Medical ADP Systems

Development problems with the Defense Department's (DOD) plan to automate medical records at hundreds of military facilities worldwide could be jeopardizing patient safety as a result of doctors providing improper care, such as prescriptions, lab work, or radiation therapy, on the basis of incomplete information. GAO concludes that the Composite Health Care System, which is intended to improve the quality of DOD health care by integrating data used to manage and treat patients, is not ready to be deployed. Two critical system development and operational problems remain unresolved--multiple patient records and archiving of patient records. Clinical users often face slow response times, and limited progress has been made in developing an efficient way to enter doctors' inpatient orders. In addition, the scope and quality of system testing have been inadequate, and test results are inconclusive. Until DOD corrects these deficiencies, operational problems will persist and patient well-being may be threatened. Cost estimates for the system now exceed the $1.6 billion congressional cost cap by $400 million. Given its importance to U.S. servicemen and women, the system must meet development requirements to establish its safety and effectiveness and to ascertain that it is the most reasonable alternative for delivering needed medical support.

GAO found that: (1) DOD wants to deploy the first phase of CHCS before addressing important capabilities involving the identification, elimination, and prevention of multiple patient records and record archival and retrieval; (2) those capabilities are critical to physician acceptance and use of CHCS and the system's ability to support clinicians' inpatient activities; (3) DOD has delayed the incorporation of inpatient order-entry capability until the second phase deployment scheduled for 1994, but faces a major developmental risk in its design and testing; (4) inadequacies in operational test and evaluation (OT&E) planning and implementation yielded inconclusive test results that may not be representative of the environment in which CHCS is to be deployed; (5) DOD is attempting to address 17 fundamental CHCS weaknesses identified in spite of the OT&E inadequacies; (6) CHCS life-cycle costs exceed the congressionally established $1.6-billion ceiling by more than $400 million; and (7) DOD has had difficulty in estimating and validating CHCS benefits, with five recent benefit studies estimating cost savings ranging between $1.7 billion and $3.8 billion. GAO believes that CHCS is not ready for deployment, since major deficiencies still exist in system capabilities and the scope and quality of testing have been inadequate.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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