VA and DOD Are Required by Law to Establish an Interagency Program Office and Achieve Full Interoperability

As previously noted, the National Defense Authorization Act for  Fiscal Year 2008 called for VA and DOD to jointly develop and  implement fully interoperable electronic health record systems or  capabilities by September 30, 2009, and established an interagency  program office to be accountable for the departments’ efforts in this  regard. The departments have been working to set up this office  since April 2008. However, more work is needed to solidify its leadership and  management capabilities if the office is to effectively function as a  single point of accountability for achieving interoperable electronic  health data. In particular, the departments have completed personnel  descriptions and recruited and hired staff for government positions  and obtained necessary contractor staff to perform the office’s  functions. Nonetheless, VA and DOD continue to fill the office’s key leadership  positions—that of director and deputy director—on an interim  basis. For example, it submitted its first  annual report to Congress that summarized the departments’ efforts  toward achieving full interoperability and the status of key activities  completed to set up the office. Further, the interagency  program office charter identified the development of metrics to  monitor the departments’ performance against interoperability  objectives as a responsibility of the office. In this regard, 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—expand questionnaires and self  assessment tools, expand Essentris in DOD, and demonstrate initial  document scanning—the departments have partially achieved  planned capabilities, with additional work needed to fully meet  clinicians’ needs. In conclusion, VA and DOD have continued to increase electronic  health information interoperability, and have taken steps to meet  the six objectives that they identified as necessary to achieve full  interoperability by September 30, 2009. To better improve the management of VA’s and DOD’s efforts to  achieve fully interoperable electronic health record systems, our  draft report recommends that the Secretaries of Defense and  Veterans Affairs emphasize the interagency program office’s  establishment of a project plan and a complete and detailed  integrated master schedule.
Why GAO Did This Study

For over a decade, the Department of Veterans Affairs (VA) and the Department of Defense (DOD) have been working on initiatives to share electronic health information. To expedite their efforts, Congress mandated in the National Defense Authorization Act for Fiscal Year 2008 that VA and DOD establish a joint interagency program office to act as a single point of accountability in the development of electronic health records systems or capabilities that allow for full interoperability (generally, the ability of systems to exchange data) by September 30, 2009. In this statement, GAO summarizes findings from its upcoming report, focusing on progress in setting up the interagency program office and the departments' actions to achieve fully interoperable capabilities by September 30, 2009. To do so, GAO analyzed agency documentation on project status and conducted interviews with agency officials.

What GAO Found

VA and DOD have made progress in setting up the interagency program office; however, the office is not yet effectively positioned to be accountable for the departments' efforts to achieve fully interoperable electronic health record systems or capabilities. The departments have taken the important steps of completing personnel descriptions and hiring necessary staff to perform the office's functions, but key leadership positions (for the Director and Deputy Director) continue to be filled on an interim basis. In addition, the office has established a charter and begun to demonstrate responsibilities outlined within this document. Nonetheless, the office is not yet fulfilling key information technology management responsibilities in the areas of performance measurement, project planning, and scheduling--all of which are essential to establishing the office as a single point of accountability for the departments' interoperability efforts. VA and DOD continue to take steps toward achieving full interoperability by the September deadline. In this regard, the departments have achieved planned capabilities for three of six interoperability objectives (see table) that they identified to meet their data sharing needs--refine social history data, share physical exam data, and demonstrate initial network gateway operation. For the remaining three objectives--expand questionnaires and self assessment tools, expand DOD inpatient medical records system, and demonstrate initial document scanning--the departments have partially achieved planned capabilities, with additional work needed to fully meet clinicians' needs for health information.