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

For almost a decade, VA and DOD have been pursuing ways to share  data in their health information systems and create comprehensive  electronic records. However, the departments have faced  considerable challenges, leading to repeated changes in the focus of  their initiatives and target dates for accomplishment. As shown in figure 1, the departments’ efforts have involved a  number of distinct initiatives, both long-term initiatives to develop  future modernized solutions, and short-term initiatives to respond to  more immediate needs to share information in existing systems. A longer term initiative was to  develop a common health information architecture that would allow  the two-way exchange of health information. These  were two demonstration projects: 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 allowing both departments’ clinicians  access to records on shared patients (that is, those who receive care  from both departments). In the long-term project  to develop modernized health information systems, the departments  have begun to implement the first release of the interface between  their modernized data repositories, among other things. In addition,  the two departments have undertaken ad hoc activities to accelerate  the transmission of health information on severely wounded  patients from DOD to VA’s four polytrauma centers. 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. In addition,  they have now implemented the first release of the CHDR interface,  which links the two departments’ repositories, at seven sites. Besides being a milestone in the development of the departments’  modernized systems, the interface implementation provides benefits  to the departments’ current systems. Although implementing this interface is an important  accomplishment, the departments are still a long way from  completion of the modernized health information systems and  comprehensive longitudinal health records. DOD, in addition to converting current records from its multiple  systems, must also address medical records that are not automated. DOD has been using FHIE to transfer information to VA since 2002. Through their efforts on these long- and near-term initiatives, VA  and DOD are achieving exchanges of various types of health  information (see attachment 1 for a summary of all the types of data  currently being shared and those planned for the future, as well as  cost data on the initiatives). DOD staff also pointed out  that this laborious process is feasible only because the number of  polytrauma patients is small (about 350 in all to date); it would not  be practical on a large scale. Although these various efforts to transfer medical information on  seriously wounded patients are working, and the departments are to  be commended on their efforts, the multiple processes and  laborious manual tasks illustrate the effects of the lack of in health information systems and the difficulties of exchanging  information in their absence. However, the exchanges are as yet limited, and significant work remains to be  done to fully achieve the goal of exchanging interoperable,  computable data, including agreeing to standards for the rem aining  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 strategytoward achieving the departments’ goal of 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 near-term initiatives involving existing systems. GAO was asked to testify on the history and current status of these long- and near-term efforts to share health information. To develop this testimony, GAO reviewed its previous work, analyzed documents, and interviewed VA and DOD officials about current status and future plans.

What GAO Found

For almost a decade, VA and DOD have been pursuing ways to share health information and 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 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 near-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, building 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 working to link other systems via this interface and extend its capabilities. 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. These multiple initiatives and ad hoc processes highlight the need for continued efforts to integrate information systems and automate information exchange. In addition, 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.