GAO’s Recent Report Highlighted DOD’s and VA’s Efforts to Share Health Information and Identified the Need to Set Up the Program Office and Finalize the Implementation Plan

In reporting on the departments’ progress toward developing fully  interoperable electronic health records in July 2008, we highlighted  several findings:    DOD and VA had established and implemented mechanisms to achieve  sharing of electronic health information at different levels of  interoperability. Also, the departments  recently expanded the number of standards and specifications with which  they expect their interoperability initiatives will comply. For example, between June  and October 2008, the departments increased the number of shared  patients for which computable outpatient pharmacy and drug allergy data  were being exchanged through the CHDR initiative by about 2,700 (from  about 18,300 to over 21,000). In addition, DOD  has reported progress toward certification of its health IT system in  adhering to applicable standards. DOD and VA have also reported progress relative to two plans that contain  objectives, initiatives, and activities related to further increasing health  information sharing. However, only 3 of the 39 activities in the Joint Strategic Plan were  described in results-oriented (i.e., objective, quantifiable, and measurable)  terms that are characteristic of effective planning and can be used as a  basis to track and measure progress toward the delivery of new  interoperable capabilities. Steps Have Been Taken to Set Up the DOD/VA Interagency Program Office, but It Is Not Positioned to Function as a Single Point of Accountability

The National Defense Authorization Act for Fiscal Year 2008 called for the  establishment of an interagency program office and for the office to be  accountable for implementing electronic health record systems or capabilities  that allow for full interoperability of personal health care information  between DOD and VA. Since we last reported, the departments have  continued taking steps to set up the program office, although they have not  yet fully executed their plan for doing so. As a result, the office is not yet in a  position to be accountable for accelerating the departments’ efforts to  achieve interoperability by the September 30, 2009 deadline. Consistent  with the plan, the departments have taken steps, such as developing  descriptions for key positions, including those of the Director and Deputy  Director. Also, since we reported in July 2008, the departments developed  the program office organization structure document that depicts the  program office’s organization. In January 2009, the  departments approved a program office charter to describe, among other  things, the mission and function of the office. Our July 2008 report recommended that the departments give priority to  establishing the program office by establishing permanent leadership and  hiring staff. To evaluate DOD and VA plans toward developing electronic health record  systems or capabilities, we obtained information from agency  documentation and interviews with cognizant DOD and VA officials  pertaining to the November 2007 VA/DOD Joint Executive Council  Strategic Plan for Fiscal Years 2008-2010, and the September 2008 DOD/VA  Information Interoperability Plan (Version 1.0) which together constitute  the departments’ overall plans for achieving full interoperability of  electronic health information. Further, we analyzed objectives  and activities from their plans to determine if DOD and VA had established  results-oriented performance measures that enable the departments to  assess progress toward achieving increased sharing capabilities and  functionality of their electronic health information systems. To determine whether the interagency program office is fully operational  and positioned to function as a single point of accountability for  developing and implementing electronic health records, we analyzed DOD  and VA documentation, including the schedule for setting up the office  identified in the DOD/VA Information Interoperability Plan.
Why GAO Did This Study

Under the National Defense Authorization Act for Fiscal Year 2008, the Department of Defense (DOD) and the Department of Veterans Affairs (VA) are required to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for interoperability (generally, the ability of systems to exchange data) and that are compliant with federal standards. The Act also established a joint interagency program office to function as a single point of accountability for the effort, which is to implement such systems or capabilities by September 30, 2009. Further, the Act required that GAO semi-annually report on the progress made in achieving these goals. For this second report, GAO evaluates the departments' progress and plans toward sharing electronic health information that comply with federal standards, and whether the interagency program office is positioned to function as a single point of accountability. To do so, GAO reviewed its past work, analyzed agency documentation, and conducted interviews.

What GAO Found

DOD and VA continue to increase health information sharing through ongoing initiatives and related activities. Specifically, the departments' are now exchanging pharmacy and drug allergy data on over 21,000 shared patients, an increase of about 2,700 patients between June and October 2008. Further, they recently expanded the number of standards and specifications with which they expect their interoperability initiatives will comply. In addition, DOD reported that it received certification of its electronic health record system. Also, the departments have defined their plans to further increase their sharing of electronic health information. In particular, they have identified the Joint Executive Council Strategic Plan and the DOD/VA Information Interoperability Plan as the key documents defining their planned efforts to provide interoperable health records. These plans identify various objectives and activities that, according to the departments, are aimed at increasing health information sharing and achieving full interoperability, as required by the National Defense Authorization Act for Fiscal Year 2008. However, neither plan identifies results-oriented (i.e., objective, quantifiable, and measurable) performance goals and measures that are characteristic of effective planning and can be used as a basis to track and assess progress toward the delivery of new interoperable capabilities. In the absence of results-oriented goals and performance measures, the departments are not positioned to adequately assess progress toward increasing interoperability. Instead, DOD and VA are limited to assessing progress in terms of activities completed and increases in data exchanged (e.g., the number of patients for which certain types of data are exchanged). The departments have continued to take steps to set up the interagency program office. For example, they have developed descriptions for key positions and agreed with GAO's July 2008 recommendation that they give priority to establishing permanent leadership and hiring staff. Also, the departments developed the program office organization structure document that depicts the office's organization and, in January 2009, the departments approved a program office charter to describe, among other things, the mission and function of the office. Nonetheless, DOD and VA have not yet fully executed their plan to set up the program office. For example, among other activities, they have not yet filled key positions for the Director and Deputy Director, or 22 of 30 other positions identified for the office. In the continued absence of a fully established program office, the departments will remain ineffectively positioned to assure that interoperable electronic health records and capabilities are achieved by the required date.