The act also called for the departments to set up  the Interagency Program Office to be a single point of accountability for  their efforts to implement these systems or capabilities by the September  30, 2009, deadline. The Interagency Program Office Has Not Functioned as the Single Point of Accountability for VA and DOD’s Efforts to Increase Electronic Health Record Interoperability

The Interagency Program Office has been involved in the various  approaches taken by VA and DOD to increase health information  interoperability and modernize their respective electronic health record  systems. These approaches have included development of the Virtual  Lifetime Electronic Record (VLER) and a new, common integrated  electronic health record (iEHR) system. Both departments  agreed with this recommendation. Thus, we  recommended that the departments develop results-oriented performance  goals and measures to be used as the basis for reporting interoperability  progress. Thus, we  recommended that the departments improve the management of their  interoperability efforts by developing a project plan and a complete and  detailed integrated master schedule. VA and DOD stated that they agreed  with this recommendation. In our January 2010 final report in response to the National Defense  Authorization Act for Fiscal Year 2008, we noted that VA and DOD  officials believed they had satisfied the act’s September 30, 2009,  requirement for full interoperability by meeting specific interoperability- related objectives that the departments had established. The Interagency Program Office Was to Be the Single Point of Accountability for Establishing a Lifetime Electronic Record for Servicemembers and Veterans, but VA and DOD Did Not Develop Complete Plans for the Effort

Although the Interagency Program Office charter named the office as the  single point of accountability for the initiative, the office did not have key  plans to define and guide the effort. In our February 2011 report on the departments’ efforts to address their  common health IT needs, we noted that, among other things, the  Interagency Program Office had not developed an approved integrated  master schedule, master program plan, or performance metrics for the  VLER initiative, as outlined in the office’s charter. To oversee  this new effort, in October 2011, VA and DOD re-chartered the  Interagency Program Office to give it increased authority, expanded  responsibilities, and increased staffing levels for leading the integrated  system effort. However, in February 2013, the  Secretaries of VA and DOD announced that they would not continue with  their joint development of a single electronic health record system. In February 2014, we reported on the departments’ decision to abandon  their plans for iEHR. Further, we recommended that VA  and DOD better position the office to function as the single point of  accountability for achieving interoperability between the departments’  electronic health record systems by ensuring that the office has authority  (1) over dedicated resources (e.g., budget and staff), (2) to develop  interagency processes, and (3) to make decisions over the departments’  interoperability efforts. The Interagency Program Office Subsequently Took Steps to Improve Interoperability Measurement and Additional Actions Are Planned

In light of the departments’ not having implemented a solution that  allowed for seamless electronic sharing of medical health care data, the  National Defense Authorization Act for Fiscal Year 2014 included  requirements pertaining to the implementation, design, and planning for  interoperability between VA and DOD’s separate electronic health record  systems. Further, a joint  governance structure between VA and DOD has been proposed that  would be expected to leverage existing joint governance facilitated by the  Interagency Program Office. Accordingly, the officials have not  yet indicated what role, if any, the Interagency Program Office is to have  in the governance process. In particular, what role, if any, that the office is to have in  VA’s acquisition of the same electronic health record system that DOD is  currently acquiring is uncertain. Recommendation for Executive Action

We are making the following recommendation to VA:  The Secretary of Veterans Affairs should ensure that the role and  responsibilities of the Interagency Program Office are clearly defined  within the governance plans for acquisition of the department’s new  electronic health record system.
Why GAO Did This Study

The National Defense Authorization Act for Fiscal Year 2008 included provisions that VA and DOD jointly develop and implement electronic health record systems or capabilities and accelerate the exchange of health care information. The act also required that these systems be compliant with applicable interoperability standards. Further, the act established a joint Interagency Program Office to act as a single point of accountability for the efforts, with the function of implementing, by September 30, 2009, electronic health record systems that allow for full interoperability.
This testimony discusses GAO's previously reported findings on the establishment and evolution of the Interagency Program Office over the last decade. In developing this testimony, GAO summarized findings from its reports issued in 2008 through 2018, and information on the departments' actions in response to GAO's recommendations.

What GAO Found

Since its establishment in 2008, the Department of Defense (DOD) and Department of Veterans Affairs (VA) Interagency Program Office has been involved in various approaches to increase health information interoperability. However, the office has not been effectively positioned to function as the single point of accountability for the departments' electronic health record system interoperability efforts. For example,
Between July 2008 and January 2010, GAO issued reports on VA's and DOD's efforts to set up the office, which highlighted steps the departments had taken, but also identified deficiencies, such as vacant leadership positions and a lack of necessary plans. GAO recommended that the departments improve management of their interoperability efforts by developing a project plan and results-oriented performance goals and measures.
In April 2009, the Interagency Program Office was assigned responsibility for establishing a lifetime electronic record for servicemembers and veterans, called the Virtual Lifetime Electronic Record. GAO reported in February 2011 that, among other things, the office had not developed and approved an integrated master schedule, a master program plan, or performance metrics for the initiative, as outlined in the office's charter. Accordingly, GAO recommended that the departments correct these deficiencies to strengthen their efforts to establish the Virtual Lifetime Electronic Record.
In March 2011, VA and DOD committed to jointly developing a new, common integrated electronic health record system and empowered the Interagency Program Office with increased authority, expanded responsibilities, and increased staffing levels for leading the integrated system effort. However, in February 2013, the departments abandoned their plan to develop the integrated system and stated that they would again pursue separate modernization efforts. In February 2014, GAO reported on this decision and recommended that VA and DOD take steps to better position the office to function as the single point of accountability for achieving interoperability between the departments' electronic health record systems.
VA and DOD stated that they agreed with the above GAO recommendations. However, in several cases the departments' subsequent actions were incomplete and did not fully address all recommendations.
In June 2017 VA announced that it planned to acquire the same electronic health record system that DOD has been acquiring. GAO testified in June 2018 that a governance structure had been proposed that would be expected to leverage existing joint governance facilitated by the Interagency Program Office. At that time, VA's program officials had stated that the department's governance plans for the new program were expected to be finalized in October 2018. However, the officials have not yet indicated what role, if any, the Interagency Program Office is to have in the governance process. Ensuring that the role and responsibilities of the office are clearly defined within these governance plans is essential to VA successfully acquiring and implementing the same system as DOD.

What GAO Recommends

GAO recommends that VA clearly define the role and responsibilities of the Interagency Program Office in the governance plans for acquisition of the department's new electronic health record syst