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Highlights

The Department of Defense (DOD) and the Department of Veterans Affairs (VA) operate two of the nation's largest health care systems. To do so, both departments rely on electronic health record systems to create, maintain, and manage patient health information. DOD and VA are currently undertaking initiatives to modernize their respective systems, jointly establish the Virtual Lifetime Electronic Record (VLER), and develop joint information technology (IT) capabilities for the James A. Lovell Federal Health Care Center (FHCC). In light of these efforts, GAO was asked to (1) identify any barriers that DOD and VA face in modernizing their electronic health record systems to jointly address their common health care business needs, and (2) identify lessons learned from DOD's and VA's efforts to jointly develop VLER and to meet the health care information needs for the FHCC. To do this, GAO analyzed departmental reviews and other documentation and interviewed DOD and VA officials.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense To ensure that DOD and VA efficiently and effectively modernize their electronic health record systems to jointly address their common health care business needs, the Secretaries of Defense and Veterans Affairs should direct the Joint Executive Council to 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.
Closed - Not Implemented

Recommendation status is Closed - Not Implemented.

The Departments of Defense (DOD) and Veterans Affairs (VA) released their joint strategic plan for fiscal years 2013 through 2015 in March 2013. The plan described the departments' intentions to pursue a single electronic health record system. However, 1 month earlier, in February 2013, the departments had abandoned the single system approach and have since taken actions to separately modernize their electronic health record systems. As a result, the plan's discussion of the single-system effort is no longer relevant.
Department of Veterans Affairs To ensure that DOD and VA efficiently and effectively modernize their electronic health record systems to jointly address their common health care business needs, the Secretaries of Defense and Veterans Affairs should direct the Joint Executive Council to 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.
Closed - Not Implemented

Recommendation status is Closed - Not Implemented.

The Departments of Defense (DOD) and Veterans Affairs (VA) released their joint strategic plan for fiscal years 2013 through 2015 in March 2013. The plan described the departments' intentions to pursue a single electronic health record system. However, 1 month earlier, in February 2013, the departments had abandoned the single system approach and have since taken actions to separately modernize their electronic health record systems. As a result, the plan's discussion of the single-system effort is no longer relevant.
Department of Veterans Affairs To ensure that DOD and VA efficiently and effectively modernize their electronic health record systems to jointly address their common health care business needs, the Secretaries of Defense and Veterans Affairs should direct the Joint Executive Council to further develop the departments' joint health architecture to include their planned future (i.e., "to be") state and a sequencing plan for how they intend to transition from their current state to the next generation of electronic health record capabilities.
Closed - Not Implemented

Recommendation status is Closed - Not Implemented.

In January 2013, the Interagency Program Office (IPO) developed an Enterprise Architecture Management Plan to provide guidance for developing joint architecture products, identify architecture governance bodies and stakeholder responsibilities, and propose high-level timelines for architecture-related activities. However, according to Department of Defense and Veterans Affairs officials, this plan is no longer operative because it does not reflect the departments' decision to pursue separate electronic health record system modernization efforts.
Department of Defense To ensure that DOD and VA efficiently and effectively modernize their electronic health record systems to jointly address their common health care business needs, the Secretaries of Defense and Veterans Affairs should direct the Joint Executive Council to further develop the departments' joint health architecture to include their planned future (i.e., "to be") state and a sequencing plan for how they intend to transition from their current state to the next generation of electronic health record capabilities.
Closed - Not Implemented

Recommendation status is Closed - Not Implemented.

In January 2013, the Interagency Program Office (IPO) developed an Enterprise Architecture Management Plan to provide guidance for developing joint architecture products, identify architecture governance bodies and stakeholder responsibilities, and propose high-level timelines for architecture-related activities. However, according to Department of Defense and Veterans Affairs officials, this plan is no longer operative because it does not reflect the departments' decision to pursue separate electronic health record system modernization efforts.
Department of Veterans Affairs To ensure that DOD and VA efficiently and effectively modernize their electronic health record systems to jointly address their common health care business needs, the Secretaries of Defense and Veterans Affairs should direct the Joint Executive Council to 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.
Closed - Not Implemented

Recommendation status is Closed - Not Implemented.

The Departments of Defense (DOD) and Veterans Affairs (VA) have not developed a process for identifying and selecting joint IT investments. DOD and VA senior leaders agreed to develop separate electronic health record solutions that adhere to the same body of technical standards, terminologies, and guidance for interoperability set forth by the Interagency Program Office. VA noted in its September 2014 recommendation status update that given these commitments, the departments' respective solutions should yield interoperable information exchanges, without the need to invest in other joint technologies. Further, as a result of the departments' strategy to implement "separate but interoperable systems," VA asserts that the concept of a joint IT investment approach is no longer practical.
Department of Defense To ensure that DOD and VA efficiently and effectively modernize their electronic health record systems to jointly address their common health care business needs, the Secretaries of Defense and Veterans Affairs should direct the Joint Executive Council to 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.
Closed - Not Implemented

Recommendation status is Closed - Not Implemented.

The Departments of Defense (DOD) and Veterans Affairs (VA) have not developed a process for identifying and selecting joint IT investments. DOD and VA senior leaders agreed to develop separate electronic health record solutions that adhere to the same body of technical standards, terminologies, and guidance for interoperability set forth by the Interagency Program Office. Given these commitments, the departments intend for their respective solutions to yield interoperable information exchanges, without the need to identify and select other joint technologies.
Department of Defense The Secretaries of Defense and Veterans Affairs should strengthen their ongoing efforts to establish VLER and the joint IT system capabilities for the FHCC by developing plans that include scope definition, cost and schedule estimation, and project plan documentation and approval.
Closed - Not Implemented

Recommendation status is Closed - Not Implemented.

The Department of Defense (DOD) Inspector General, which has responsibility for tracking the department's actions in response to GAO's recommendations, stated that the department did not agree to take any corrective actions on this recommendation. Accordingly, the department did not take steps to strengthen its efforts to establish VLER and the expected IT system capabilities for the FHCC by documenting and approving project plans that included scope definition, as well as estimated costs and schedules.
Department of Veterans Affairs The Secretaries of Defense and Veterans Affairs should strengthen their ongoing efforts to establish VLER and the joint IT system capabilities for the FHCC by developing plans that include scope definition, cost and schedule estimation, and project plan documentation and approval.
Closed - Not Implemented

Recommendation status is Closed - Not Implemented.

The Department of Veterans Affairs (VA) did not stengthen its efforts to establish VLER and the expected IT system capabilities for the FHCC by documenting and approving project plans that included scope definition, as well as estimated costs and schedules.

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