GAO’s recommendations database contains report recommendations that still need to be addressed.
GAO’s priority recommendations are those that we believe warrant priority attention.
We sent letters to the heads of key departments and agencies, urging them to continue focusing on these issues.
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As of February 9, 2020, there are 4958 open recommendations, of which 422 are priority recommendations. Recommendations remain open until they are designated as Closed-implemented or Closed-not implemented.
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Recommendation: The Secretary of Veterans Affairs should ensure that the role and responsibilities of the Interagency Program Office are clearly defined within the governance plans for acquisition of the department's new electronic health record system. (Recommendation 1)
Agency: Department of Veterans Affairs Status: Open Priority recommendation
Comments: The Department of Veterans Affairs (VA) concurred with our recommendation to ensure that the role and responsibilities of the Interagency Program Office (IPO) are clearly defined within the governance plans for acquisition of the department's new electronic health record system. According to the department, the Joint Executive Committee (JEC), a joint governance body comprised of leadership from the Department of Defense and VA, approved a role for the IPO that included providing expertise, guidance, and support for both DOD and VA and joint governance bodies as the departments continue to acquire and implement interoperable electronic health record systems. However, the department has not yet provided documentation supporting these actions and how they relate to VA's governance structure for the new acquisition. In addition, the role described does not appear to position the IPO to be the single point of accountability originally described in the National Defense Authorization Act for Fiscal Year 2008. We will continue to monitor the department's governance plans for the acquisition of the new electronic health record system and the relationship with the IPO.
Recommendation: The Administrator of the Centers for Medicare and Medicaid Services should develop processes and procedures to ensure that qualified entities and researchers have implemented information security controls effectively throughout their agreements with CMS. (Recommendation 3)
Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services Status: Open Priority recommendation
Comments: HHS previously stated that they will be engaging a contractor to review the current data security framework and make recommendations on specific controls and implementation requirements that would be appropriate for those entities. The agency did not provide a timeframe for when this review would be complete. As of May 2019, HHS had not provided any further information in response to our inquiries.
Recommendation: To ensure that CMS and ONC can effectively monitor the effect of the EHR programs and progress made toward goals, the Secretary of Health and Human Services should direct the agencies to develop performance measures to assess outcomes of the EHR programs--including any effects on health care quality, efficiency, and patient safety and other health care reform efforts that are intended to work toward similar outcomes.
Agency: Department of Health and Human Services Status: Open Priority recommendation
Comments: HHS neither agreed nor disagreed with our recommendation. In July 2015, CMS noted that the agency is working to align the programs to better enable monitoring using outcome-oriented performance measures and noted that the agency is collecting data that will help them to develop such measures. CMS did not indicate when HHS plans to develop such measures as GAO recommended. In June 2016, CMS also noted that it analyzed the results of the EHR programs as of October 2015, but did not indicate that it used performance measures that assess outcomes. In September 2017, HHS officials provided us a variety of publically available reports, which they indicated show how program participants are progressing in the EHR programs and the related impacts. In 2018, CMS changed the name of these programs to the Promoting Interoperability programs to focus on improving interoperability and patients' access to health information, and officials noted that the agency is working to develop related outcome-based measures. To fully implement this recommendation, CMS needs to develop performance measures that enable the agency to assess whether the Promoting Interoperability programs are improving outcomes, such as health care quality, efficiency, and patient safety, as we recommended.