The  joint effort is expected to result in the secured sharing of health data  between the new systems that each department is currently  developing and beginning to implement—VA’s HealtheVet VistA and  DOD’s CHCS II. According to the departments, they planned to be able to exchange  selected health information through CHDR by October 2005. Accordingly, we recommended that  the departments  ●  develop an architecture for the electronic interface between their  health systems that includes system requirements, design  specifications, and software descriptions;  ●  select a lead entity with final decision-making authority for the  ●  establish a project management structure to provide day-to-day  guidance of and accountability for their investments in and  implementation of the interface capability; and  ●  create and implement a comprehensive and coordinated project  management plan for the electronic interface that defines the  technical and managerial processes necessary to satisfy project  requirements and includes (1) the authority and responsibility of  each organizational unit; (2) a work breakdown structure for all  of the tasks to be performed in developing, testing, and  implementing the software, along with schedules associated with  the tasks; and (3) a security policy. Besides pursuing their long-term goals for future systems through  the HealthePeople (Federal) strategy, the departments are working  on two demonstration projects that focus on exchanging  information between existing systems: (1) Bidirectional Health  Information Exchange, a project to exchange health information on  shared patients, and (2) Laboratory Data Sharing Interface, an  application used to transfer laboratory work orders and results. VA and DOD Are Exchanging Limited Medical Information between Existing Health Systems

VA and DOD have begun to implement applications developed under  two demonstration projects that focus on the exchange of electronic  medical information. The first—the Bidirectional Health Information  Exchange—has been implemented at five VA/DOD locations and the  second—Laboratory Data Sharing Interface—has been implemented  at six VA/DOD locations. Table 2 shows the locations at which it has been or  is to be implemented. VA and DOD Are Taking Actions to Achieve a Virtual Medical Record, but Much Work Remains

Besides the near-term initiatives just discussed, VA and DOD  continue their efforts on the longer term goal: to achieve a virtual  medical record based on the two-way exchange of computable data  between the health information systems that each is currently  developing. Also in response to our recommendations, the departments have  established project accountability and implemented a joint project  management structure. Without a plan of sufficient detail, VA  and DOD increase the risk that the CHDR project will not deliver the  planned capabilities in the time and at the cost expected. Second, at present, health information in systems other  than CHCS (such as the Clinical Information System and the  Integrated Clinical Database) is not yet being captured in the  Clinical Data Repository. In summary, developing an electronic interface that will enable VA  and DOD to exchange computable patient medical records is a  highly complex undertaking that could lead to substantial benefits— improving the quality of health care and disability claims processing  for the nation’s military members and veterans. VA and DOD have  made progress in the electronic sharing of patient health data in  their limited, near-term demonstration projects, and have taken an  important step toward their long-term goals by improving the  management of the CHDR program. I would be pleased to  respond to any questions that you or other members of the  Committee may have at this time.
Why GAO Did This Study

For the past 7 years, the Departments of Veterans Affairs (VA) and Defense (DOD) have been working to exchange patient health information electronically and ultimately to have interoperable electronic medical records. Sharing medical information helps (1) promote the seamless transition of active duty personnel to veteran status and (2) ensure that active duty military personnel and veterans receive high-quality health care and assistance in adjudicating their disability claims. This is especially critical in the face of current military responses to national and foreign crises. In testimony before the Veterans' Affairs Subcommittee on Oversight and Investigations in March and May 2004, GAO discussed the progress being made by the departments in this endeavor. In June 2004, at the Subcommittee's request, GAO reported on its review of the departments' progress toward the goal of an electronic two-way exchange of patient health records. GAO is providing an update on the departments' efforts, focusing on (1) the status of ongoing, near-term initiatives to exchange data between the agencies' existing systems and (2) progress in achieving the longer term goal of exchanging data between the departments' new systems.

What GAO Found

In the past year, VA and DOD have begun to implement applications that exchange limited electronic medical information between the departments' existing health information systems. These applications are (1) Bidirectional Health Information Exchange, a project to achieve the two-way exchange of health information on patients who receive care from both VA and DOD, and (2) Laboratory Data Sharing Interface, an application used to electronically transfer laboratory work orders and results between the departments. The Bidirectional Health Information Exchange application has been implemented at five sites, at which it is being used to rapidly exchange information such as pharmacy and allergy data. Also, the Laboratory Data Sharing Interface application has been implemented at six sites, at which it is being used for real-time entry of laboratory orders and retrieval of results. According to the departments, these systems enable lower costs and improved service to patients by saving time and avoiding errors. VA and DOD are continuing with activities to support their longer term goal of sharing health information between their systems, but the goal of two-way electronic exchange of patient records remains far from being realized. Each department is developing its own modern health information system--VA's HealtheVet VistA and DOD's Composite Health Care System II--and they have taken steps to respond to GAO's June 2004 recommendations regarding the program to develop an electronic interface that will enable these systems to share information. That is, they have developed an architecture for the interface, established project accountability, and implemented a joint project management structure. However, they have not yet developed a clearly defined project management plan to guide their efforts, as GAO previously recommended. Further, they have not yet fully populated the repositories that will store the data for their future health systems, and they have experienced delays in their efforts to begin a limited data exchange. Lacking a detailed project management plan increases the risk that the departments will encounter further delays and be unable to deliver the planned capabilities on time and at the cost expected.