Recommendation: For implementation of the EHR system at future VA medical facilities, we recommend that the Secretary of VA direct the EHRM Executive Director to clarify terminology and include adequate detail in descriptions of local workshop sessions to facilitate the participation of all relevant stakeholders including medical facility clinicians and staff. (Recommendation 1)

Agency: Department of Veterans Affairs
Status: Open

Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Recommendation: The TSA Administrator should update the BASE cybersecurity template to ensure it reflects cybersecurity key practices, including the Detect and Recover functions outlined in the NIST Cybersecurity Framework. (Recommendation 2)

Agency: Department of Homeland Security: Transportation Security Administration
Status: Open

Comments: TSA concurred with this recommendation and said it would take steps to implement it by updating the BASE Cybersecurity Security Action Item section to ensure it reflects the NIST Cybersecurity Framework Detect and Recover functions. When we confirm what actions TSA has taken in response to this recommendation, we will provide updated information.

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Acquisition and Sustainment develop and implement a plan to guide and coordinate efforts to implement the Wideband AOA recommendations to support timely, informed decisions on its next wideband satellite communications architecture. (Recommendation 1)

Agency: Department of Defense: Office of the Secretary of Defense
Status: Open

Comments: DOD concurred with our recommendation, but as of July 2020 is still working to implement its corrective action plan.

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) were clearly defined within the governance plans for acquisition of the department's new electronic health record system. As of December 2019, VA and the Department of Defense (DOD) have replaced the IPO with a new joint governance body. Specifically, the Federal Electronic Health Record Modernization (FEHRM) program office has been established to serve as the single point of accountability in the delivery of a common health record between the departments and the advancement of interoperability with the private sector. In its charter, the FEHRM was described as a single decision-making authority to manage issues in support of the departments' integrated electronic health record objectives and its leadership is responsible for, among other things, working to formulate, oversee, de-conflict, and ensure adherence to electronic health record-related VA and DOD policies. However, the corresponding Implementation Plan that is intended to document how the FEHRM executes its full responsibilities has yet to be issued. To fully implement this recommendation, VA needs to document the role and responsibilities of the FEHRM with respect to VA's acquisition of its new electronic health record system, explaining the role, if any, the FEHRM will have in the governance process. We will continue to monitor the departments' incorporation of the FEHRM into the plans for the ongoing acquisition.

Recommendation: The Administrator of FEMA should work with regional emergency communications coordination working group members to reach consensus on and implement an ongoing mechanism to encourage nationwide collaboration across these groups, considering the costs of one or more suitable methods, such as a national-level working group that uses virtual or other means of coordination, as appropriate. (Recommendation 1)

Agency: Department of Homeland Security: Directorate of Emergency Preparedness and Response: Federal Emergency Management Agency
Status: Open

Comments: DHS concurred with our recommendation. DHS created a national RECCWG website as part of the Homeland Security Information Network in fall 2019, and began a phased roll-out of 10 regional sub-pages available to all RECCWG members can post content and share information on exercises and training. In August 2020 FEMA officials confirmed the national site and all 10 regional sites were operational. They said that briefings on how to use the website for the regions are ongoing. We will continue to follow up on DHS's actions to implement the recommendation.

Recommendation: Regarding the National 911 Program, the Administrator of NHTSA should develop specific program goals and performance measures related to NG911 implementation. (Recommendation 1)

Agency: Department of Transportation: National Highway Traffic Safety Administration
Status: Open

Comments: In October 2019, the Department of Transportation (DOT) indicated that the National Highway Transportation Safety Administration (NHTSA) is working to implement the recommendation and plans to complete implementation in July 2020. When we confirm what actions NHTSA has taken in response to this recommendation, we will provide updated information.

Recommendation: Regarding the National 911 Program, the Administrator of NHTSA should, in collaboration with the appropriate federal agencies, determine roles and responsibilities of federal agencies participating in the National NG911 Roadmap initiative in order to carry out the national-level tasks over which each agency has jurisdiction. (Recommendation 2)

Agency: Department of Transportation: National Highway Traffic Safety Administration
Status: Open

Comments: In October 2019, the Department of Transportation (DOT) indicated that the National Highway Transportation Safety Administration (NHTSA) is working to implement the recommendation and plans to complete implementation in July 2020. When we confirm what actions NHTSA has taken in response to this recommendation, we will provide updated information.

