Computer-Based Patient Records
Short-Term Progress Made, but Much Work Remains to Achieve a Two-Way Data Exchange Between VA and DOD Health Systems Gao ID: GAO-04-271T November 19, 2003For the past 5 years, the Departments of Veterans Affairs and Defense have been working to exchange health care data and create electronic records for veterans and active duty personnel. Such exchange is seen as a means of reducing the billions of dollars that the departments spend annually on health care services and making such data more readily accessible to those treating our country's approximately 13 million veterans, military personnel, and dependents. This is especially critical when military personnel are engaged in conflicts all over the world, and their health records can reside at multiple locations. GAO has reported on these efforts several times, most recently in September 2002. At the request of the Subcommittee, GAO is updating its observations on the departments' efforts, focusing on (1) the reported status of the ongoing, one-way exchange of data, the Federal Health Information Exchange, and (2) progress toward achieving the longer term two-way exchange under the HealthePeople (Federal) initiative.
Access to medical data that includes information on the entire lives of veterans and active duty military personnel represents an enormous step toward enhanced and more effective medical care. VA and DOD are pursuing this goal in two stages. Federal Health Information Exchange: This current, one-way transfer of health care data from DOD to VA is already allowing clinicians in VA medical centers to make faster, more informed decisions through ready access to information on almost 2 million patients, thereby improving their level of health care delivery. The program's fiscal year 2003 cost was just over $11 million. HealthePeople (Federal): The realization of this longer term strategy to enable electronic, two-way information sharing is farther out on the horizon. The departments are proceeding with projects that are expected to result in a limited two-way exchange of health data by the end of 2005. However, VA and DOD face significant challenges in implementing a full data exchange capability. Although a high-level strategy exists, the departments have not yet clearly articulated a common health information infrastructure and architecture to show how they intend to achieve the data exchange capability or what they will be able to exchange by the end of 2005. In addition, critical to achieving the twoway exchange will be completing the standardization of the clinical data that these departments plan to share. Without standardization, the task of sharing meaningful data could be more complex and may not prove successful.
GAO-04-271T, Computer-Based Patient Records: Short-Term Progress Made, but Much Work Remains to Achieve a Two-Way Data Exchange Between VA and DOD Health Systems
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Testimony:
Before the Subcommittee on Oversight and Investigations, Committee on
Veterans' Affairs, House of Representatives:
United States General Accounting Office:
GAO:
For Release on Delivery Expected at 10:30 a.m. EST:
Wednesday, November 19, 2003:
Computer-Based Patient Records:
Short-Term Progress Made, but Much Work Remains to Achieve a Two-Way
Data Exchange Between VA and DOD Health Systems:
Statement of Linda D. Koontz, Director Information Management Issues:
GAO-04-271T:
GAO Highlights:
Highlights of GAO-04-271T, a report to the Subcommittee on Oversight
and Investigations, House Committee on Veterans' Affairs
Why GAO Did This Study:
For the past 5 years, the Departments of Veterans Affairs and Defense
have been working to exchange health care data and create electronic
records for veterans and active duty personnel. Such exchange is seen
as a means of reducing the billions of dollars that the departments
spend annually on health care services and making such data more
readily accessible to those treating our country‘s approximately 13
million veterans, military personnel, and dependents. This is
especially critical when military personnel are engaged in conflicts
all over the world, and their health records can reside at multiple
locations.
GAO has reported on these efforts several times, most recently in
September 2002. At the request of the Subcommittee, GAO is updating
its observations on the departments‘ efforts, focusing on (1) the
reported status of the ongoing, one-way exchange of data, the Federal
Health Information Exchange, and (2) progress toward achieving the
longer term two-way exchange under the HealthePeople (Federal)
initiative.
What GAO Found:
Access to medical data that includes information on the entire lives
of veterans and active duty military personnel represents an enormous
step toward enhanced and more effective medical care. VA and DOD are
pursuing this goal in two stages.
* Federal Health Information Exchange. This current, one-way transfer
of health care data from DOD to VA is already allowing clinicians in
VA medical centers to make faster, more informed decisions through
ready access to information on almost 2 million patients, thereby
improving their level of health care delivery. The program‘s fiscal
year 2003 cost was just over $11 million.
