At the highest level,  data are in a format that a computer can understand and operate on,  whereas at the minimum type of interoperability, the data are in a format  that is viewable, so that information is available for a human being to read  and interpret. Not all data require the same level of interoperability. This guidance is codified in an interoperability specification for each use  case that integrates the standards. DOD and VA Are Currently Sharing Health Information at Different Levels of Interoperability, but More Work Remains to Share All Health Information

DOD and VA have established and implemented mechanisms for  electronic sharing of health information, some of which is exchanged in  computable form, while other information is viewable only. Currently, the types of  computable health data being exchanged are limited to outpatient  pharmacy and drug allergy data. Further, although VA’s health information is all captured  electronically, many DOD medical facilities continue to rely on paper  records. According to the departments’ officials, the DOD/VA Information  Interoperability Plan (targeted for approval in August 2008) is to address  these and other issues and define tasks required to guide the development  and implementation of interoperable, bidirectional, and standards-based  electronic health records and capabilities for military and veteran  beneficiaries. DOD and VA Have Adopted Standards to Allow Sharing and Are Taking Steps to Follow Federal Standards, Which Continue to Evolve

DOD and VA have agreed upon numerous common standards that allow  them to share health data, which include standards that are part of current  and emerging federal interoperability specifications. Continuing  their historical involvement in efforts to agree upon standards for the  electronic exchange of clinical health information, the departments are  also participating in recent ongoing standards-related initiatives led by the  Office of the National Coordinator for Health Information Technology  (within the Department of Health and Human Services). The departments’ efforts to share data and to be involved in  standardization activities are important mechanisms for ensuring that their  electronic health records are both interoperable and aligned with  emerging standards and specifications. DOD and VA Have Taken Steps to Establish the Joint Interagency Program Office, but the Office Does Not Yet Have Permanent Leadership, Staff, or Facilities

To accelerate the departments’ ongoing interoperability efforts, Congress  included provisions establishing a joint interagency program office in the  National Defense Authorization Act for Fiscal Year 2008. Under the act,  the Secretary of Defense and the Secretary of Veterans Affairs were  required to jointly develop schedules and benchmarks for setting up the  DOD/VA Interagency Program Office, as well as for other activities for  achieving interoperable health information (that is, establishing system  requirements, acquisition and testing, and implementation of interoperable  electronic health records or capabilities). However, the effort to set up the program office is still in its early  stages. The positions of Director and Deputy Director are not yet  permanently filled, permanent staff have not yet been hired, and facilities  have not yet been designated for housing the office. However, if the plan includes the essential elements needed to guide the  departments in achieving their long-term goal of seamless sharing of  health information, it could improve the prospects for the successful  achievement of this goal. In view of the short timeframes, without a fully established  program office and a finalized implementation plan with set milestones,  the departments may be challenged in meeting the required date for  achieving interoperable electronic health records and capabilities. Appendix I: Scope and Methodology

To describe the progress of the Department of Defense (DOD) and  Department of Veterans Affairs (VA) to date on developing electronic  health records systems or capabilities that allow for full interoperability of  personal health care information between the departments, 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

Under the National Defense Authorization Act for Fiscal Year 2008, the Department of Defense (DOD) and the Department of Veterans Affairs (VA) are required to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for full interoperability (generally, the ability of systems to use data that are exchanged) and that are compliant with federal standards. The act also established a joint interagency program office to act as a single point of accountability for the effort, whose function is to implement such systems or capabilities by September 30, 2009. Further, the act required that GAO semi-annually report on the progress made in achieving these goals. For this first report, GAO describes the departments' progress to date in sharing electronic health information, developing electronic health records that comply with federal standards, and setting up the joint interagency program office. To do so, GAO reviewed its past work, analyzed agency documentation, and conducted interviews with agency officials.

What GAO Found

DOD and VA are sharing some, but not all, electronic health information at different levels of interoperability. Specifically, pharmacy and drug allergy data on about 18,300 patients who receive care from both departments are exchanged at the highest level of interoperability--that is, in computable form; at this level, the data are in a standardized format that a computer application can act on (for example, to provide alerts to clinicians of drug allergies). In other cases, data can be viewed only--a lower level of interoperability that still provides clinicians with important information. However, not all electronic health information is yet shared, and information is still captured on paper at many DOD medical facilities. According to the departments, a DOD/VA Information Interoperability Plan (targeted for approval in August 2008) is to address these and other issues and define tasks required to guide the development and implementation of an interoperable electronic health record capability. If properly developed and implemented, the plan could help the departments achieve the goal of seamless sharing of health information. DOD and VA have agreed upon numerous common standards that allow them to share health data, which include standards that are part of current and emerging federal interoperability specifications. This collaboration provided the essential foundation for the departments to begin sharing computable health data. The departments are currently participating in recent initiatives led by the Office of the National Coordinator for Health Information Technology (within the Department of Health and Human Services) that are aimed at promoting the adoption of federal standards and broader use of electronic health records. These initiatives include identifying relevant existing standards, identifying and addressing overlaps and gaps in the standards, and developing interoperability specifications and certification criteria based on these standards. The involvement of the departments in these activities is an important mechanism for aligning their electronic health records with emerging federal standards. In establishing the joint interagency program office, Congress directed the departments to develop an implementation plan for setting up the office and carrying out related activities (such as validating and establishing requirements for interoperable health capabilities). The departments' effort to set up the program office is still in its early stages. Leadership positions in the office are not yet permanently filled, staffing is not complete, and facilities to house the office have not been designated. Further, the implementation plan is currently in draft, and although it includes schedules and milestones, dates for several activities have not yet been determined (such as implementing a capability to share immunization records), even though all capabilities are to be achieved by September 2009. Without a fully established program office and a finalized implementation plan with set milestones, the departments may be challenged in meeting the required date for achieving interoperable electronic health records and capabilities.