Efforts to Adopt and Implement Federal Interoperability Standards Are Ongoing

Any level of interoperability depends on the use of agreed-upon  standards to ensure that information can be shared and used. The President’s executive order of April 2004 that called for  widespread adoption of interoperable electronic health records by  2014, established the Office of the National Coordinator for Health  Information Technology within the Department of Health and  Human Services (HHS) to, among other things, develop, maintain,  and direct the implementation of a strategic plan to guide the  nationwide implementation of interoperable health IT in both the  public and private health care sectors. DOD and VA Are Sharing Some, but Not All, Health Information at Different Levels of Interoperability

DOD and VA are electronically sharing health information as a result  of their long- and short-term initiatives to achieve interoperability;  some of this information is exchanged in computable form, while  other information is viewable only. However, not all electronic  health information is yet shared. In this  regard, DOD and VA have agreed upon numerous common  standards that allow them to share health data, which include  standards that are part of current and emerging federal  interoperability specifications. The foundation built by this  collaborative process has allowed the two departments to begin  sharing computable health data (the highest level of  interoperability). Under the act, the Secretary of Defense and the Secretary of  Veterans Affairs were required to jointly develop schedules and  benchmarks for setting up the DOD/VA Interagency Program Office,  and for other activities to achieve interoperable health information  (that is, establishing system requirements, acquisition and testing,  and implementation of interoperable electronic health records or  capabilities). The Acting Director added that  program staff are expected to be in place, and the office is expected  to be fully operational by December 2008. In addition, according to department officials, the interagency  program office will play a crucial role in coordinating the  departments’ efforts to accelerate their interoperability efforts. To better ensure that the effort by DOD and VA to achieve fully  interoperable electronic health record systems or capabilities is  accelerated, our July report included recommendations that the  departments give priority to fully establishing the interagency  program office and finalizing the implementation plan. Prompt  action by the departments to address these recommendations is  critical to developing and implementing electronic health record  systems or capabilities that allow for full interoperability of personal  health care information by September 30, 2009, as specified in the  National Defense Authorization Act for Fiscal Year 2008. Recognizing the importance of timely implementation of such  capabilities, Congress established a requirement for an interagency  program office as a single point of accountability, and a deadline of  about one year from now to achieve full interoperability of personal  health care information between the departments. In view of this  short timeframe and as we have recommended, a fully functioning  program office and a finalized plan with set milestones are critical  steps toward achieving interoperable electronic health records and  capabilities. Although completion of the DOD/VA Information  Interoperability Plan is an important and positive accomplishment,  without permanent program office leadership, staff, and facilities or  fully established milestones, the departments may nonetheless  remain challenged in achieving interoperable electronic health  information to the extent and in the manner that most effectively  serves military service members and veterans.
Why GAO Did This Study

The National Defense Authorization Act for Fiscal Year 2008 required the Department of Defense (DOD) and the Department of Veterans Affairs (VA) to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for full interoperability (generally, the ability of systems to use data that are exchanged) and that are compliant with federal standards. The act also established an interagency program office to function as a single point of accountability for the effort and whose role 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; its first report was issued in July 2008. In that report, GAO described the departments' progress in sharing electronic health information, developing electronic health records that comply with federal standards, and establishing the interagency program office. In this testimony, GAO discusses its July 2008 report and updated information obtained from the departments.

What GAO Found

DOD and VA are sharing some, but not all, electronic health information. This includes exchanging some information in computable form, which is the highest level of interoperability. In other cases, data can be viewed only--a lower level of interoperability that still provides clinicians with important information. The departments have undertaken a number of initiatives, resulting in varied sharing capabilities. However, information is still being captured in paper records at many DOD medical facilities, and not all electronic health information is being shared. Further enhancing sharing and interoperability depends on adherence to common standards. The two departments have agreed on numerous common standards and are working with federal groups and each other to ensure adherence to such standards and to align their initiatives with emerging standards. These efforts, led by the Office of the National Coordinator for Health Information Technology (within the Department of Health and Human Services), include identifying relevant existing standards, identifying and addressing overlaps and gaps in the standards, and developing interoperability specifications and certification criteria based on these standards. The departments are also in the process of setting up a new interagency program office that will play a crucial role in accelerating their efforts to achieve electronic health records and capabilities that allow for full interoperability. However, the program office is not expected to be fully operational until the end of the year, which will allow the departments only 9 months to meet the deadline for full interoperability between the departments by September 2009. While DOD and VA have produced a plan for achieving interoperability within this time period, many milestones have yet to be determined. In view of the short timeframe and without a fully established program office and a complete plan with fully established milestones, the departments may be challenged in achieving interoperable electronic health records and capabilities that most effectively serve military service members and veterans.