* HealthePeople (Federal). The realization of this longer term
strategy to enable electronic, two-way information sharing is farther
out on the horizon. The departments are proceeding with projects that
are expected to result in a limited two-way exchange of health data by
the end of 2005. However, VA and DOD face significant challenges in
implementing a full data exchange capability. Although a high-level
strategy exists, the departments have not yet clearly articulated a
common health information infrastructure and architecture to show how
they intend to achieve the data exchange capability or what they will
be able to exchange by the end of 2005. In addition, critical to
achieving the two-way exchange will be completing the standardization
of the clinical data that these departments plan to share. Without
standardization, the task of sharing meaningful data could be more
complex and may not prove successful.
www.gao.gov/cgi-bin/getrpt?GAO-04-271T.
To view the full product, including the scope and methodology, click
on the link above. For more information, contact Linda D. Koontz at
(202) 512-6240 or koontzl@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting us to testify on actions of the Department of
Veterans Affairs (VA) and the Department of Defense (DOD) to achieve
the ability to exchange patient health care data and create an
electronic record for veterans and active duty personnel. VA and DOD,
collectively, provided health care services to approximately 13 million
veterans, military personnel, and dependents at a cost of about $47
billion in fiscal year 2002. While in military status and later as
veterans, many patients tend to be highly mobile and, consequently,
their health records may be at multiple federal and nonfederal medical
facilities, both in and outside of the United States. Thus, having
readily accessible data on active duty personnel and veterans is
important to facilitate providing quality health care to them.
VA and DOD have been pursuing ways to share data in their health
information systems and create electronic records since 1998, their
actions following the President's call for the development of an
interface to allow the two departments to share patient health
information.[Footnote 1] Since undertaking this mission, however, the
departments have faced considerable challenges, leading to repeated
changes in the focus of their initiative and the target dates for its
accomplishment. Our prior reports supporting the initiative[Footnote 2]
noted disappointing progress, exacerbated in large part by inadequate
accountability and poor planning and oversight, which raised doubts
about the departments' ability to achieve an electronic interface among
their health information systems. When we last reported on the
initiative in September 2002,[Footnote 3] VA and DOD had taken some
actions aimed at strengthening their joint efforts. For example, they
had clarified key roles and responsibilities for the initiative and
begun executing revised near-and long-term strategies for achieving the
electronic information exchange capability.
My statement today will discuss our observations regarding VA's and
DOD's continued actions over the past year to further their
implementation of the electronic information exchange, including an
update on (1) the status and reported benefits of the ongoing near-term
initiative, the Federal Health Information Exchange (FHIE), and (2) the
departments' progress and challenges in achieving the longer term, two-
way exchange of data under the HealthePeople (Federal) initiative.
In conducting this work, we obtained and reviewed relevant
documentation and interviewed key agency officials regarding VA's
decisions and actions, in conjunction with DOD, to develop an
electronic medical record for exchanging patient information. We
analyzed the departments' plans and strategies for the HealthePeople
(Federal) initiative and data on patient information that is currently
being transmitted by DOD to VA. In addition, to observe data retrieval
capabilities of the Federal Health Information Exchange, we conducted a
site visit at the VA medical center in Washington, D.C. We performed
our work in accordance with generally accepted government auditing
standards, from March through November 2003.
Results in Brief:
The current one-way transfer of health information resulting from the
departments' near-term solution--the Federal Health Information
Exchange--represents a positive undertaking that has begun enabling
information sharing between DOD and VA. As part of the initiative,
electronic health data from separated (retired or discharged) service
members contained in DOD's Military Health System Composite Health Care
System are being transmitted monthly to a VA FHIE repository,[Footnote
4] which VA clinicians access through the department's current health
system, the Veterans Health Information Systems and Technology
Architecture. As a result, VA clinicians now have more readily
accessible DOD health data, such as laboratory, pharmacy, and radiology
records, on almost 2 million patients and have noted the benefits of
this current capability in improving health care delivery. Further,
although not originally included in the FHIE plan, VA officials have
stated that efforts are underway to provide access to outpatient and
retail pharmacy data.
Realizing the departments' longer term strategy--HealthePeople
(Federal)--is farther out on the horizon. VA officials have stated that
the departments are on schedule to provide a limited capability for an
electronic, two-way exchange of patient health information by the end
of 2005. However, VA and DOD face significant challenges in
implementing a full data exchange capability. Although a high-level
strategy exists, the departments have not yet clearly articulated a
common health information infrastructure and architecture to show how
they intend to achieve the data exchange capability or what exactly
they will be able to exchange by the end of 2005. In addition, critical
to achieving the two-way exchange will be completing the
standardization of the clinical data that these departments plan to
share. Without standardization, the task of sharing meaningful data is
made more complex, and may not prove successful. Until these essential
issues are resolved, the departments cannot be assured that the
HealthePeople (Federal) initiative will deliver expected benefits
within established time frames.
