Computer-Based Patient Records
Sound Planning and Project Management Are Needed to Achieve a Two-Way Exchange of VA and DOD Health Data Gao ID: GAO-04-402T March 17, 2004A critical component of the Department of Veterans Affairs' (VA) information technology program is its ongoing work with the Department of Defense (DOD) to achieve the ability to exchange patient health care data and create electronic records for use by veterans, active military personnel, and their health care providers. GAO testified before Congress last November that one-way sharing of data, from DOD to VA medical facilities, had been realized. At the Congress's request, GAO assessed, among other matters, VA's and DOD's progress since that time toward defining a detailed strategy for and developing the capability of a twoway exchange of patient health information.
Since November, VA and DOD have made little progress in determining their approach for achieving the two-way exchange of patient health data. Department officials recognize the importance of an architecture to articulate how they will electronically interface their health systems, but continue to rely on a nonspecific, high-level strategy--in place since September 2002--to guide their development and implementation of this capability. VA officials stated that an initiative begun this month to satisfy a mandate of the Bob Stump National Defense Authorization Act for Fiscal Year 2003 will be used to better define the electronic interface needed to exchange patient health data. However, this project is at an early stage, and the departments have not yet fully identified the approach or requirements for this undertaking. Given these uncertainties, there is little evidence of how this project will contribute to defining a specific architecture and technological solution for achieving the two-way health data exchange. These uncertainties are further complicated by the absence of sound project management to guide the departments' actions. At present, neither department has the authority to make final decisions binding on the other, and day-to-day oversight of the joint initiative to develop an electronic interface is limited. Progress toward defining data standards continues, but delays have occurred in the development and deployment of the agencies' individual health information systems.
GAO-04-402T, Computer-Based Patient Records: Sound Planning and Project Management Are Needed to Achieve a Two-Way Exchange of VA and DOD Health Data
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United States General Accounting Office:
GAO:
Testimony before the Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs, House of Representatives:
For Release on Delivery:
Expected at 10:00 a.m. EST Wednesday, March 17, 2004:
COMPUTER-BASED PATIENT RECORDS:
Sound Planning and Project Management Are Needed to Achieve a Two-Way
Exchange of VA and DOD Health Data:
Statement of Linda D. Koontz:
Director, Information Management Issues:
GAO-04-402T:
GAO Highlights:
Highlights of GAO-04-402T, testimony before the Subcommittee on
Oversight and Investigations, House Committee on Veterans' Affairs:
Why GAO Did This Study:
A critical component of the Department of Veterans Affairs' (VA)
information technology program is its ongoing work with the Department
of Defense (DOD) to achieve the ability to exchange patient health care
data and create electronic records for use by veterans, active military
personnel, and their health care providers.
GAO testified before the Subcommittee last November that one-way
sharing of data, from DOD to VA medical facilities, had been realized.
At the Subcommittee's request, GAO assessed, among other matters, VA's
and DOD's progress since that time toward defining a detailed strategy
for and developing the capability of a two-way exchange of patient
health information.
What GAO Found:
Since November, VA and DOD have made little progress in determining
their approach for achieving the two-way exchange of patient health
data. Department officials recognize the importance of an architecture
to articulate how they will electronically interface their health
systems, but continue to rely on a nonspecific, high-level strategy--in
place since September 2002--to guide their development and
implementation of this capability (see figure).
High-Level Strategy Intended To Allow Two-Way Exchange of Health Data:
[See PDF for image]
Source: VA and DOD:
[End of figure]
VA officials stated that an initiative begun this month to satisfy a
mandate of the Bob Stump National Defense Authorization Act for Fiscal
Year 2003 will be used to better define the electronic interface needed
to exchange patient health data. However, this project is at an early
stage, and the departments have not yet fully identified the approach
or requirements for this undertaking. Given these uncertainties, there
is little evidence of how this project will contribute to defining a
specific architecture and technological solution for achieving the two-
way health data exchange.
