This  agreement also established FHIE as a joint activity that would allow  the exchange of health care information in two phases. The revised strategy also envisioned achieving a longer term, two- way exchange of health information between DOD and VA. The  joint effort is expected to result in the secured sharing of health data  required by VA’s and DOD’s health care providers between systems  that each department is currently developing—DOD’s Composite  Health Care System (CHCS) II and VA’s HealtheVet VistA. The record will be updated as the service member  receives medical care. Progress Toward Achieving HealthePeople (Federal) Faces Continued Challenges and Risks

As we have noted, achieving the longer term capability to exchange  health data in a secure, two-way electronic format between new  health information systems that VA and DOD are developing is a  challenging and complex undertaking, in which success depends on  having a clearly articulated architecture, or blueprint, defining how  specific technologies will be used to deliver the capability. Currently, VA and DOD are proceeding with the development of  their new health information systems and with the identification of  standards that are essential to sharing common health data. In addition, as we reported in March, the  departments have continued essential steps toward standardizing  clinical data, having adopted data and message standards that are  important for exchanging health information between disparate  systems. Although department officials consider the pharmacy data prototype  to be an initial step toward achieving HealthePeople (Federal), how  and to what extent the prototype will contribute to defining the  electronic interface for a two-way data exchange between VA’s and  DOD’s new health information systems are unclear. Yet VA and DOD have not developed a strategy  to articulate the integration approach, time frames, and resource  requirements associated with implementing the prototype results to  define the technological features of the two-way data exchange  capability under HealthePeople (Federal). The relationships among the management  entities involved with the initiative have not been clearly  established, and no one entity has authority to make final project  decisions binding on the other. Further, although the departments have designated a project  manager and established a project plan defining the work tasks and  management structure for the pharmacy prototype, they continue to  lack a comprehensive and coordinated project plan for  HealthePeople (Federal), to explain the technical and managerial  processes that have been instituted to satisfy project requirements  for this broader initiative. In discussing their management of HealthePeople  (Federal), VA and DOD program officials stated this week that the  departments had begun actions to develop a project plan and define  the management structure for this initiative. Given the significance of readily accessible health data for  improving the quality of health care and disability claims processing  for military members and veterans, we currently have a draft report  at the departments for comment, in which we are recommending to  the Secretaries of Veterans Affairs and Defense, a number of actions  for addressing the challenges to, and improving the likelihood of,  successfully achieving the electronic two-way exchange of patient  health information. In summary, VA’s and DOD’s pursuit of various initiatives to achieve  the electronic sharing of patient health data represents an important  step toward providing more high-quality health care for active duty  military personnel and veterans. However, the continued absence of an architecture and defined  technological solution for an electronic interface for their new  health information systems, coupled with the need for more  comprehensive and coordinated management of the projects  supporting the development of this capability, elevates the  uncertainty about how VA and DOD intend to achieve this capability  and in what time frame.
Why GAO Did This Study

Providing readily accessible health information on veterans and active duty military personnel is highly essential to ensuring that these individuals are given quality health care and assistance in adjudicating disability claims. Moreover, ready access to health information is consistent with the President's recently announced intention to provide electronic health records for most Americans within 10 years. In an attempt to improve the sharing of health information, the Departments of Veterans Affairs (VA) and Defense (DOD) have been working, since 1998, toward the ability to exchange electronic health records for use by veterans, military personnel, and their health care providers. In testimony before Congress last November and again this past March, GAO discussed the progress being made by the departments in this endeavor. While a measure of success has been achieved--the one-way transfer of health data from DOD to VA health care facilities--identifying the technical solution for a two-way exchange, as part of a longer term HealthePeople (Federal) initiative, has proven elusive. At Congress's request, GAO reported on its continuing review of the departments' progress toward this goal of an electronic two-way exchange of patient health records.

What GAO Found

VA and DOD are continuing with activities to support the sharing of health data; nonetheless, achieving the two-way electronic exchange of patient health information, as envisioned in the HealthePeople (Federal) strategy, remains far from being realized. Each department is proceeding with the development of its own health information system--VA's HealtheVet VistA and DOD's Composite Health Care System (CHCS) II; these are critical components for the eventual electronic data exchange capability. The departments are also proceeding with the essential task of defining data and message standards that are important for exchanging health information between their disparate systems. In addition, a pharmacy data prototype initiative begun this past March, which the departments stated is an initial step to defining the technology for the two-way data exchange, is ongoing. However, VA and DOD have not yet defined an architecture to guide the development of the electronic data exchange capability, and lack a strategy to explain how the pharmacy prototype will contribute toward determining the technical solution for achieving HealthePeople (Federal). As such, there continues to be no clear vision of how this capability will be achieved, and in what time period. Compounding the challenge faced by the departments is that they continue to lack a fully established project management structure for the HealthePeople (Federal) initiative. As a result, the relationships between the departments' managers is not clearly defined, a lead entity with final decision-making authority has not been designated, and a coordinated, comprehensive project plan that articulates the joint initiative's resource requirements, time frames, and respective roles and responsibilities of each department has not yet been established. In discussing the need for these components, VA and DOD program officials stated this week that the departments had begun actions to develop a project plan and define the management structure for HealthePeople (Federal). In the absence of such components, the progress that VA and DOD have achieved is at risk of compromise, as is assurance that the ultimate goal of a common, exchangeable two-way health record will be reached. Given the importance of readily accessible health data for improving the quality of health care and disability claims processing for military members and veterans, we currently have a draft report at the departments for comment, in which we are making recommendations to the Secretaries of Veterans Affairs and Defense for addressing the challenges to, and improving the likelihood of successfully achieving the electronic two-way exchange of patient health information.