Veterans Affairs

On October 16, 2003, GAO testified before Congress at a hearing on whether DOD and VA are providing seamless health care coverage to transitioning veterans. This letter responds to a request thst we provide answers to follow-up questions from the hearing.

VA and DOD have been pursuing ways to share data in their health information systems and create electronic records since 1998, when the Government Computer-Based Patient Record (GCPR) project was initiated. GCPR was envisioned as an electronic interface that would allow physicians and other authorized users at VA, DOD, and Indian Health Service (IHS) health facilities to access data from any of the other agencies' health facilities. Since undertaking this mission, however, VA and DOD have faced considerable challenges, leading to repeated changes in the focus of their initiative and the target dates for its accomplishment. The near-term initiative--the Federal Health Information Exchange--was completed in July 2002 and enabled the one-way transfer of data from DOD's existing health care information system to a separate database that VA hospitals could access. This initiative has shown success in allowing clinicians in VA medical centers ready access to information--such as laboratory, pharmacy, and radiology records--on almost 2 million patients. However, the departments' strategy for an envisioned longer-term, two-way exchange of clinical information is farther out on the horizon. This initiative, 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. VA and DOD anticipated achieving a limited capability for two-way data exchange by the end of 2005. Nonetheless, VA and DOD continue to face significant challenges in realizing this longerterm capability. In addition, critical to the two-way exchange will be completing the standardization of the clinical data that these departments plan to share. Achieving the technical capability to unify VA's and DOD's patient care records in and of itself will not ensure the seamless transition of health care data. Other issues that the departments need to address include (1) reaching consensus on and implementing data standards, (2) capturing complete and accurate medical information on service members, and (3) ensuring privacy and security compliance.