Lacking A Defined Strategy, VA And DOD Have Made Limited Progress Toward A Common Health Information Exchange

VA’s and DOD’s ability to exchange data between their separate health  information systems is crucial to achieving the goals of HealthePeople  (Federal). VA officials stated that they recognize the  importance of a clearly defined architecture, but acknowledged that the  departments’ actions were continuing to be driven by the less-specific,  high-level strategy that has been in place since September 2002. Specifically, officials in both departments pointed to a project that they  are undertaking in response to requirements of the National Defense  Authorization Act for Fiscal Year 2003, which mandated that VA and DOD  develop a real-time interface, data exchange, and capability to check  prescription drug data for outpatients by October 1, 2004. By late February, VA had hired a supporting contractor to develop the  planned prototype, but the departments had not yet fully defined their  approach or requirements for developing and demonstrating its  capabilities. Thus,  given the early stage of the prototype and the uncertainties regarding what  capabilities it will demonstrate, there is little evidence and assurance as to  how or whether this project will contribute to defining the architecture  and technological solution for the two-way exchange of patient health  information. However, neither department has had the  authority to make final project decisions binding on the other, and there  has been a visible absence of day-to-day project oversight for the joint  initiative to develop an electronic interface between the departments’  planned information systems. Since November, both departments have delayed key milestones  associated with the development and deployment of their individual health  information systems. However, in seeking a virtual  medical record based on the two-way exchange of data between their  separate health information systems, VA and DOD have chosen an  approach that necessitates the highest levels of project discipline,  including a well-defined architecture for describing the interface for a  common health information exchange and an established project  management structure to guide the investment in and implementation of  this electronic capability. The HIPAA  privacy rule has a specific exception  authorizing one-way sharing of health  data at the time of a service member’s  separation.
Why GAO Did This Study

A critical component of the Department of Veterans Affairs' (VA) information technology program is its ongoing work with the Department of Defense (DOD) to achieve the ability to exchange patient health care data and create electronic records for use by veterans, active military personnel, and their health care providers. GAO testified before Congress last November that one-way sharing of data, from DOD to VA medical facilities, had been realized. At the Congress's request, GAO assessed, among other matters, VA's and DOD's progress since that time toward defining a detailed strategy for and developing the capability of a twoway exchange of patient health information.

What GAO Found

Since November, VA and DOD have made little progress in determining their approach for achieving the two-way exchange of patient health data. Department officials recognize the importance of an architecture to articulate how they will electronically interface their health systems, but continue to rely on a nonspecific, high-level strategy--in place since September 2002--to guide their development and implementation of this capability. VA officials stated that an initiative begun this month to satisfy a mandate of the Bob Stump National Defense Authorization Act for Fiscal Year 2003 will be used to better define the electronic interface needed to exchange patient health data. However, this project is at an early stage, and the departments have not yet fully identified the approach or requirements for this undertaking. Given these uncertainties, there is little evidence of how this project will contribute to defining a specific architecture and technological solution for achieving the two-way health data exchange. These uncertainties are further complicated by the absence of sound project management to guide the departments' actions. At present, neither department has the authority to make final decisions binding on the other, and day-to-day oversight of the joint initiative to develop an electronic interface is limited. Progress toward defining data standards continues, but delays have occurred in the development and deployment of the agencies' individual health information systems.