are interoperable, bidirectional, and standards-based. The 
departments reported that they are currently in various stages of 
acting on the specific recommendations that the task force made for 
providing timely, high-quality care through effective electronic 
sharing of health information. Beyond this, we previously recommended 
that, among other actions, VA and DOD designate a lead entity with 
final decisionmaking authority and establish a clear line of authority 
for the earlier, near-term government computer-based patient record 
project. In line with our recommendations, VA and DOD made overall 
management and accountability enhancements that could provide lessons 
learned for improving the departments' approach to successfully 
accomplishing the longer term initiative to develop a two-way health 
information exchange.

BACKGROUND:

In 1998 VA and DOD, along with the Indian Health Service (IHS), began 
an initiative to share patient health care data, called the government 
computer-based patient record (GCPR) project. At that time, each agency 
collected and maintained patient health information in separate 
systems, and their health facilities could not electronically share 
patient health information across agency lines. GCPR was envisioned as 
an electronic interface that would allow physicians and other 
authorized users at VA, DOD, and IHS health facilities to access data 
from any of the other agencies' health facilities. The interface was 
expected to compile requested patient information in a "virtual" record 
that could be displayed on a user's computer screen.

In reporting on the initiative in April 2001,[Footnote 6] we raised 
doubts about GCPR's ability to provide expected benefits. We noted that 
the project was experiencing schedule and cost overruns and was 
operating without clear goals, objectives, and consistent leadership. 
We recommended that the participating agencies (1) designate a lead 
entity with final decisionmaking authority and establish a clear line 
of authority for the GCPR project, and (2) create comprehensive and 
coordinated plans that included an agreed-upon mission and clear goals, 
objectives, and performance measures, to ensure that the agencies could 
share comprehensive, meaningful, accurate, and secure patient health 
care data. VA, DOD, and IHS agreed with our findings and 
recommendations.

In March 2002, however, we again reported that the project was 
continuing to operate without clear lines of authority or a lead entity 
responsible for final decisionmaking.[Footnote 7] Further, the project 
continued to move forward without comprehensive and coordinated plans 
and an agreed-upon mission and clear goals and measures. In addition, 
the participating agencies had announced a revised strategy that was 
considerably less encompassing than the project was originally intended 
to be. For example, rather than serve as an interface to allow data 
sharing across the three agencies' disparate systems, as originally 
envisioned, the revised strategy initially called only for a one-way 
transfer of data from DOD's current health care information system to a 
separate database that VA hospitals could access. In further reporting 
on this initiative in June 2002, we recommended that VA, DOD, and IHS 
revise the original goals and objectives of the project to align with 
their current strategy, commit the executive support necessary to 
adequately manage the project, and ensure that it followed sound 
project management principles.[Footnote 8]

In September 2002 we reported that VA and DOD had made some progress 
toward electronically sharing patient health data.[Footnote 9] The two 
departments had renamed the project the Federal Health Information 
Exchange (FHIE) program and, consistent with our prior recommendation, 
had finalized a memorandum of agreement designating VA as the lead 
entity for implementing the program. With this agreement, FHIE became a 
joint effort between VA and DOD to achieve the exchange of health care 
information in two phases. The first phase, completed in mid-July 2002, 
enabled the one-way transfer of data from DOD's existing health 
information system to a separate database that VA hospitals could 
access. A second phase, finalized earlier this month, completed VA's 
and DOD's efforts to add to the base of patient health information 
available to VA clinicians via this one-way sharing capability. VA and 
DOD reported total FHIE costs of about $85 million through fiscal year 
2003.

The revised strategy also envisioned VA and DOD pursuing a longer term, 
two-way exchange of health information. This initiative, known as 
HealthePeople (Federal), is premised upon the departments' development 
of a common health information architecture comprising standardized 
data, communications, security, and high-performance health 
information systems. The joint effort is expected to result in the 
secured sharing of health data required by VA's and DOD's health care 
providers between systems that each department is currently developing-
-DOD's Composite Health Care System II (CHCS II) and VA's HealtheVet 
VistA.

DOD began developing CHCS II in 1997 and has completed its associated 
clinical data repository that is key to achieving an electronic 
interface. DOD expects to complete deployment of all of its major 
system capabilities by September 2008.[Footnote 10] The department 
reported expenditures of about $464 million for the system through 
fiscal year 2003. VA began work on HealtheVet VistA and its associated 
health data repository in 2001, and expects to complete all six 
initiatives that make up this system in 2012.[Footnote 11] VA reported 
spending about $120 million on HealtheVet VistA through fiscal year 
2003.