Background:
In 1998, VA and DOD, along with the Indian Health Service (IHS), began
the Government Computer-Based Patient Record (GCPR) project--an
initiative to share patient health care data. At that time, each agency
collected and maintained patient health information in separate
systems, and their health facilities could not electronically share
patient health information across agency lines. GCPR was envisioned as
an electronic interface that would allow physicians and other
authorized users at VA, DOD, and IHS health facilities to access data
from any of the other agencies' health facilities. The interface was
expected to compile requested patient information in a "virtual" record
that could be displayed on a user's computer screen.
In reporting on the initiative in April 2001,[Footnote 5] we raised
doubts about GCPR's ability to provide expected benefits. We noted that
the project was experiencing schedule and cost overruns and was
operating without clear goals, objectives, and consistent leadership.
We recommended that the participating agencies (1) designate a lead
entity with final decision-making authority and establish a clear line
of authority for the GCPR project, and (2) create comprehensive and
coordinated plans that included an agreed-upon mission and clear goals,
objectives, and performance measures, to ensure that the agencies could
share comprehensive, meaningful, accurate, and secure patient health
care data. VA, DOD, and IHS agreed with our findings and
recommendations.
In March 2002, however, we again reported that the project was
continuing to operate without clear lines of authority or a lead entity
responsible for final decision-making.[Footnote 6] Further, the project
continued to move forward without comprehensive and coordinated plans,
including an agreed-upon mission and clear goals, objectives, and
performance measures. In addition, the participating agencies had
announced a revised strategy that was considerably less encompassing
than the project was originally intended to be. For example, rather
than serve as an interface to allow data sharing across the three
agencies' disparate systems, as originally envisioned, the revised
strategy initially called only for a one-way transfer of data from
DOD's current health care information system to a separate database
that VA hospitals could access. In further reporting on this initiative
in June 2002, we recommended that VA, DOD, and IHS revise the original
goals and objectives of the project to align with their current
strategy, commit the executive support necessary to adequately manage
the project, and ensure that it followed sound project management
principles.[Footnote 7]
When we last testified on the initiative in September 2002,[Footnote 8]
VA had reported some progress toward achieving shared patient health
care data and the two departments had formally revised both the name
and the strategy for the initiative. Specifically, the two departments
had renamed the project the Federal Health Information Exchange (FHIE)
Program. In addition, consistent with our prior recommendation, they
had finalized a memorandum of agreement designating VA as the lead
entity in implementing FHIE.
With this agreement, FHIE became a joint effort between VA and DOD to
achieve the exchange of health care information in two phases. The
first phase, completed in mid-July 2002, enabled the one-way transfer
of data from DOD's existing health care information system to a
separate database that VA hospitals could access.
Further, the revised strategy envisioned VA and DOD pursuing a longer
term, two-way exchange of clinical information.[Footnote 9] This
initiative, known as HealthePeople (Federal), is premised upon the
departments' development of a common health information infrastructure
and architecture comprising standardized data, communications,
security, and high-performance health information systems. The
departments developed the strategy for achieving the two-way exchange
in September 2002 and anticipated achieving a limited capability by the
end of 2005.
VA AND DOD Continue to Report Success in Implementing the Feeral Health
Information Exchange Near-Term Solution:
Over the past year, VA and DOD have continued to realize success in the
implementation and use of FHIE. In achieving the exchange of health
care information, electronic data from separated (retired or
discharged) service members contained in DOD's Military Health System
Composite Health Care System (CHCS) are being transmitted monthly to a
VA FHIE repository, which VA clinicians access through the Computerized
Patient Record System (CPRS) in the Veterans Health Information Systems
and Technology Architecture (VistA), VA's current health care system.
This information exchange capability is currently available to all VA
medical centers and has given VA clinicians the ability to access and
display the data through CPRS remote data views[Footnote 10] about 6
weeks after the service member's separation. VA and DOD reported
spending about $11 million in fiscal year 2003 to cover completion and
maintenance of FHIE.
