In this regard, DOD and VA have initiated work focused  on near-term objectives including standardizing their existing health data  and making them viewable by both departments’ clinicians in an  integrated format. Further, the IPO has issued guidance outlining the technical  approach for achieving interoperable capabilities between the  departments’ systems. Even with the actions taken, however, the two  departments did not, by the October 2014 deadline established in the  fiscal year 2014 NDAA 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. DOD, VA, and the IPO have Taken Actions to Achieve Interoperability

As part of the approach toward achieving interoperability between their  electronic health record systems, both DOD and VA, along with the IPO,  have taken actions focused on near-term objectives including  standardizing data and expanding the functionality and availability of  patient health information. VA officials stated that the  department plans to certify that it has met the requirement later in  calendar year 2015. For example,  among these metrics, the Health Data Interoperability Management Plan  calls for tracking the percentage of data domains within the departments’  current health information systems that are mapped to selected national  standards. While the IPO has developed process metrics and begun reporting the  departments’ progress related to standardizing and exchanging health  data, the office has not specified outcome-oriented metrics and  established goals that are important to gauging the impact that increased  interoperability has on improving health care services. Conclusions

DOD and VA, with guidance from the IPO, have taken actions to increase  interoperability between their electronic health record systems, as called  for in the fiscal year 2014 NDAA. To address the  2016 requirement, DOD has issued plans and announced the award of a  contract for acquiring a modernized system to include interoperability  capabilities across military operations. VA, for its part, has issued plans  describing an incremental approach to modernizing its existing electronic  health records system. While IPO officials have said that a team has been tasked to  identify metrics that would be more meaningful for determining the impact  of increased interoperability, no time frame has been identified for when  this team will report its results and when the IPO plans to incorporate  these metrics into its guidance. Without  defining outcome-oriented metrics and related goals and incorporating  these into the current approach, the departments and the IPO will not be  positioned to assess and report on the status of interoperability-related  activities and determine areas that need improvement. Recommendations for Executive Action

To facilitate oversight and inform decision making regarding their  respective department’s interoperability-related activities, we recommend  that the Secretaries of Defense and Veterans Affairs, working with the  Interagency Program Office, take the following three actions: establish a time frame for identifying outcome-oriented metrics, ensure related goals are defined to provide a basis for assessing and  reporting on the status of interoperability-related activities and the  extent to which interoperability is being achieved by the departments’  modernized electronic health record systems, and update IPO guidance to reflect the metrics and goals identified. For  example, the department contended that its limited initial deployment of  the new system, combined with the pending documentation of  interoperability, will satisfy the statutory requirement to “deploy  modernized electronic health record software supporting clinicians of the  departments by no later than December 31, 2016, while ensuring  continued support and compatibility with the interoperability platform and  full standards-based interoperability.” We disagree with DOD’s position  and reaffirm our finding that DOD’s and VA’s plans—if implemented as  currently described—indicate that deployment of the new systems will not  be completed across the departments until after 2016 and that much  additional work is needed to extend access to the modernized software to  all relevant users and department locations. To evaluate the actions taken with regard to planning for electronic health  record interoperability between the departments’ systems, we reviewed  our previous work related to electronic health records and DOD and VA  efforts to develop health information systems, interoperable health  records, and interoperability standards to be implemented in federal  health care programs.
Why GAO Did This Study

DOD and VA operate two of the nation's largest health care systems, serving approximately 16 million veterans and active duty service members and their beneficiaries, at a cost of more than $100 billion a year. For almost two decades, the departments have been engaged in various efforts to advance DOD and VA electronic health record interoperability. Among their most recent efforts, the DOD and VA Secretaries have committed the departments to achieving interoperability between their separate electronic health record systems.
The Consolidated Appropriations Act , 2014, and accompanying Joint Explanatory Statement, included a provision for GAO to review the departments' efforts. GAO evaluated the actions taken by DOD, VA, and the IPO to plan for and measure the progress toward achieving interoperability between the departments' electronic health record systems. GAO reviewed relevant program documents and interviewed agency officials.

What GAO Found

The Departments of Defense (DOD) and Veterans Affairs (VA), with guidance from the Interagency Program Office (IPO) that is tasked with facilitating the departments' efforts to share health information, have taken actions to increase interoperability between their electronic health record systems. Among other things, DOD and VA have initiated work focused on near-term objectives, including standardizing their existing health data and making them viewable by both departments' clinicians in an integrated format. The departments also have developed longer-term plans to modernize their respective electronic health record systems. For its part, the IPO has issued guidance outlining the technical approach for achieving interoperability between the departments' systems.
Even with the actions taken, DOD and VA did not, by the October 1, 2014, deadline established in the National Defense Authorization Act (NDAA) for Fiscal Year 2014 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. Both departments stated that they intend to do so later in calendar year 2015. Further, the departments' system modernization plans identify a number of key activities to be implemented beyond December 31, 2016—the deadline established in the NDAA for the two departments to deploy modernized electronic health record software to support clinicians while ensuring full standards-based interoperability. Specifically, DOD has issued plans and announced the contract award for acquiring a modernized system to include interoperability capabilities across military operations. In addition, VA has issued plans describing an incremental approach to modernizing its existing electronic health records system. These plans—if implemented as currently described—indicate that deployment of the new systems with interoperability capabilities will not be completed across the departments until after 2018.
The IPO has taken steps to develop process metrics intended to monitor progress related to the data standardization and exchange of health information consistent with its responsibilities. For example, it has issued guidance that calls for tracking metrics, such as the percentage of data domains within the departments' current health information systems that are mapped to national standards. However, the office has not yet specified outcome-oriented metrics and established related goals that are important to gauging the impact that interoperability capabilities have on improving health care services for shared patients. IPO officials said this work is ongoing and that a team is working with DOD, VA, and subject matter experts to identify metrics that would provide more meaningful measures of the impact of increased interoperability. However, the IPO has not identified a time frame for when this team will report its results and when the IPO plans to incorporate these metrics and goals into its guidance. Without ensuring that outcome-oriented metrics and related goals are defined and incorporated into the current approach, the departments and the IPO will not be positioned to assess and report on the status of interoperability-related activities and determine areas that need improvement.

What GAO Recommends

GAO recommends that DOD and VA, working with the IPO, establish a time frame for identifying outcome-oriented metrics; define related goals to provide a basis for assessing and reporting on the status of interoperability; and update IPO guidance to reflect the metrics and goals identified. DOD and VA concurred with GAO's recommendations.