Under the HealthePeople (Federal) strategy, VA and DOD envision that, 
upon entering military service, a health record for the service member 
will be created and stored in DOD's CHCS II clinical data repository. 
The record will remain in the clinical data repository and be updated 
as the service member receives medical care. When the individual 
separates from active duty and, if eligible, seeks medical care at a VA 
facility, VA will then create a medical record for the individual, 
which will be stored in its health data repository. Upon viewing the 
medical record, the VA clinician would be alerted and provided access 
to clinical information on the individual also residing in DOD's 
repository. In the same manner, when a veteran seeks medical care at a 
military treatment facility, the attending DOD clinician would be 
alerted and provided with access to the health information existing in 
VA's repository. According to VA and DOD, the planned approach would 
make virtual medical records displaying all available patient health 
information from the two repositories accessible to both departments' 
clinicians. VA officials have stated that they anticipate being able to 
exchange some degree of health information through an interface of 
their health data repository with DOD's clinical data repository by the 
end of calendar year 2005.

LACKING A DEFINED STRATEGY, VA AND DOD HAVE MADE LIMITED PROGRESS 
TOWARD A COMMON HEALTH INFORMATION EXCHANGE:

VA's and DOD's ability to exchange data between their separate health 
information systems is crucial to achieving the goals of HealthePeople 
(Federal). Yet successfully sharing patient health information via a 
secure electronic interface between each of their data repositories can 
be complex and challenging, and depends on their having a clearly 
articulated architecture, or blueprint, defining how specific 
technologies will be used to achieve the interface. Developing, 
maintaining, and using an architecture is a best practice in 
engineering information systems and other technological solutions. An 
architecture would articulate, for example, the system requirements and 
design specifications, database descriptions, and software 
descriptions that define the manner in which the departments will 
electronically store, update, and transmit their data.

Equally critical is an established project management structure to 
guide project development. Industry best practices and information 
technology project management principles[Footnote 12] stress the 
importance of accountability and sound planning for any project, 
particularly an interagency effort of the magnitude and complexity of 
this one. Inherent in such planning is the development and use of a 
project management plan that describes, among other factors, the 
project's scope, implementation strategy, lines of responsibility, 
security requirements, resources, and estimated schedule for 
development and implementation.

As was the situation when we testified last November, VA and DOD 
continue to lack an explicit architecture detailing how they intend to 
achieve the data exchange capability, or just what they will be able to 
exchange by the end of 2005--their projected time frame for putting 
this capability into operation. VA officials stated that they recognize 
the importance of a clearly defined architecture, but acknowledged that 
the departments' actions were continuing to be driven by the less-
specific, high-level strategy that has been in place since September 
2002.

The officials added that just this month, the departments had taken a 
first step toward trying to determine how their separate data 
repositories would interface to enable the two-way exchange of patient 
health records. Specifically, officials in both departments pointed to 
a project that they are undertaking in response to requirements of the 
National Defense Authorization Act for Fiscal Year 2003, which mandated 
that VA and DOD develop a real-time interface, data exchange, and 
capability to check prescription drug data for outpatients by October 
1, 2004.[Footnote 13] VA's Deputy Chief Information Officer for Health 
stated that they hope to determine from a prototype planned for 
completion by next September whether the interface technology developed 
to meet this mandate can be used to facilitate the exchange of data 
between the health information systems that they are currently 
developing.

By late February, VA had hired a supporting contractor to develop the 
planned prototype, but the departments had not yet fully defined their 
approach or requirements for developing and demonstrating its 
capabilities. DOD officials stated that the departments would rely on 
the contractor to more fully define the technical requirements for the 
prototype. Further, according to VA officials, since the departments' 
new health information systems that are intended to be used under 
HealthePeople (Federal) have not yet been completed, the demonstration 
may only test the ability to exchange data in VA's and DOD's existing 
health systems--the Veterans Information Systems and Technology 
Architecture and the Composite Health Care System, respectively. Thus, 
given the early stage of the prototype and the uncertainties regarding 
what capabilities it will demonstrate, there is little evidence and 
assurance as to how or whether this project will contribute to defining 
the architecture and technological solution for the two-way exchange of 
patient health information.