According to program officials, FHIE is showing positive results by
providing a wide range of health care information to enable clinicians
to make faster and more informed decisions regarding the care of
veterans. The officials stated that the repository presently contains
data on almost 2 million patients. This includes clinical data on
almost 1.8 million personnel who separated from the military between
1987 and June 2003. The data consist of over 23 million laboratory
records, 24 million pharmacy records, and over 4 million radiology
records. A second phase of the FHIE initiative, completed in September
2003, added to the base of health information available to VA
clinicians by including discharge summaries;[Footnote 11] allergy
information; admissions, disposition, and transfer information; and
consultation results. A clinician at VA's Washington, D.C. medical
center noted that the information provided through FHIE has proved
particularly valuable for treating emergency-room and first-time
patients by providing ready access to information on patients' existing
medical conditions and current drug prescriptions.
The program manager added that FHIE is providing ready access to health
information. It is currently capable of accommodating up to 800 queries
per hour, with an average response rate of 4 seconds per query. For the
month of September 2003, VA clinicians made over 1,900 authorized
queries to the database. Further, as we observed during an FHIE
demonstration at the medical center, the capability has resulted in an
almost instantaneous display of DOD patient data in the same format as
other data residing in CPRS, thus facilitating its use.
Although nearing completion, VA officials indicated, additional patient
information from DOD will be added to the FHIE database. For example,
they stated that efforts are currently under way to add, by the end of
December, outpatient pharmacy data (such as mail order and retail
pharmacy profiles) that are housed in DOD's Pharmacy Data Transaction
Service, and by the end of February 2004, other outpatient records.
Actions Toward a Common Health Information Infrastructure Are
Progressing, but Significant Challenges Remain:
Beyond FHIE, VA and DOD are proceeding with a joint, long-term strategy
involving the two-way exchange of clinical information. Under this
strategy, VA and DOD plan to seek opportunities for sharing existing
systems and technology and explore the convergence of VA and DOD health
information applications consistent with mission requirements.
According to the Veterans Health Administration's Acting Deputy Chief
Information Officer (CIO) for Health, and the Military Health System's
CIO, this joint VA/DOD initiative is expected to allow the secured
sharing of health data required by their health care providers between
systems that each is currently developing--DOD's Composite Health Care
System II (CHCS II) and VA's HealtheVet VistA. Critical to achieving
this capability is an interface to allow the exchange of patient health
information between each system's data repository.
Under the HealthePeople (Federal) strategy, upon entering military
service, a health record for the service member will be created and
stored in DOD's CHCS II clinical data repository. The record will
remain in the clinical data repository and be updated as the service
member receives medical care. When the individual separates from active
duty and, if eligible, seeks medical care at a VA facility, VA will
then create a medical record for the individual, which will be stored
in its health data repository. Upon viewing the medical record, the VA
clinician would be alerted and provided access to clinical information
on the individual also residing in DOD's repository. In the same
manner, when a veteran seeks medical care at a military treatment
facility, the attending DOD clinician would be alerted and provided
access to the clinical information existing in VA's repository.
According to VA and DOD, the planned approach would make virtual
medical records displaying all available clinical information from the
two repositories accessible to both departments' clinicians.
VA and DOD Are Making Progress, but Full Implementation of Joint
Strategy Is Years Away:
VA's and DOD's joint strategy for accomplishing the two-way exchange of
health information, developed in September 2002, depends on
successfully implementing and achieving an electronic interface between
individual health information systems that each department is currently
developing. These systems development efforts began as separate,
department-specific initiatives in which VA aimed to enhance its
existing health information system utilizing modern tools and
languages, and DOD aimed to replace several of its health information
systems to achieve cost efficiencies and a computer-based patient
record. Work on modernizing VA's new system, HealtheVet (VistA), began
in 2001, and development of DOD's new system, CHCS II, began in 1997.
Since establishing the strategy, VA and DOD have made some progress on
systems development efforts that will support achieving health data
exchange. Currently, VA and DOD are in different stages of completing
their systems. As shown in table 1, VA began work on one of the key
initiatives intended to support HealthePeople (Federal)--the health
data repository--in June 2001; it is currently testing the design of
this database. VA plans to complete the repository by July 2006; it
projects completing all six initiatives comprising HealtheVet (VistA)
over the next 9 years, with a final module on scheduling replacement
expected in May 2012.
Table 1: HealtheVet (VistA) Initiatives:
HealtheVet Initiative: Health Data Repository (HDR); Purpose: Establish
a repository of clinical information normally residing on one or more
independent platforms; Initiative Start Date: June 2001; Projected
Completion Date: 2006.