These uncertainties are further complicated by the absence of sound
project management to guide the departments' actions. At present,
neither department has the authority to make final decisions binding on
the other, and day-to-day oversight of the joint initiative to develop
an electronic interface is limited. Progress toward defining data
standards continues, but delays have occurred in the development and
deployment of the agencies' individual health information systems.
www.gao.gov/cgi-bin/getrpt?GAO-04-402T.
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:
I am pleased to be here today to participate in continuing discussions
of the Department of Veterans Affairs' (VA) information technology
program. My testimony focuses on a critical aspect of that program--
VA's work with the Department of Defense (DOD) to achieve the ability
to exchange patient health care data and create an electronic medical
record for veterans and active duty military personnel. As you are well
aware, having readily accessible medical data on these individuals--
many of whom are highly mobile and may have health records at multiple
medical facilities within and outside of the United States--is
important to providing high-quality health care to them and to
adjudicating any disability claims that they may have. VA and DOD have
been pursuing ways to share data in their health information systems
and create electronic records since 1998, yet accomplishing a two-way
health data exchange has been elusive.
When we testified on this initiative last November,[Footnote 1] VA and
DOD had achieved a measure of success in sharing data through the one-
way transfer of health information from DOD to VA health care
facilities.[Footnote 2] Yet VA and DOD faced significant challenges and
were far from realizing a longer term objective: providing a virtual
medical record based on the two-way exchange of data, as part of their
HealthePeople (Federal) initiative. The departments had not clearly
articulated a common health information architecture, and lacked the
details and specificity essential to determining how they would achieve
this capability.
At your request, my testimony will discuss our review of VA's and DOD's
actions since November toward defining a detailed strategy and
developing the capability for a two-way exchange of patient health
information. In addition, I will provide an update on actions that the
departments have taken to address recommendations resulting from prior
reviews of their efforts to share medical data,[Footnote 3] including
those articulated in the May 2003 report of the President's task force
on the development of electronic medical records.[Footnote 4]
In conducting this work, we analyzed key documentation supporting VA's
and DOD's strategy for developing and implementing the two-way
electronic exchange of health data, including deployment and conversion
plans, project schedules, and status reports for their individual
health information systems. In addition, we reviewed documentation to
identify the costs incurred by VA and DOD in developing technology to
support the sharing of health data, including costs associated with the
government computer-based patient record and federal health information
exchange initiatives, and with VA's and DOD's ongoing projects to
develop new health information systems. We supplemented our analyses
with interviews of VA and DOD officials responsible for key decisions
and actions on the initiatives. Further, we analyzed documentation and
interviewed relevant VA and DOD officials to determine actions that
have been taken to address our previous recommendations related to the
government computer-based patient record initiative and those contained
in the President's task force report. We did not verify the
departments' reported actions in response to the President's task force
recommendations. We performed our work in accordance with generally
accepted government auditing standards, from December 2003 through
March of this year.
RESULTS IN BRIEF:
Since November, VA and DOD have made little progress toward defining
how they intend to achieve the two-way exchange of patient health data
under the HealthePeople (Federal) initiative. Although VA officials
recognize the importance of having an architecture to describe in
detail how they plan to develop an electronic interface between their
health information systems, they acknowledged that the departments'
actions are continuing to be driven by a less-specific, high-level
strategy that has been in place since September 2002. VA and DOD
officials stated that they intend to rely on an initiative being
undertaken this month to satisfy a mandate of the Bob Stump National
Defense Authorization Act for Fiscal Year 2003[Footnote 5] to better
define the electronic interface needed to exchange patient health
information. However, this project is at an early stage, and the
departments have not yet fully determined the approach or requirements
for this undertaking. Given these uncertainties, there is little
evidence as to whether and how this project will contribute to defining
an explicit architecture and technological solution for achieving the
two-way exchange of patient health information.