Further compounding the challenges and uncertainty that VA and DOD face 
is the lack of a fully established project management structure to 
ensure the necessary day-to-day guidance of and accountability for the 
departments' investments in and implementation of the electronic 
interface between their systems. Officials in both departments maintain 
that they are collaborating on this initiative through a joint working 
group and with oversight provided by the Joint Executive Council and 
VA/DOD Health Executive Council.[Footnote 14] However, neither 
department has had the authority to make final project decisions 
binding on the other, and there has been a visible absence of 
day-to-day project oversight for the joint initiative to develop an 
electronic interface between the departments' planned information 
systems. Further, VA and DOD are operating without a project management 
plan describing the overall development and implementation of the 
interface, including the specific roles and responsibilities of each 
department in developing, testing, and deploying the interface and 
addressing security requirements. In discussing these matters last 
week, VA officials stated that the departments had recently designated 
a program manager for the planned prototype. Further, VA and DOD 
officials added that they had begun discussions to establish an overall 
project plan and finalize roles and responsibilities for managing the 
joint initiative to develop an electronic interface. Until these 
essential project management elements are fully established, VA and DOD 
will lack assurance that they can successfully develop and implement an 
electronic interface and the associated capability for exchanging 
health information within the time frames that they have established.

Progress Toward Achieving a Two-Way Data Exchange Has Been Limited:

In the absence of an architecture and project management structure for 
the initiative, VA and DOD have continued to make only limited progress 
toward developing the technological solution essential to interfacing 
their patient health information. To their credit, the departments have 
continued essential steps toward standardizing clinical data--
important for exchanging health information between disparate systems. 
The Institute of Medicine's Committee on Data Standards for Patient 
Safety has reported the lack of common data standards as a key factor 
preventing information sharing within the health care industry. Over 
the past 4 months, VA and DOD have agreed to adopt additional data 
standards[Footnote 15] for uniformly presenting in any system data 
related to demographics, immunizations, medications, names of 
laboratory tests ordered, and laboratory result contents.

Nonetheless, as reflected in figure 1, the technology needed to achieve 
a two-way exchange of patient health information remains far from 
complete, with only DOD's data repository having been fully developed.

Figure 1: VA/DOD High-level Strategy for the Two-Way Exchange of Health 
Data:

[See PDF for image]

Source: VA and DOD:

[End of figure]

Since November, both departments have delayed key milestones associated 
with the development and deployment of their individual health 
information systems. VA program officials told us that completion of a 
prototype for the department's health data repository has been delayed 
approximately a year, until the end of this June. The officials 
explained that earlier testing of the prototype had slowed clinicians' 
use of the clinical applications, necessitating a revised approach to 
populating the repository. In addition, while DOD officials previously 
stated that the department planned to complete the deployment of its 
first release of CHCS II functionality (a capability for integrating 
DOD clinical outpatient processes into a single patient record) in 
September 2005, the agency has now extended its completion date to June 
2006. According to DOD officials, the schedule for completing this 
deployment was revised because of a later than anticipated decision on 
when the department could proceed with its worldwide deployment. 
Collectively, the lack of an architecture and project management 
structure, coupled with delays in the departments' completion of key 
projects, places VA and DOD at increased risk of being unable to 
successfully accomplish the HealthePeople (Federal) initiative and the 
overall goal of more effectively meeting service members' and veterans' 
health care and disability needs.

VA AND DOD COULD BENEFIT FROM CURRENT AND PAST RECOMMENDATIONS ON 
SHARING ELECTRONIC MEDICAL RECORDS:

Mr. Chairman, as part of our review, you asked that we update the 
status of VA's and DOD's actions to address prior recommendations 
related to sharing electronic medical information. In this regard, both 
the President's task force and we have made a number of recommendations 
to VA and DOD for improving health care delivery to beneficiaries 
through better coordination and management of their electronic health 
sharing initiatives. In its final report of May 2003,[Footnote 16] the 
President's task force recommended specific actions for providing 
timely, high-quality care through effective electronic sharing of 
health information, such as the development and deployment, by fiscal 
year 2005, of electronic medical records that are interoperable, 
bidirectional, and standards-based. The departments reported that they 
are in various stages of acting on these recommendations, with 
anticipated completion dates ranging from June of this year to 
September 2005. Our attachment to this statement summarizes these 
specific recommendations, and the departments' reported actions to 
address them. Giving full consideration to these recommendations could 
provide VA and DOD with relevant information for determining how to 
proceed with the HealthePeople (Federal) initiative.

Also, as mentioned earlier, our prior reviews of the departments' 
project to develop a government computer-based patient record 
determined that the lack of a lead entity, clear mission, and detailed 
planning to achieve that mission had made it difficult to monitor 
progress, identify project risks, and develop appropriate contingency 
plans. As a result, in reporting on this initiative in April 2001 and 
again in June 2002, we made several recommendations to help strengthen 
the management and oversight of this project. VA and DOD have taken 
specific measures in response to our recommendations for enhancing 
overall management and accountability of the project, with demonstrated 
improvements and outcomes. Extending these practices to current 
activities supporting the development of HealthePeople (Federal) could 
strengthen the departments' approach to successfully accomplishing a 
two-way health information exchange.

