	Background

Since 1998 VA and DOD have been trying to achieve the capability to share  patient health care data electronically. The Two-Way Exchange Could Benefit from Improved Planning and Project Management

While VA and DOD are making progress in agreeing to and adopting  standards for clinical data, they continue to face significant challenges in  providing a virtual medical record based on the two-way exchange of data  as part of their HealthePeople (Federal) initiative. VA and DOD lack an explicit architecture that provides details on what  specific technologies they will use to achieve the exchange capability, or  just what they will be able to exchange by the end of 2005—their projected  date for having this capability operational. However, the departments are currently operating without a project  management plan for HealthePeople (Federal) that describes the specific  responsibilities of each department in developing, testing, and deploying  the interface and addressing security requirements. These critical components are currently  lacking; thus, the departments risk investing in a capability that could fall  short of expectations. The continued absence of these components  elevates concerns about exactly what capabilities VA and DOD will  achieve—and when. Recommendations for Executive Action

To encourage significant progress on achieving the two-way exchange of  health information, we recommend that the Secretaries of Veterans Affairs  and Defense instruct the Acting Chief Information Officer for Health and  the Chief Information Officer for the Military Health System, respectively,  to    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 initiative;    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.
Why GAO Did This Study

A critical element of the Department of Veterans Affairs' (VA) information technology program is its continuing work with the Department of Defense (DOD) to achieve the ability to exchange patient health care information and create electronic medical records for use by veterans, active-duty military personnel, and their health care providers.

What GAO Found

While VA and DOD continue to move forward in agreeing to and adopting standards for clinical data, they have made little progress since last winter toward defining how they intend to achieve an electronic medical record based on the two-way exchange of patient health data. The departments continue to face significant challenges in achieving this capability. VA and DOD lack an explicit architecture--a blueprint--that provides details on what specific technologies will be used to achieve the electronic medical record by the end of 2005. The departments have not fully implemented a project management structure that establishes lead decision-making authority and ensures the necessary day-to-day guidance of and accountability for their investment in and implementation of this project. They are operating without a project management plan describing the specific responsibilities of each department in developing, testing, and deploying the electronic interface. In seeking to provide a two-way exchange of health information between their separate health information systems, VA and DOD have chosen a complex and challenging approach--one that necessitates the highest levels of project discipline. Yet critical project components are currently lacking. As such, the departments risk investing in a capability that could fall short of what is expected and what is needed. Until a clear approach and sound planning are made integral parts of this initiative, concerns about exactly what capabilities VA and DOD will achieve--and when--will remain.