In this  regard, the departments have achieved planned capabilities for three of  the interoperability objectives—refine social history data, share physical  exam data, and demonstrate initial network gateway operation. For the remaining three objectives, the departments have partially  achieved planned capabilities, with additional work needed to fully meet  the objectives. Regarding the objective to expand questionnaires and self- assessment tools, this additional work is intended to be completed by  September 2009. With respect to the objectives to expand Essentris and  demonstrate initial document scanning, department officials stated that  they also intend to meet these objectives; however, additional work will be  required beyond September to perform all the activities necessary to meet  clinicians’ needs for health information. DOD/VA Interagency Program Office Has Made Progress in Becoming Operational, but Is Not Fully Functioning as a Single Point of Accountability

The DOD/VA Interagency Program Office is not yet effectively positioned  to serve as a single point of accountability for the implementation of fully  interoperable electronic health record systems or capabilities. Since we  last reported in January 2009, the departments have made progress in  setting up the office by hiring additional staff, although they continue to  fill key leadership positions on an interim basis. In addition, the office has  begun to demonstrate responsibilities outlined in its charter, but is not yet  fulfilling key IT management responsibilities in the areas of performance  measurement, scheduling, and project planning. Table 2 provides the  status of selected key activities to establish the interagency program  office. Moreover, in the absence of these critical  activities, the office is not effectively positioned to function as the single  point of accountability for achieving full interoperability. In particular, the departments have taken steps to meet  their six interoperability objectives by September 30, 2009. Key contributors to this report are listed in appendix V.

Appendix I: Scope and Methodology

To evaluate the Department of Defense’s (DOD) and Veterans Affairs’ (VA)  progress toward developing electronic health record systems or  capabilities that allow for full interoperability of personal health care  information, 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. We obtained and analyzed agency documentation and  interviewed program officials to determine DOD’s and VA’s progress  towards achieving full interoperability by September 30, 2009, as required  by the National Defense Authorization Act for Fiscal Year 2008.
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 systems or 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 third report, GAO evaluated (1) the departments' progress and plans toward sharing fully interoperable electronic health information that comply with federal standards and (2) whether the interagency program office is positioned to function 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 have taken steps to meet six objectives that they identifiedforachieving full interoperability in compliance with applicable standards (see table) by September 30, 2009. Specifically, the departments have achieved planned capabilities for three of the objectives--refine social history data, share physical exam data, and demonstrate initial network gateway operation. For the remaining three objectives, the departments have partially achieved planned capabilities, with additional work needed to fully meet the objectives. Regarding the objective to expand questionnaires and self-assessment tools, this additional work is intended to be completed by the deadline. The departments' officials have stated that they intend to meet the objectives to expand DOD's inpatient medical records system and demonstrate initial document scanning; however, additional work will be required beyond September to perform all the activities necessary to meet clinicians' needs for health information. The DOD/VA Interagency Program Office is not yet effectively positioned to function as a single point of accountability for the implementation of fully interoperable electronic health record systems or capabilities between DOD and VA. While the departments have made progress in setting up the office by hiring additional staff, they continue to fill key leadership positions on an interim basis. Further, while the office has begun to demonstrate responsibilities outlined in its charter, it is not yet fulfilling key information technology management responsibilities in the areas of performance measurement (as GAO previously recommended), project planning, and scheduling, which are essential to establishing the office as a single point of accountability for the departments' interoperability efforts.