In summary, Mr. Chairman, achieving an electronic interface to enable 
VA and DOD to exchange patient medical records between their health 
information systems is an important goal, with substantial implications 
for improving the quality of health care and disability claims 
processing for our nation's military members and veterans. However, in 
seeking a virtual medical record based on the two-way exchange of data 
between their separate health information systems, VA and DOD have 
chosen an approach that necessitates the highest levels of project 
discipline, including a well-defined architecture for describing the 
interface for a common health information exchange and an established 
project management structure to guide the investment in and 
implementation of this electronic capability. At this time, the 
departments lack these critical components, and thus risk investing in 
a capability that could fall short of their intended goals. The 
continued absence of a clear approach and sound planning for the design 
of this new electronic capability elevates concerns and skepticism 
about exactly what capabilities VA and DOD will achieve as part of 
HealthePeople (Federal), and in what time frame.

Mr. Chairman, this concludes my statement. I would be pleased to 
respond to any questions that you or other members of the Subcommittee 
may have at this time.

CONTACTS AND ACKNOWLEDGMENTS:

For information about this testimony, please contact Linda D. Koontz, 
Director, Information Management Issues, at (202) 512-6240 or at 
koontzl@gao.gov, or Valerie C. Melvin, Assistant Director, at (202) 
512-6304 or at melvinv@gao.gov. Other individuals making key 
contributions to this testimony include Nabajyoti Barkakati, Michael P. 
Fruitman, Carl L. Higginbotham, Barbara S. Oliver, J. Michael Resser, 
Sylvia L. Shanks, and Eric L. Trout.

Appendix: VA's and DOD's Reported Actions to Address Recommendations in 
the President's Task Force Report of May 26, 2003:

Recommendations; 
1. VA and DOD should develop and deploy by fiscal year 2005 electronic 
medical records that are interoperable, bi-directional, and standards-
based; 
Reported Actions; 
Department of Veterans Affairs (VA): The VA/DOD Joint Strategic Plan 
and the Joint Electronic Health Records Plan have set September 2005 as 
the target date by which VA and DOD will achieve interoperability of 
health data. The VA/DOD Health Executive Council Information 
Management/Information Technology Work Group is on track to complete 
this capability by the end of fiscal year 2005. In March 2004, the 
departments awarded a contract to develop a bi-directional pharmacy 
solution that will demonstrate interoperability in a prototype 
environment. The departments are on track to complete the prototype by 
October 2004; 
Reported Actions; Department of Defense (DOD): Operational 
interoperability is planned for fiscal year 2005.The pharmacy prototype 
is the initial effort within the Clinical Health Data Repositories 
(CHDR) framework. This framework is the effort to develop software 
component services that will be used by the VA and DOD data 
repositories. The prototype has a planned completion date of October 
2004.

Recommendations; 
2. The Administration should direct the Department of Health and Human 
Services to declare the two departments to be a single health care 
system for purposes of implementing the Health Insurance Portability 
and Accountability Act (HIPAA) regulations; 

Reported Actions; 
Department of Veterans Affairs (VA): This issue remains under review by 
the Veterans Health Administration's HIPAA Program Office. It is VA's 
understanding that VA and DOD have concluded that this is not necessary 
in order to share information on patients that both departments are 
treating; 
Reported Actions; Department of Defense (DOD): DOD believes that it and 
VA can achieve the appropriate sharing of protected health information 
within the guidelines of the current regulations. The HIPAA privacy 
rule has a specific exception authorizing one-way sharing of health 
data at the time of a service members' separation. This supports the 
"seamless transition to veteran status." 

Recommendations; 
3. The departments should implement by fiscal year 2005 a mandatory 
single separation physical as a prerequisite of promptly completing the 
military separation process. Upon separation, DOD should transmit an 
electronic Department of Defense (DD) 214 (discharge paperwork) to VA; 
Reported Actions; Department of Veterans Affairs (VA): The Joint 
Strategic Plan has set June 2004 as the target date for the departments 
to develop an implementation plan for the one physical exam protocol. 
VA and DOD are currently piloting the single separation physical exam 
that meets DOD needs and VA's rating criteria at 16 Benefits Delivery 
at Discharge sites; 
Reported Actions; Department of Defense (DOD): The departments are 
currently testing an advanced technological demonstration project that 
transfers images of paper personnel documents to VA from official 
military personnel file repositories in the Army, Navy, and Marine 
Corps, with Air Force integration into the program in process 
(including the DD214). When fully operational, this system will send 
digital images of any personnel record to the VA within 48 hours of the 
request.

