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Highlights

Under the National Defense Authorization Act for Fiscal Year 2008, the Department of Defense (DOD) and the Department of Veterans Affairs (VA) are required to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for interoperability (generally, the ability of systems to exchange data) and that are compliant with federal standards. The Act also established a joint interagency program office to function as a single point of accountability for the effort, which is to implement such systems or capabilities by September 30, 2009. Further, the Act required that GAO semi-annually report on the progress made in achieving these goals. For this second report, GAO evaluates the departments' progress and plans toward sharing electronic health information that comply with federal standards, and whether the interagency program office is positioned to function as a single point of accountability. To do so, GAO reviewed its past work, analyzed agency documentation, and conducted interviews.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense 1. To better ensure that DOD and VA achieve interoperable electronic health record systems or capabilities, the Secretaries of Defense and Veterans Affairs should develop results-oriented (i.e., objective, quantifiable, and measurable) goals and associated performance measures for the departments' interoperability objectives and document these goals and measures in their interoperability plans.
Closed - Implemented
In January 2010, DOD and VA reported that they had achieved their objectives for electronic health record interoperability, though they had not developed and documented results-oriented goals and associated performance measures as the basis for reporting achievement of their objectives. However, in April 2010, the VA/DOD Joint Executive Council released its joint strategic plan for fiscal years 2010-2012, which describes the departments' strategic direction for joint efforts related to health care, including interoperability of IT systems. The joint strategic plan articulates seven performance-based objectives related to health systems interoperability and establishes corresponding activities, milestones, and performance measures intended to assist the departments in meeting their stated goals. For example, one objective is to support continuity of patient care by increasing the type and amount of electronic image data shared between VA and DOD. The departments intend to report to an executive-level work group on the status of technical solutions to increase their ability to access to scanned records; develop testing schedules for technical solutions by a set deadline; and implement technical solutions on a limited scale by a set deadline. Their performance metric is completion of 75 percent of their stated activities and milestones.
Department of Veterans Affairs 2. To better ensure that DOD and VA achieve interoperable electronic health record systems or capabilities, the Secretaries of Defense and Veterans Affairs should use results-oriented performance goals and measures as the basis for future assessments and reporting of interoperability progress.
Closed - Implemented
VA agreed with our recommendation and in January 2010 the department stated that it intended to include results-oriented goals in its future plans. In April 2010, the VA/DOD Joint Executive Council released its joint strategic plan for fiscal years 2010-2012, which describes the departments' strategic direction for joint efforts related to health care, including interoperability of IT systems. The joint strategic plan articulates seven performance-based objectives related to health systems interoperability and establishes corresponding activities, milestones, and performance measures intended to assist the departments in meeting their stated goals. The establishment and use of these results-oriented goals and associated performance measures is an important step for the departments, given that they have ongoing interoperability initiatives including development of a Virtual Lifetime Electronic Record.
Department of Veterans Affairs 3. To better ensure that DOD and VA achieve interoperable electronic health record systems or capabilities, the Secretaries of Defense and Veterans Affairs should develop results-oriented (i.e., objective, quantifiable, and measurable) goals and associated performance measures for the departments' interoperability objectives and document these goals and measures in their interoperability plans.
Closed - Implemented
In January 2010, DOD and VA reported that they had achieved their objectives for electronic health record interoperability, though they had not developed and documented results-oriented goals and associated performance measures as the basis for reporting achievement of their objectives. However, in April 2010, the VA/DOD Joint Executive Council released its joint strategic plan for fiscal years 2010-2012, which describes the departments' strategic direction for joint efforts related to health care, including interoperability of IT systems. The joint strategic plan articulates seven performance-based objectives related to health systems interoperability and establishes corresponding activities, milestones, and performance measures intended to assist the departments in meeting their stated goals. For example, one objective is to support continuity of patient care by increasing the type and amount of electronic image data shared between VA and DOD. The departments intend to report to an executive-level work group on the status of technical solutions to increase their ability to access to scanned records; develop testing schedules for technical solutions by a set deadline; and implement technical solutions on a limited scale by a set deadline. Their performance metric is completion of 75 percent of their stated activities and milestones.
Department of Defense 4. To better ensure that DOD and VA achieve interoperable electronic health record systems or capabilities, the Secretaries of Defense and Veterans Affairs should use results-oriented performance goals and measures as the basis for future assessments and reporting of interoperability progress.
Closed - Implemented
DOD agreed with our recommendation and in January 2010 the department stated that it intended to include results-oriented goals in its future plans. In April 2010, the VA/DOD Joint Executive Council released its joint strategic plan for fiscal years 2010-2012, which describes the departments' strategic direction for joint efforts related to health care, including interoperability of IT systems. The joint strategic plan articulates seven performance-based objectives related to health systems interoperability and establishes corresponding activities, milestones, and performance measures intended to assist the departments in meeting their stated goals. The establishment and use of these results-oriented goals and associated performance measures is an important step for the departments, given that they have ongoing interoperability initiatives including development of a Virtual Lifetime Electronic Record.

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