In March 2011, the secretaries of the two departments announced that  they would develop a new, joint integrated electronic health record  system (referred to as iEHR). However, as of October 2015, the departments have not  provided us with a comparison of the estimated costs of their current and  previous approaches. On the other hand, with respect to their assertions  that separate systems could be achieved faster, both departments have  developed schedules that indicate their separate modernizations are not  expected to be completed until after the 2017 planned completion date for  the previous single system approach. In light of the departments’ not having yet implemented a solution that  allows for seamless electronic sharing of health care data, the National  Defense Authorization Act (NDAA) for Fiscal Year 2014 included  requirements pertaining to the implementation, design, and planning for  interoperability between VA’s and DOD’s electronic health record  systems. Interoperability Efforts Continue, but DOD and VA Need to Develop Goals and Metrics for Assessing Their Progress

Our August 2015 report noted that the departments have engaged in  several near-term efforts focused on expanding interoperability between  their existing electronic health record systems. In addition, VA and DOD have both moved forward with plans to  modernize their respective electronic health record systems. The IPO has also taken actions to facilitate departmental interoperability  efforts. While these are important steps toward greater interoperability, VA and  DOD nonetheless did not, by the October 1, 2014, deadline established  by the 2014 National Defense Authorization Act for compliance with  national data standards, certify that all health care data in their systems  complied with national standards and were computable in real time. Additionally, the departments acknowledged that they do not expect to  complete a number of key activities related to their electronic health  record system efforts until sometime after the December 31, 2016,  statutory deadline for deploying modernized electronic health record  software with interoperability. The IPO is responsible for monitoring and reporting on the departments’  progress in achieving interoperability and coordinating with VA and DOD  to ensure that these efforts enhance health care services. Toward this  end, the office issued guidance that identified a variety of process- oriented metrics to track, for example, the percentage of data domains  that have been mapped to national standards. Nevertheless, as we reported in August 2015, the IPO had yet to specify  outcome-oriented metrics and goals that would gauge the impact  interoperable health record capabilities will have on the departments’  health care services. However, the IPO had not established a time-frame for  completing such metrics and incorporating them into the office’s  guidance. Accordingly, we recommended that the departments,  working with the IPO, establish a time frame for identifying outcome- oriented metrics, define related goals as a basis for determining the  extent to which the departments’ modernized electronic health records  systems are achieving interoperability, and update IPO guidance  accordingly. Both departments concurred with our recommendations. Yet while the departments’ various initiatives  over the years have increased the amount of patient health data  exchanged by the departments and made accessible to providers, these  efforts have been beset by persistent management challenges and  uncertainty about the extent to which fully interoperable capabilities will  be achieved and when. As we stressed in our report, establishing measurable goals  for improving the care that VA and DOD provide to the millions of service  members, veterans, and their beneficiaries is essential to more effectively  position the departments to do so.
Why GAO Did This Study

VA and DOD operate two of the nation's largest health care systems, serving millions of veterans and active duty members and their beneficiaries. For almost two decades the departments have undertaken various efforts to advance interoperability between their respective electronic health record systems. While the departments have made progress, these initiatives have also faced significant management challenges. Among their recent initiatives, the secretaries of the two departments committed to establishing interoperability between their separate electronic health record systems, which they are working to modernize.
This statement summarizes GAO's August 2015 report (GAO-15-530) on VA and DOD's efforts to achieve interoperability between their health records systems.

What GAO Found

As GAO reported in August 2015, the Departments of Veterans Affairs (VA) and Defense (DOD), with guidance from the Interagency Program Office (IPO) tasked with facilitating the departments' efforts to share health information, have taken actions to increase interoperability between their existing electronic health record systems. These actions have included work on near-term objectives such as standardizing certain health data and making them viewable by clinicians in both departments in an integrated format. The departments also developed plans for their longer-term initiatives to modernize their respective electronic health record systems. In accordance with its responsibilities, the IPO issued guidance outlining the technical approach for achieving interoperability between the departments' systems.
Having taken these actions, however, the departments did not, by the October 1, 2014, deadline established in the National Defense Authorization Act (NDAA) for Fiscal Year 2014 for compliance with national standards, certify that all health care data in their systems complied with national data standards and were computable in real time. Moreover, the departments do not plan to complete the modernization of their electronic health record systems until well after the December 2016 statutory deadline by which they are to deploy modernized electronic health record software while ensuring full interoperability. Specifically, VA plans to modernize its existing system, while DOD plans to acquire a new system; but their plans indicate that deployment of the new systems with interoperable capabilities will not be complete until after 2018.
Consistent with its responsibilities, the IPO took steps to begin developing metrics to monitor progress related to the standardization of the departments' data and their exchange of health information. For example, it called for the development of tracking metrics to gauge the percentage of data domains within the departments' current systems that have been mapped to national standards. However, the office had not defined outcome-oriented metrics and related goals to measure the effectiveness of interoperability efforts in terms of improving health care services for patients served by both departments. IPO officials said that work was ongoing to develop more meaningful measures of progress, but the office had not established a time frame for completing this work or incorporating the outcome metrics and associated goals into its guidance. GAO concluded that without defining outcome-oriented metrics and related goals and incorporating them into their current approach, the departments and the IPO will not be in a position to effectively assess their progress toward further achieving interoperability and identifying the benefits that their efforts yield.

What GAO Recommends

In its August 2015 report, GAO recommended that VA and DOD, working with the IPO, establish a time frame for identifying outcome-oriented metrics, define goals to provide a basis for assessing and reporting on the status of interoperability, and update the IPO's guidance accordingly. The departments concurred with GAO's recommendations.