4. By fiscal year 2004, VA and DOD should initiate a process for 
routine sharing of each service member's assignment history, location, 
occupational exposure, and injuries information; 
Reported Actions; Department of Veterans Affairs (VA): Both the Health 
Executive Council (through the Deployment Health Work Group) and the 
VA/DOD Benefits Executive Council are currently developing and 
implementing processes to address these issues; 
Reported Actions; Department of Defense (DOD): DOD is already providing 
VA with daily information on personnel separating from active duty, 
which includes assignment history, location, and occupational duties 
through the DD214. DOD's TRICARE On Line provides health care 
professionals with access to the individual service member's pre-and 
post-deployment health assessments The Defense Occupational and 
Environmental Health Readiness System with CHCS II, is capturing data 
on occupational exposures and transferring it to the clinical data 
repository. When these systems are fully operational, appropriate 
information will be able to be shared via a two-way exchange with VA. 

Source: VA and DOD.

[End of table]

(310701):

FOOTNOTES

[1] U.S. General Accounting Office, Computer-Based Patient Records: 
Short-Term Progress Made, but Much Work Remains to Achieve a Two-Way 
Data Exchange Between VA and DOD Health Systems, GAO-04-271T 
(Washington, D.C.: November 19, 2003).

[2] The one-way transfer of health care data from DOD to VA is being 
accomplished as part of the Federal Health Information Exchange 
initiative.

[3] U.S. General Accounting Office, Veterans Affairs: Sustained 
Management Attention Is Key to Achieving Information Technology 
Results, GAO-02-703 (Washington, D.C.: June 12, 2002) and Computer-
Based Patient Records: Better Planning and Oversight By VA, DOD, and 
IHS Would Enhance Health Data Sharing, GAO-01-459 (Washington, D.C.: 
April 30, 2001).

[4] President's Task Force to Improve Health Care Delivery For Our 
Nation's Veterans, Final Report (Washington, D.C.: May 26, 2003).

[5] P.L. 107-314, sec. 724 (2002).

[6] GAO-01-459.

[7] U.S. General Accounting Office, VA Information Technology: Progress 
Made, but Continued Management Attention Is Key to Achieving Results, 
GAO-02-369T (Washington, D.C.: March 13, 2002).

[8] GAO-02-703.

[9] U.S. General Accounting Office, VA Information Technology: 
Management Making Important In Addressing Key Challenges, GAO-02-1054T 
(Washington, D.C.: September 26, 2002). 

[10] DOD's CHCS II capabilities are being deployed in blocks. Block 1 
provides a graphical user interface for clinical outpatient processes; 
block 2 supports general dentistry; block 3 provides pharmacy, 
laboratory, radiology, and immunizations capabilities; block 4 provides 
inpatient and scheduling capabilities; and block 5 will provide 
additional capabilities as defined.

[11] The six initiatives that make up HealtheVet VistA are health data 
repository, billing replacement, laboratory, pharmacy, imaging, and 
appointment scheduling replacement.

[12] Institute of Electrical and Electronics Engineers, IEEE/EIA Guide 
for Information Technology (IEEE/EIA 12207.1-1997), April 1998.

[13] Sec. 724 of the act mandates that the Secretaries of Veterans 
Affairs and Defense seek to ensure that, on or before October 1, 2004, 
the two departments' pharmacy data systems are interoperable for VA and 
DOD beneficiaries by achieving real-time interface, data exchange, and 
checking of prescription drug data of outpatients and using national 
standards for the exchange of outpatient medication information. The 
act further states that if the specified interoperability is not 
achieved by that date, then the Secretary of Veterans Affairs shall 
adopt DOD's Pharmacy Data Transaction System for VA's use.

[14] The Joint Executive Council is composed of the Deputy Secretary of 
Veterans Affairs, the Undersecretary of Defense for Personnel and 
Readiness, and the cochairs of joint councils on health, benefits, and 
capital planning. The council meets on a quarterly basis to recommend 
strategic direction of joint coordination and sharing efforts. The VA/
DOD Health Executive Council is composed of senior leaders from VA and 
DOD, who work to institutionalize sharing and collaboration of health 
services and resources. The council is cochaired by the VA 
Undersecretary for Health and DOD Assistant Secretary of Defense for 
Health Affairs, and meets on a bimonthly basis.

[15] When we testified last November, VA and DOD had agreed to four 
standards to allow the transmission of messages and one standard 
allowing laboratory results. 

[16] President's Task Force, Final Report, May 26, 2003.