Accordingly, we recommended that the departments   develop an architecture for the electronic interface between their  health systems that includes system requirements, design  specifications, and software descriptions;  ● select a lead entity with final decision-making authority for the  establish a project management structure to provide day-to guidance of and accountability for their inv estments in and  implementation of the interface capability; and  create and management plan for the electronic interface that defines the  technical and managerial processes necessary to satisfy project  requirements and includes (1) the authority and responsibility of  each organizational unit; (2) a work breakdown structure for all o the tasks to be performed in developing, testing, and implemen the software, along with schedules associated with the tasks; and  (3) a security policy. Besides pursuing their long-term goals for future systems through  the HealthePeople (Federal) strategy, the departments are working  on two demonstration projects that focus on exchanging  information between existing systems: (1) Bidirectional Health  Information Exchange, a project to exchange health information on  shared patients, and (2) Laboratory Data Sharing Interface, an  application used to transfer laboratory work orders and results. These demonstration projects were planned in response to  provisions of the Bob Stump National Defense Authorization Act of  2003, which mandated that VA and DOD conduct demonstration  projects that included medical information and information  technology systems to be used as a test for evaluating the feasibi advantages, and disadvantages of measures and programs designed  to improve the sharing and coordination of health care and health  care resources between the departments. The Benefits Delivery Network, parts of  which were developed in the 1960s, contains over 3 million veterans  benefits records, including compensation and pension, education,  and vocational rehabilitation and employment. In 1996, after experiencing numerous false starts  and spending approximately $300 million on the overall  modernization of BDN, VBA revised its strategy and narrowed its  focus to modernizing the compensation and pension payment  system. This application exchanges  data between VA’s VistA system and DOD’s CHCS system (and  AHLTA where implemented). The primary benefit of BHIE is near-real-time access to patient  medical information for both VA and DOD, which is not available  through FHIE. It has now been deployed to six sites. VA and DOD Are Taking Action to Achieve a Virtual Medical Record, but Much Work Remains

Besides the near-term initiatives just discussed, VA and DOD  continue their efforts on the longer term goal: to achieve a virtual  medical record based on the two-way exchange of computable data  between the health information systems that each is currently  developing. According to VA, the integrated master plan is to be completed by  the end of August 2006. VA and DOD have  made progress in the electronic sharing of patient health data in  their limited, near-term demonstration projects, and have taken a important step toward their long-term goals by improving the  management of the CHDR program. While the departments have ma progress in developing a project management plan, it is not yet  complete. VA has also been working to modernize the delivery of benefits  through its development of VETSNET, but the pace of progress has  been discouraging. Until VBA  develops an integrated project plan that addresses the long-stan management weaknesses that we and others have identified, it will  be uncertain when and at what cost VETSNET will be delivered. It also needed to develop and  implement action plans to move VBA from the current to the replacement system and to ensure that the  Benefits Delivery Network would be able to continue accurately processing benefits payments until the new  system was deployed.
Why GAO Did This Study

The Department of Veterans Affairs (VA) is engaged in an ongoing effort to share electronic medical information with the Department of Defense (DOD), which is important in helping to ensure high-quality health care for active duty military personnel and veterans. Also important, in the face of current military responses to national and foreign crises, is ensuring effective and efficient delivery of veterans' benefits, which is the focus of VA's development of the Veterans Service Network (VETSNET), a modernized system to support benefits payment processes. GAO is testifying on (1) VA's efforts to exchange medical information with DOD, including both near-term initiatives involving existing systems and the longer term program to exchange data between the departments' new health information systems, and (2) VA's ongoing project to develop VETSNET. To develop this testimony, GAO relied on its previous work and followed up on agency actions to respond to GAO recommendations.

What GAO Found

VA and DOD are implementing near-term demonstration projects that exchange limited electronic medical information between their existing systems, and they are making progress in their longer term effort to share information between the new health information systems that each is developing. Two demonstration projects have been implemented at selected sites: (1) a project to achieve the two-way exchange of health information on patients who receive care from both departments and (2) an application to electronically transfer laboratory work orders and results. According to VA and DOD, these projects have enabled lower costs and improved service to patients by saving time and avoiding errors. In their longer term effort, VA and DOD have made progress, in response to earlier GAO recommendations, by designating a lead entity with final decision-making authority and establishing a project management structure. However, VA and DOD have not yet developed a clearly defined project management plan that gives a detailed description of the technical and managerial processes necessary to satisfy project requirements, as GAO previously recommended. Moreover, the departments have experienced delays in their efforts to begin exchanging patient health data; they have not yet fully populated the repositories that will store the data for their future health systems. As a result, much work remains to be done before the departments achieve their ultimate goal of sharing virtual medical records. VA has also been working to modernize the delivery of benefits through its development of VETSNET, but the pace of progress has been discouraging. Originally initiated in 1986, this program was prompted by the need to modernize VA's Benefits Delivery Network--parts of which are now 40-year-old technology--on which the department relies to make benefits payments, including compensation and pension, education, and vocational rehabilitation and employment. In 1996, after experiencing numerous false starts and spending approximately $300 million, VBA revised its strategy and narrowed its focus to modernizing the compensation and pension system. In earlier reviews, GAO has made numerous recommendations to improve the program's management, including the development of an integrated project plan. In response to GAO's recommendations as well as those of an independent evaluator, VA is now developing an integrated master plan for the compensation and pension system, which it intends to complete in August. Until VA addresses the managerial and program weaknesses that have hampered the program, it is uncertain when VA will be able to end its reliance on its aging benefits technology.