HealtheVet Initiative: Billing Replacement; Purpose: Obtain a modern,
high-performance billing system that will support an increase to third-
party payments; Initiative Start Date: April 2002; Projected Completion
Date: 2006.
HealtheVet Initiative: Laboratory; Purpose: Clinically oriented system
designed to provide data to health care personnel; Initiative Start
Date: February 2003; Projected Completion Date: 2007.
HealtheVet Initiative: Pharmacy; Purpose: Facilitate improved VA
pharmacy operations, customer service, and patient safety, concurrent
with the pursuit of full reengineering of VA pharmacy applications;
Initiative Start Date: April 2002; Projected Completion Date: 2008.
HealtheVet Initiative: Imaging; Purpose: Provide complete online data
to healthcare providers, to increase clinician productivity, facilitate
medical decision-making, and improve quality of care; Initiative Start
Date: October 2002; Projected Completion Date: 2011.
HealtheVet Initiative: Appointment Scheduling Replacement; Purpose:
Provide VistA users with a redesigned scheduling capability to better
meet the needs of VHA facility staff and patients; Initiative Start
Date: May 2001; Projected Completion Date: 2012.
Source: VA:
[End of table]
As table 2 reflects, DOD is incrementally deploying CHCS II in five
blocks, with each block providing additional capabilities to its
system. The department is currently proceeding with limited deployment
of its graphical user interface for clinical outpatient processes. In
addition, DOD has completed its clinical data repository, and a
department official stated that as each site implements CHCS II, data
in CHCS will be converted to the new system. DOD expects to complete
deployment of all of its major system capabilities by September 2008.
Table 2: CHCS II Deployment Information:
Block Number: 1 (release 1); Major Capabilities: Adds a graphical user
interface for clinical outpatient processes; Status: Limited deployment
underway; Projected Completion Date: September 2005.
Block Number: 2 (release 2); Major Capabilities: Support for general
dentistry; Status: Deployment to Operation, Test & Evaluation sites
during the 2nd Qtr of FY04; Projected Completion Date: September 2005.
Block Number: 3 (releases 3&4); Major Capabilities: Provides pharmacy,
laboratory, radiology, and immunizations capabilities; Status: Plan
under way to award a contract for Block 3 in 2nd Qtr FY 04 and begin
requirements analysis by 4th Qtr FY04; Projected Completion Date:
September 2006.
Block Number: 4 (releases 5&6); Major Capabilities: Provides inpatient
and scheduling capabilities; Status: Begin requirements development and
analysis in 2nd Qtr FY 04; Projected Completion Date: September 2007.
Block Number: 5 (release 7); Major Capabilities: Additional
Capabilities as Defined; Status: Begin requirements development and
analysis in early 1st Qtr FY05; Projected Completion Date: September
2008.
Source: DOD.
[End of table]
Although VA and DOD officials do not expect their departments' systems
to be fully implemented until 2012 and 2008, respectively, they
anticipate being able to exchange some degree of clinical information
through an interface between DOD's clinical data repository and VA's
planned health data repository by the end of calendar year 2005. VA
officials explained that by that time, they expect to have developed
the HealtheVet (VistA) health data repository to a point at which it
will have limited data. However, the departments have not yet
articulated exactly what data will be available.
Also critical, VA and DOD have begun adopting data standards. Data
standardization is essential to allowing the exchange of health
information from disparate systems and improving decision-making by
providing health information when and where it is needed. In accordance
with the Consolidated Health Informatics Initiative,[Footnote 12] in
March 2003, VA and DOD, along with the Department of Health and Human
Services, announced the adoption of four standards to allow the
transmission of messages and one standard that allows laboratory
results to be presented uniformly in any system. In addition, VA
officials stated that the departments have examined and concluded that
their existing legislation and policies meet the intent of the Health
Insurance Portability and Accountability Act.
VA and DOD Face Challenges in Moving Toward HealthePeople (Federal):
VA and DOD face key challenges to completing HealthePeople (Federal)
that raise doubts as to when and to what extent a true virtual health
record will be achieved. Although a high-level strategy exists, the
HealthePeople (Federal) joint work group faces the challenge of clearly
articulating a common health information infrastructure and
architecture to show how they intend to achieve the data exchange
capability, or just what they will be able to exchange by the end of
2005. Such an architecture is necessary for ensuring that the
departments have defined a level of detail and specificity needed to
build the data repository interface, including interface requirements
and design specifications. For example, having detailed specifications
would assist VA in making critical decisions such as the manner in
which it will store its electronic data. According to VA officials,
they have not yet determined whether one central or several regional
data repositories would best facilitate access to the patient
information and achieve the timely response rates required by
clinicians at its medical facilities.
