To assess Defense’s continuing efforts to address past problems, we examined (1) Defense’s August 1994 Performance Management Plan Version 5.0, (2) Defense’s August 1993 deployment plan, Implementation and Use of the CHCS, (3) Defense deployment schedules through October 4, 1995, (4) monthly progress reports provided to Defense by the CHCS contractor through December 1995, (5) Defense’s May 1995 report on VAX/PC system sizing algorithms, (6) Defense’s June 1995 report on high-end system sizing algorithms, and (7) Defense’s July 1995 report on the high-end computing platform for CHCS. They were provided by the Assistant Secretary of Defense for Health Affairs and are incorporated as appendix I.

	CHCS Deployment Is Complete

At the end of 1995, Defense completed deployment of CHCS to 526 of its 815 medical treatment facilities worldwide. Given the complexity of the design and development of CHCS and the number of facilities involved, this was not an easy task. Key to the successful development and deployment of CHCS has been the leadership provided by the Deputy Assistant Secretary of Defense for Health Services Operations and Readiness and the CHCS program manager and their application of a set of fundamental information management practices that we refer to as best practices. This amount exceeds Defense’s $2.8 billion estimated system life-cycle cost by $1.3 billion. Productivity increases would come from improved scheduling and improved access to patient information. Defense’s analysis of those requirements led it to conclude that in order to provide physicians with this capability, it needed to develop a clinically-oriented graphical user interface (GUI). Specifically, Defense has (1) updated its performance management plan to include procedures for investigating and correcting extremely long response times and (2) improved its measures of system reserve capacity by developing performance simulation models for each CHCS computer platform that forecast computer resource capacity requirements. In recent meetings, they said they are reviewing Defense’s CHCS backup and recovery plan to address rapid repair or replacement of damaged CHCS equipment. Medical ADP Systems: Defense’s Tools and Methodology for Managing CHCS Performance Need Strengthening (GAO/AIMD-94-61, July 15, 1994). Medical ADP Systems: Composite Health Care System: Defense Faces a Difficult Task (GAO/IMTEC-90-42, March 15, 1990).
Why GAO Did This Study

Pursuant to a legislative requirement, GAO reviewed the Department of Defense's (DOD) Composite Health Care System (CHCS), focusing on: (1) DOD efforts to complete deployment of CHCS to military medical treatment facilities worldwide; (2) DOD efforts to address previously identified problems; and (3) a new CHCS operational issue.

What GAO Found

GAO found that: (1) DOD completed deployment of CHCS to 526 medical treatment facilities worldwide, which was difficult because of the system's complexity and the number of sites involved; (2) two DOD officials ensured the deployment's success by providing leadership and using fundamental information management practices; (3) DOD expects CHCS benefits to exceed its costs by $1.3 billion over the system's expected life; (4) CHCS should improve scheduling, give greater and quicker access to patient information, and increase the timeliness of medical care; (5) DOD has made progress in addressing its two previously identified problems by developing a prototype clinically oriented graphical user interface to make patient order-entry less cumbersome and strengthening the tools and methodology needed to manage CHCS performance; (6) DOD has updated its CHCS performance management plan and developed performance simulation models for each CHCS computer platform; (7) the lack of an effective plan for rapidly repairing or replacing CHCS equipment damaged by disaster remains a problem; and (8) DOD did not address this problem because of cost concerns and a lack of accurate information, but it is reconsidering its options for providing equipment adequate backup.