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Opportunities exist for DOD and VA to jointly modernize their electronic health record systems

Why Area Is Important

The Departments of Defense (DOD) and Veterans Affairs (VA) operate two of the nation's largest health care systems, providing health care to 9.6 million active duty service members and their beneficiaries and 6 million veterans at estimated annual costs of about $49 billion and $48 billion, respectively. Although they have identified many common health care business needs, both departments have spent large sums of money to develop and operate electronic health record systems that they rely on to create and manage patient health information. Furthermore, the departments have each begun multimillion dollar modernizations of their electronic health record systems. Specifically, DOD has obligated approximately $2 billion over the 13-year life of its Armed Forces Health Longitudinal Technology Application (AHLTA) and requested $302 million in fiscal 2011 year funds for a new system. For its part, VA reported spending almost $600 million from 2001 to 2007 on eight projects as part of its Veterans Health Information Systems and Technology Architecture (VistA) modernization. In April 2008, VA estimated an $11 billion total cost to complete the modernization by 2018.

What GAO Found

Although DOD and VA have many common health care business needs, the departments have begun separate modernizations of their electronic health record systems. Reduced duplication in this area could save system development and operation costs while supporting higher-quality health care for service members and veterans.

In May 2010, the departments identified 10 areas—inpatient documentation, outpatient documentation, pharmacy, laboratory, order entry and management, scheduling, imaging and radiology, third-party billing, registration, and data sharing—in which they have common business needs. Moreover, the results of a 2008 study conducted for the departments found that over 97 percent of functional requirements for an inpatient electronic health record system are common to both departments. Nevertheless, DOD has initiated an effort called the EHR (Electronic Health Record) Way Ahead to modernize AHLTA. At the same time, VA has begun a separate effort to modernize VistA.

The departments' distinct modernization efforts are due in part to barriers they face to jointly addressing their common health care system needs. These barriers stem from weaknesses in three key information technology (IT) management areas: strategic planning, enterprise architecture, and investment management. First, the departments have not articulated explicit plans, goals, and time frames for jointly addressing the health IT requirements common to their electronic health record systems. For example, DOD's and VA's joint strategic plan, which is intended to describe the departments' coordination and sharing efforts, does not discuss how or when the departments propose to identify and develop joint health IT solutions, and department officials have not yet determined whether the IT capabilities developed for the new Federal Health Care Center can or will be implemented at other DOD and VA medical facilities. Second, although DOD and VA have taken steps toward developing and maintaining elements of a joint health architecture, such as a description of business processes and supporting technologies, it is not being used to guide the departments' health IT modernization efforts. For example, the departments have not defined how they intend to transition from their current architecture to a planned future state. Third, DOD and VA have not established a joint process for selecting IT investments based on criteria that consider cost, benefit, schedule, and risk elements, which would help to ensure that the chosen solution meets their common health IT needs and provides better value and benefits to the government as a whole. Without these key management capabilities in place, DOD and VA are impeded in identifying and implementing efficient and effective IT solutions to jointly address their common needs and achieving the seamless, comprehensive access to information that is necessary to optimally treat patients as they transition from servicemember to veteran status.

Actions Needed

GAO's recent work identified several actions that the Secretaries of Defense and Veterans Affairs could take to overcome barriers that DOD and VA face in modernizing their electronic health record systems to jointly address their common health care business needs, including the following:

  • Revise the departments' joint strategic plan to include information discussing their electronic health record system modernization efforts and how those efforts will address the departments' common health care business needs.
  • Further develop the departments' joint health architecture to include their planned future state and transition plan from their current state to the next generation of electronic health record capabilities.
  • Define and implement a process, including criteria that considers costs, benefits, schedule, and risks, for identifying and selecting joint IT investments to meet the departments' common health care business needs.

Officials from both DOD and VA agreed with these recommendations. GAO will continue to monitor their progress on this important issue.

Efforts by the departments to jointly identify and develop common IT solutions to address their mutual health care needs could result in system development and operation cost savings while supporting higher-quality health care for service members and veterans. Although the financial benefit of reducing duplication in this area is to be determined, a joint approach to electronic health record modernization should not only result in cost savings, it should also improve the departments' ability to share health information, which in turn can optimize the quality of health care the departments provide to service members and veterans.

Framework for Analysis

The information contained in this analysis is based on findings from GAO's recent report on DOD and VA electronic health record system modernizations and the other products listed under the "Related GAO Products" tab.

Area Contact

For additional information about this area, contact Valerie C. Melvin at (202) 512-6304 or

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