DOD and VA Identified Interoperability Objectives and Formed an Interagency Program Office

As previously noted, the National Defense Authorization Act for Fiscal  Year 2008 called for DOD and VA to jointly develop and implement, by  September 30, 2009, electronic health record systems or capabilities that  allow for full interoperability of personal health care information that are  compliant with applicable federal interoperability standards. Among the specific responsibilities  identified in the charter was the development of a plan, schedule, and  performance measures to guide the departments’ electronic health record  interoperability efforts. Subsequent to an April 2009 Presidential announcement, the departments  approved a new version of the interagency program office’s charter in  September to expand the office’s responsibilities to include coordination  and oversight of the development of a Virtual Lifetime Electronic Record  (VLER). Moreover, our report and testimony also noted that the departments’  interagency program office was not effectively positioned to function as a  single point of accountability for achievement of full interoperability  because it did not yet have fundamental IT management capabilities and  was not fulfilling key responsibilities, including establishment of  performance measures, a project plan, or a detailed schedule. Although DOD and VA Have Met Their Six Interoperability Objectives, Additional Work Remains to Meet Clinicians’ Evolving Needs

DOD and VA have achieved planned capabilities for the three remaining  objectives (expand questionnaires and self-assessment tools, expand  Essentris in DOD, and demonstrate initial document scanning). Having  now met all six of their interoperability objectives, the departments’  officials, including the co-chairs of the group responsible for representing  the clinician user community, believe they have satisfied the September  30, 2009, requirement for developing and implementing systems or  capabilities that allow for full interoperability. Nevertheless, the  departments are planning additional actions to further increase their  interoperable capabilities, recognizing that clinicians’ needs for  interoperable electronic health records are evolving. Clinicians have identified additional needs with respect to social history  and physical exam data that have emerged since existing capabilities were  made available in those areas. DOD plans to further expand the implementation of Essentris to sites  beyond those achieved as of September 2009. DOD/VA Interagency Program Office Has Made Progress toward Filling Positions, but Has Not Fully Implemented Recommended Management Improvements

The interagency program office is not yet positioned to function as a single  point of accountability for the implementation of interoperable electronic  health record systems or capabilities. Since we last reported, the  departments have made progress in setting up the office by hiring  additional staff, including a permanent director. In addition, consistent  with our prior recommendations, the office has begun to demonstrate  responsibilities outlined in its charter in the areas of scheduling, planning,  and performance measurement. However, the office’s efforts to develop its  capabilities in these areas are incomplete. However, the schedule does not include information about the tasks,  resource needs, or relationships between tasks for the testing activity. Specifically, the office has been focused on verifying  achievement of the six interoperability objectives. Furthermore, implementation of our  recommendations will also better position the office to function as a single  point of accountability for the delivery of interoperable electronic health  records, which are intended to improve service members’ and veterans’  health care. Key contributors to this report are listed in appendix V.

Appendix I: Scope and Methodology

To determine the extent to which the Department of Defense (DOD) and  the Department of Veterans Affairs (VA) developed and implemented  electronic health record systems or capabilities that allowed for full  interoperability by the September 30, 2009, deadline, we reviewed our  previous work on DOD and VA efforts to develop health information  systems, interoperable health records, and interoperability standards to be  implemented in federal health care programs.
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 their exchange of health information and to develop capabilities that allow for interoperability (generally, the ability of systems to exchange data) by September 30, 2009. It also required compliance with federal standards and the establishment of a joint interagency program office to function as a single point of accountability for the effort. Further, the act directed GAO to semiannually report on the progress made in achieving these requirements. For this fourth report, GAO determined the extent to which (1) DOD and VA developed and implemented electronic health record systems or capabilities that allowed for full interoperability by September 30, 2009, and (2) the interagency program office established by the act is functioning as a single point of accountability. To do so, GAO analyzed agency documentation on project status and conducted interviews with agency officials.

What GAO Found

DOD and VA previously established six objectives that they identified as necessary for achieving full interoperability; they have now met the remaining three interoperability objectives that GAO previously reported as being partially achieved--expand questionnaires and self-assessment tools, expand DOD's inpatient medical records system, and demonstrate initial document scanning. As a result of meeting the six objectives, the departments' officials, including the co-chairs of the group responsible for representing the clinician user community, believe they have satisfied the September 30, 2009, requirement for full interoperability. Nevertheless, DOD and VA are planning additional actions to further increase their interoperable capabilities and address clinicians' evolving needs for interoperable electronic health records. Specifically, (1) DOD and VA plan to meet additional needs that have emerged with respect to social history and physical exam data; (2) DOD plans to further expand the implementation of its inpatient medical records system to sites beyond those achieved as of September 2009; and (3) DOD and VA plan to test the capability to scan documents, in follow-up to their demonstration of an initial document scanning capability. Additionally, in response to a Presidential announcement, the departments are beginning to plan for the development and implementation of a virtual lifetime electronic record, which is intended to further increase their interoperable capabilities. The interagency program office is not yet positioned to function as a single point of accountability for the implementation of interoperable electronic health record systems or capabilities. The departments have made progress in setting up their interagency program office by hiring additional staff, including a permanent director. In addition, consistent with GAO's previous recommendations, the office has begun to demonstrate responsibilities outlined in its charter in the areas of scheduling, planning, and performance measurement. However, the office's effort in these areas does not fully satisfy the recommendations and are incomplete. Specifically, the office does not yet have a schedule that includes information about tasks, resource needs, or relationships between tasks associated with ongoing activities to increase interoperability. Also, key IT management responsibilities in the areas of planning and performance measurement remain incomplete. Among the reasons officials cited for not yet completing a schedule, plan, or performance measures were the office's need to focus on verifying achievement of the six interoperability objectives and participating in the departments' efforts to define the virtual lifetime electronic record. Nonetheless, if the program office does not fulfill key management responsibilities as GAO previously recommended, it may not be positioned to function as a single point of accountability for the delivery of future interoperable capabilities, including the development of the virtual lifetime electronic record.