Health Information Systems: National Practitioner Data Bank Continues to Experience Problems

Highlights

GAO reviewed the Department of Health and Human Services' (HHS) National Practitioner Data Bank's management controls, focusing on whether HHS: (1) ensures that the data bank timely and securely accepts and responds to user requests; (2) adequately monitors contractor operations of the data bank's automated system; and (3) future directional planning and financing is adequate.

Recommendations

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Health and Human Services	To improve the data bank's timeliness in responding to queries, the Secretary of Health and Human Services (HHS) should direct the Administrator of the Health Resources and Services Administration (HRSA) to establish a user fee policy that sets fees commmensurate with the costs for processing queries for each type of media used.	Closed – Implemented HHS changed user fees, effective July 1, 1993, to: (1) recognize the difference in processing costs for queries submitted on paper and those submitted electronically; and (2) encourage more extensive use of electronic querying.
Department of Health and Human Services	To improve the data bank's timeliness in responding to queries, the Secretary of Health and Human Services should direct the Administrator, Health Resources and Services Administration (HRSA), to send information to reporting and querying organizations that encourages the use of social security numbers and explains how supplying social security numbers can improve the timeliness of query responses.	Closed – Implemented HHS agrees with the recommendation, and its Division of Quality Assurance has modified and distributed revised instructions to all Data Bank reporters and queriers indicating that the practitioner's social security number should be submitted if it was obtained in accordance with Section 7 of the Privacy Act of 1974.
Department of Health and Human Services	To improve the handling of query responses containing sensitive malpractice payment or adverse action information, the Secretary of Health and Human Services should direct the Administrator, HRSA, to institute additional safeguards to ensure that practitioner identification data on these queries match reports and that responses are mailed to the correct recipients.	Closed – Implemented With its recent award of a $12-million contract to develop a new system, HHS has begun to further implement its long-range strategy to minimize the use of hard copy documents through the use of online transmission of queries, responses to queries, and adverse action and malpractice payment reports through a secure data network. In the interim, a number of other changes are being implemented to help ensure that responses are mailed to the correct recipients (e.g., printing additional identification data on each page of query responses and requesting entities to submit a single complete official mailing address.
Department of Health and Human Services	The Secretary of Health and Health Services should direct the Administrator, HRSA, to use necessary technical expertise to perform routine on-site monitoring of the contractor's operation of the automated system. Such monitoring should include, at a minimum: (1) comprehensive reviews of the contractor's implementation of test plans, corrective actions to remedy known weaknesses, and documentation for data backup; (2) obtaining full documentation of the automated system, including software; and (3) analyses of contractor proposals of system changes based on reviews of system documentation and test results.	Closed – Implemented HHS has initiated on-going efforts that use agency personnel and contractor support to monitor the data bank contractor's operations. These activities satisfy the intent of the recommendation.
Department of Health and Human Services	The Secretary of Health and Human Services should direct the Deputy Assistant Secretary of the Office of Information Resources Management, which is responsible for ensuring consistency with information resources management requirements, to provide independent technical oversight of the HHS organization responsible for developing the new automated system to ensure that it follows sound system development life-cycle practices, including ensuring that a detailed identification of user needs is performed.	Closed – Implemented In accordance with GAO's recommendation, the Deputy Assistant Secretary for Information Resources Management is providing oversight of development activities for the new system, and a detailed user needs assessment is being conducted.
Department of Health and Human Services	The Secretary of Health and Human Services should not award a contract for the development of a new automated system until ensuring that user needs have been adequately identified, requirements have been fully defined, and alternatives have been assessed.	Closed – Implemented HHS has delayed contract award to take the steps recommended by GAO.
Department of Health and Human Services	The Secretary of Health and Human Services should immediately pursue funding authority for development of the new system.	Closed – Not Implemented On the basis of language in the fiscal year 1993 appropriations bill, which allowed recovery of full operating costs with a user fee of $6 per query, HHS has taken a position that development costs may be funded with user fees. On July 1, 1993, the change in the user fee structure to fund the development of the new processing system was initiated. In addition to the user fee of $6 per query, funds have been appropriated annually to pay the cost of ongoing system enhancements. HHS considers this recommendation to be implemented.

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Computer securityHealth care personnelHospital care servicesMalpractice (medical)Medical information systemsSystems designHospitalsDatabasesUser feesHealth care