Another critical challenge to successfully implementing HealthePeople
(Federal) will be completing the standardization of the data elements
of each department's health records. While standards for laboratory
results were adopted in 2003, VA and DOD face a significant undertaking
to standardize the remaining health data. To lend perspective to the
enormity of this task, according to the joint strategy that VA and DOD
have developed, VA will have to migrate over 150 variations of clinical
and demographic data to one standard, and DOD will have to migrate over
100 variations of clinical data to one standard. VA officials have
indicated that as various HealtheVet (VistA) applications are
developed, they plan to incorporate clinical data standards. Further,
they and DOD officials maintain that their departments, along with the
Department of Health and Human Services, are actively pursuing the
development and adoption of such data standards. Nonetheless, they
remain uncertain as to what degree of standardization (beyond the
laboratory result standard that has been adopted) will be achieved by
the 2005 milestone for implementing the two-way exchange of health
information.
In summary, in pursuing an electronic exchange of patient health
information, VA and DOD are taking a vital step toward facilitating
services to our nation's active duty personnel and veterans. The
ability to readily access medical records covering the lifecycle of
service members and veterans would enhance the effectiveness of care to
these individuals. In working toward this capability, VA and DOD have
achieved a measure of success in sharing data, as evidenced by VA
clinicians now having access to military health records for veterans
through FHIE. However, a virtual medical record based on the two-way
exchange of data between VA and DOD is far from being achieved. The
departments face significant challenges in realizing this longer term
strategy. Without having clearly articulated a common health
information infrastructure and architecture, the departments lack the
details and specificity essential to determining how they will achieve
the data exchange capability.
Mr. Chairman, this concludes my statement. I would be pleased to
respond to any questions that you or other members of the Subcommittee
may have at this time.
Contacts and Acknowledgments:
For information regarding this testimony, please contact Linda D.
Koontz, Director, or Valerie Melvin, Assistant Director, Information
Management Issues, at (202) 512-6240 or at koontzl@gao.gov or
melvinv@gao.gov, respectively. Other individuals making key
contributions to this testimony include Barbara S. Oliver, Eric L.
Trout, Michael P. Fruitman, and J. Michael Resser.
FOOTNOTES
[1] In 1996, the Presidential Advisory Committee on Gulf War Veterans'
Illnesses reported on many deficiencies in VA's and DOD's data
capabilities for handling service members' health information. In
November 1997, the President called for the two agencies to start
developing a "comprehensive, life-long medical record for each service
member," and in 1998 issued a directive requiring VA and DOD to develop
a "computer-based patient record system that will accurately and
efficiently exchange information."
[2] U.S. General Accounting Office, Computer-Based Patient Records:
Better Planning and Oversight by VA, DOD, and IHS [Indian Health
Service] Would Enhance Health Data Sharing, GAO-01-459 (Washington,
D.C.: Apr. 30, 2001); VA Information Technology: Progress Made, but
Continued Management Attention Is Key to Achieving Results, GAO-02-369T
(Washington, D.C.: Mar. 13, 2002); and VA Information Technology:
Management Making Important Progress in Addressing Key Challenges
GAO-02-1054T (Washington, D.C.: Sept. 26, 2002).
[3] GAO-02-1054T.
[4] A repository is an information system used to store and access
data.
[5] GAO-01-459.
[6] GAO-02-369T.
[7] U.S. General Accounting Office, Veterans Affairs: Sustained
Management Attention Is Key to Achieving Information Technology
Results, GAO-02-703 (Washington, D.C.: June 12, 2002).
[8] GAO-02-1054T.
[9] IHS, which had been a part of the early efforts, was not included
in FHIE, but was expected to assume a role in the longer term project-
-HealthePeople (Federal).
[10] CPRS remote data views is an application that allows authorized
users to access patient health care data from any VA medical facility.
[11] Discharge summaries will include inpatient histories, diagnoses,
and procedures.
[12] The Consolidated Health Informatics Initiative, created under the
President's Management Agenda, identified a portfolio of 24 target
areas for data and messaging standards that would enable all agencies
in the federal health enterprise to more readily exchange clinical
health information.
