VA and DOD Have Been Working to Exchange Health Information Since 1998

For nearly a decade, VA and DOD have been undertaking initiatives to  exchange data between their health information systems and create  comprehensive electronic records. However, the departments have faced  considerable challenges in project planning and management, leading to  repeated changes in the focus and target completion dates of the  initiatives. A longer-term  initiative was to develop a common health information architecture that  would allow a two-way exchange of health information. The two repositories are to exchange information through an interface  named CHDR. In October 2004, responding to a congressional mandate, the departments  established two more short-term initiatives: the Laboratory Data Sharing  Interface, aimed at allowing VA and DOD facilities to share laboratory  resources, and the Bidirectional Health Information Exchange (BHIE),  aimed at giving both departments’ clinicians access to records on shared  patients (that is, those who receive care from both departments). In the long-term project to  modernize their health information systems, the departments have begun,  among other things, to implement the first release of the interface between  their modernized data repositories. VA and DOD Have Begun Deployment of a Modernized Data Interface

In their long-term effort to share health information, VA and DOD have  completed the development of their modernized data repositories, agreed  on standards for various types of data, and begun to populate the  repositories with these data. At 7 sites, VA  and DOD are now exchanging limited medical information for shared  patients: specifically, computable outpatient pharmacy and drug allergy  information. Once in the repositories, these computable data can be used by DOD  and VA at all sites through their existing systems. Although implementing this interface is an important accomplishment, the  departments are still a long way from completing the modernized health  information systems and comprehensive longitudinal health records. This involves different tasks for  each department. Short-Term Projects Are Allowing VA and DOD to Exchange Limited Health Information

In addition to the long-term effort previously described, the two  departments have made some progress in meeting immediate needs to  share information in their respective legacy systems through short-term  projects which, as mentioned earlier, are in various stages of completion. One-Way Transfer Capability Is Operational

DOD has been using FHIE to transfer information to VA since 2002. Table 4 summarizes  the types of health data currently shared via the long- and short-term  initiatives we have described, as well as additional types of data that are  currently planned for sharing. Special Procedures Provide Information to VA Polytrauma Centers

In addition to the information technology initiatives described, DOD and  VA have set up special procedures to transfer medical information to VA’s  four polytrauma centers, which treat active duty service members and  veterans severely wounded in combat. DOD staff pointed out that this  laborious process is feasible only because the number of polytrauma  patients is small. These special efforts to transfer medical information on seriously  wounded patients represent important additional steps to facilitate the  sharing of information that is vital to providing polytrauma patients with  quality health care. Work still to be done includes agreeing to  standards for the remaining categories of medical information; populating  the data repositories with all this information; completing the  development of HealtheVet VistA, and AHLTA; and transitioning from the  legacy systems. Further, it is not clear how all the initiatives we have described  today are to be incorporated into an overall strategy toward achieving the  departments’ goal of a comprehensive, seamless exchange of health  information.
Why GAO Did This Study

The Department of Veterans Affairs (VA) and the Department of Defense (DOD) are engaged in ongoing efforts to share medical information, which is important in helping to ensure high-quality health care for active-duty military personnel and veterans. These efforts include a long-term program to develop modernized health information systems based on computable data: that is, data in a format that a computer application can act on--for example, to provide alerts to clinicians of drug allergies. In addition, the departments are engaged in short-term initiatives involving existing systems. GAO was asked to testify on the history and current status of the departments' efforts to share health information. To develop this testimony, GAO reviewed its previous work, analyzed documents about current status and future plans and interviewed VA and DOD officials.

What GAO Found

For almost a decade, VA and DOD have been pursuing ways to share health information and to create comprehensive electronic medical records. However, they have faced considerable challenges in these efforts, leading to repeated changes in the focus of their initiatives and target completion dates. Currently, the two departments are pursuing both long- and short-term initiatives to share health information. Under their long-term initiative, the modern health information systems being developed by each department are to share standardized computable data through an interface between data repositories associated with each system. The repositories have now been developed, and the departments have begun to populate them with limited types of health information. In addition, the interface between the repositories has been implemented at seven VA and DOD sites, allowing computable outpatient pharmacy and drug allergy data to be exchanged. Implementing this interface is a milestone toward the departments' long-term goal, but more remains to be done. Besides extending the current capability throughout VA and DOD, the departments must still agree to standards for the remaining categories of medical information, populate the data repositories with this information, complete the development of the two modernized health information systems, and transition from their existing systems. While pursuing their long-term effort to develop modernized systems, the two departments have also been working to share information in their existing systems. Among various short-term initiatives are a completed effort to allow the one-way transfer of health information from DOD to VA when service members leave the military, as well as ongoing demonstration projects to exchange limited data at selected sites. One of these projects, which builds on the one-way transfer capability, developed an interface between certain existing systems that allows a two-way view of current data on patients receiving care from both departments. VA and DOD are now expanding the sharing of additional medical information by using this interface to link other systems and databases. The departments have also established ad hoc processes to meet the immediate need to provide data on severely wounded service members to VA's polytrauma centers, which specialize in treating such patients. These processes include manual workarounds (such as scanning paper records) that are generally feasible only because the number of polytrauma patients is small. While these multiple initiatives and ad hoc processes have facilitated degrees of data sharing, they nonetheless highlight the need for continued efforts to integrate information systems and automate information exchange. At present, it is not clear how all the initiatives are to be incorporated into an overall strategy focused on achieving the departments' goal of comprehensive, seamless exchange of health information.