Recommendation: Regarding the National 911 Program, the Administrator of NHTSA should develop an implementation plan to support the completion of the National NG911 Roadmap's national-level tasks. (Recommendation 3)

Agency: Department of Transportation: National Highway Traffic Safety Administration
Status: Open

Comments: In October 2019, the Department of Transportation (DOT) indicated that the National Highway Transportation Safety Administration (NHTSA) is working to implement the recommendation and plans to complete implementation in July 2020. When we confirm what actions NHTSA has taken in response to this recommendation, we will provide updated information.

Recommendation: To ensure progress is made toward the implementation of any IT enhancements needed to establish electronic public health situational awareness network capabilities mandated by PAHPRA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to task an integrated project team, made up of an IT project manager and business owner, with including specific actions in the Public Health and Medical Situational Awareness Strategy Implementation Plan for conducting all activities required to establish and operate the network.

Agency: Department of Health and Human Services
Status: Open

Comments: Officials have previously acknowledged that a public health situational awareness network capability is important for identifying, processing, and comprehending data in real-time and stated that such a capability requires coordination and participation from numerous federal entities, including numerous HHS's operating divisions. However, as of January 2020, GAO has not received any information demonstrating progress made to implement our recommendation. Further, HHS has not provided us with a plan of action describing how they would implement the recommendation. Until steps are taken to implement our recommendation, HHS may not make the progress needed to establish an electronic public health situational awareness network capability mandated by PAHPRA in 2013 and the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019.

Recommendation: To ensure progress is made toward the implementation of any IT enhancements needed to establish electronic public health situational awareness network capabilities mandated by PAHPRA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to task the integrated project team with developing a project management plan that includes measurable steps--including a timeline of tasks, resource requirements, estimates of costs, and performance metrics--that can be used to guide and monitor HHS's actions to establish the network defined in the plans.

Agency: Department of Health and Human Services
Status: Open

Comments: Officials have previously acknowledged that a public health situational awareness network capability is important for identifying, processing, and comprehending data in real-time and stated that such a capability requires coordination and participation from numerous federal entities, including numerous HHS's operating divisions. However, as of February 2020 agency officials have not indicated whether or not they concur with the recommendation, nor have they taken any action or provided a plan of action describing how they would implement the recommendation. Until steps are taken to implement our recommendation, HHS may not make progress toward establishing an electronic public health situational awareness network capability mandated by PAHPRA in 2013 and in the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 .

Recommendation: To ensure progress is made toward the implementation of any IT enhancements needed to establish electronic public health situational awareness network capabilities mandated by PAHPRA, the Secretary of HHS should direct the Assistant Secretary for Preparedness and Response to conduct all IT management and oversight processes related to the establishment of the network in accordance with Enterprise Performance Life Cycle Framework guidance, under the leadership of the HHS CIO.

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: In HHS' Public Health and Social Services Emergency Fund's fiscal year 2021 budget justification-which includes the Office of the Assistant Secretary for Preparedness and Response-the agency stated it "concurred" with this recommendation. However, as of February 2020, GAO has not received any information demonstrating progress made to implement our recommendation. Until then, HHS may continue to lack the necessary progress needed in order to establish an electronic public health situational awareness network capability mandated by PAHPRA. To address this recommendation, HHS needs to direct the Assistant Secretary for Preparedness and Response to conduct all IT management and oversight processes related to the establishment of the network in accordance with Enterprise Performance Life Cycle Framework guidance.

Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to establish and implement a plan for updating the pharmacy system to address the inefficiencies with viewing patient medication data in the Outpatient Pharmacy application and between the pharmacy application and viewers.

Agency: Department of Veterans Affairs
Status: Open

Comments: VA concurred with our recommendation and in August 2017 stated that it had identified $4 million in fiscal year 2018 to establish a pharmacy graphical user interface. As of September 2020, VA was still in the process of implementing the pharmacy graphical user interface, which it estimated it would deploy in December 2020. We will continue to monitor the situation.

Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to complete a plan for the implementation of an approach to data standardization that will support the capability for clinicians and pharmacists to view complete DOD data and receive order checks that consistently include DOD data.

Agency: Department of Veterans Affairs
Status: Open

Comments: VA concurred in principle with our recommendation and in May 2018 awarded a contract to implement the same electronic health record system that is being deployed by DOD, which is intended to present VA clinicians with complete DOD data and the ability to perform order checks on DOD data. In parallel, the department is continuing and expanding the implementation of data standardization. According to the department's September 2020 update, the agency had updated its pharmacy system to improve data standardization. However, the agency had not submitted sufficient documentation to close the recommendation. We will continue to monitor the situation.

Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to conduct an assessment to determine to what extent interoperability of VA's pharmacy system with DOD's pharmacy system is impacting transitioning service members.

Agency: Department of Veterans Affairs
Status: Open

Comments: VA concurred with our recommendation and in May 2017 stated that the health executive committee would complete an assessment to determine the extent interoperability with DOD's pharmacy system is impacting transitioning service members. In October 2017, VA conducted an assessment, however it was limited to one part of its system, the Joint Legacy Viewer (JLV), and read-only data. In September 2020, the agency provided a written response to supplement its October 2017 assessment with additional data regarding the potential impact of failures of its system to exchange pharmacy and allergy data with DOD. However, VA had not submitted sufficient documentation to close the recommendation. We will continue to monitor the situation.

Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to develop and execute a plan for implementing the capability to send outbound e-prescriptions to non-VA pharmacies, in accordance with National Council for Prescription Drug Programs standards.

Agency: Department of Veterans Affairs
Status: Open

Comments: VA concurred with our recommendation and in August 2017 stated that it will review its plan for e-prescribing functionality after it has signed a contract to adopt the electronic health record system that is being deployed by DOD. Although VA awarded the contract for the new electronic health record system in May 2018, VA had not submitted sufficient documentation to close the recommendation as of September 2020. We will continue to monitor the situation.

Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to ensure that the department's evaluation of alternatives for electronic health records includes consideration for additional generation level 3 capability such as navigating from an alert to medication order in the electronic health record system.

Agency: Department of Veterans Affairs
Status: Open

Comments: VA concurred with our recommendation and in August 2017 stated that it had entered into contract negotiations to acquire and deploy a level 3 electronic health record system that is expected to address pharmacy functions. As of September 2020, the agency had not submitted sufficient documentation to close the recommendation. We will update the status of this recommendation when VA provides documentation of its evaluation of alternatives to us.

Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to reassess the priority for establishing an inventory management capability to monitor and update medication levels and track when to reorder medications.

Agency: Department of Veterans Affairs
Status: Open

Comments: VA concurred with our recommendation and in August 2017 stated that it will reassess the prioritization of medication inventory management after a contract for adoption of the electronic health record system is signed. As of September 2020, VA had not submitted sufficient documentation to close the recommendation. We will continue to monitor the situation.

Recommendation: To ensure that DOD program managers have the necessary information to maintain complete visibility and accountability of ITEF-funded equipment in SCIP, the Secretary of Defense should identify the root causes, such as potential interoperability and data reporting issues within SCIP and other DOD data systems, for why DOD components are not ensuring that ITEF-funded equipment transportation dates are captured in SCIP.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of October 2019, DOD was in the process of developing a plan to address this recommendation. GAO is continuing to monitor DOD's progress in addressing this recommendation.

Recommendation: To ensure that DOD program managers have the necessary information to maintain complete visibility and accountability of ITEF-funded equipment in SCIP, the Secretary of Defense should develop an action plan with associated milestones and time frames for addressing the root causes for why DOD components are not ensuring that ITEF-funded equipment transportation dates are captured in SCIP.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of October 2019, DOD was in the process of developing a plan to address this recommendation. GAO is continuing to monitor DOD's progress in addressing this recommendation.

Recommendation: To ensure that DOD program managers have the necessary information to maintain complete visibility and accountability of ITEF-funded equipment in SCIP, the Secretary of Defense should develop written procedures that specify under which data field ITEF-funded equipment transfer dates should be captured in the Enhanced Freight Tracking System in SCIP.

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with this recommendation. The department commented that the relevant organizations have most, if not all, of the written procedures that are necessary for reporting these dates in the Enhanced Freight Tracking System. However, it would coordinate with all interested parties to update these procedures if needed. As of October 2019, GAO was continuing to monitor DOD's progress in addressing this recommendation.

Recommendation: To ensure that DOD program managers have the necessary information to maintain complete visibility and accountability of ITEF-funded equipment in SCIP, the Secretary of Defense should update the 1st Theater Sustainment Command's (1st TSC) written standard operating procedures to include the 1st TSC commander's verbal order requiring the inclusion of unique equipment case identifier information for ITEF-funded equipment on transfer documentation.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of October 2019, DOD officials said they had updated the 1st TSC's written standard operating procedures to include the 1st TSC's commander's verbal order, and GAO was in the process of obtaining documentation of these changes.