Adding to the challenge and uncertainties of developing the electronic
interface is that VA and DOD have not fully established a project
management structure to ensure the necessary day-to-day guidance of and
accountability for the departments' investment in and implementation of
this capability. Although maintaining that they are collaborating on
this initiative through a joint working group and receiving oversight
from executive-level councils, neither department has had the authority
to make final project decisions binding on the other. Further, the
departments are operating without a project management plan describing
the specific responsibilities of VA and DOD in developing, testing, and
deploying the interface. In the absence of an explicit architecture and
critical project management, VA and DOD are progressing slowly in their
development of this important technology. The departments have
continued to define data standards that are essential to facilitating
the exchange of data, but have experienced delays in key milestones
associated with the development and deployment of their individual
health information systems. Such delays call into question the
departments' ability to meet their target date for beginning to
exchange patient health information in 2005.
Both the President's task force and we have made multiple
recommendations aimed at improving VA's and DOD's success in
undertaking projects intended to achieve the electronic exchange of
patient health records. For example, the task force recommended
developing and deploying, by fiscal year 2005, electronic medical
records that are interoperable, bidirectional, and standards-based. The
departments reported that they are currently in various stages of
acting on the specific recommendations that the task force made for
providing timely, high-quality care through effective electronic
sharing of health information. Beyond this, we previously recommended
that, among other actions, VA and DOD designate a lead entity with
final decisionmaking authority and establish a clear line of authority
for the earlier, near-term government computer-based patient record
project. In line with our recommendations, VA and DOD made overall
management and accountability enhancements that could provide lessons
learned for improving the departments' approach to successfully
accomplishing the longer term initiative to develop a two-way health
information exchange.
BACKGROUND:
In 1998 VA and DOD, along with the Indian Health Service (IHS), began
an initiative to share patient health care data, called the government
computer-based patient record (GCPR) project. 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 6] 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 decisionmaking 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 decisionmaking.[Footnote 7] Further, the project
continued to move forward without comprehensive and coordinated plans
and an agreed-upon mission and clear goals and 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 8]
In September 2002 we reported that VA and DOD had made some progress
toward electronically sharing patient health data.[Footnote 9] The two
departments had renamed the project the Federal Health Information
Exchange (FHIE) program and, consistent with our prior recommendation,
had finalized a memorandum of agreement designating VA as the lead
entity for implementing the program. 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
information system to a separate database that VA hospitals could
access. A second phase, finalized earlier this month, completed VA's
and DOD's efforts to add to the base of patient health information
available to VA clinicians via this one-way sharing capability. VA and
DOD reported total FHIE costs of about $85 million through fiscal year
2003.
The revised strategy also envisioned VA and DOD pursuing a longer term,
two-way exchange of health information. This initiative, known as
HealthePeople (Federal), is premised upon the departments' development
of a common health information architecture comprising standardized
data, communications, security, and high-performance health
information systems. The joint effort is expected to result in the
secured sharing of health data required by VA's and DOD's health care
providers between systems that each department is currently developing-
-DOD's Composite Health Care System II (CHCS II) and VA's HealtheVet
VistA.
DOD began developing CHCS II in 1997 and has completed its associated
clinical data repository that is key to achieving an electronic
interface. DOD expects to complete deployment of all of its major
system capabilities by September 2008.[Footnote 10] The department
reported expenditures of about $464 million for the system through
fiscal year 2003. VA began work on HealtheVet VistA and its associated
health data repository in 2001, and expects to complete all six
initiatives that make up this system in 2012.[Footnote 11] VA reported
spending about $120 million on HealtheVet VistA through fiscal year
2003.
Under the HealthePeople (Federal) strategy, VA and DOD envision that,
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 with access to the health information existing in
VA's repository. According to VA and DOD, the planned approach would
make virtual medical records displaying all available patient health
information from the two repositories accessible to both departments'
clinicians. VA officials have stated that they anticipate being able to
exchange some degree of health information through an interface of
their health data repository with DOD's clinical data repository by the
end of calendar year 2005.
LACKING A DEFINED STRATEGY, VA AND DOD HAVE MADE LIMITED PROGRESS
TOWARD A COMMON HEALTH INFORMATION EXCHANGE:
VA's and DOD's ability to exchange data between their separate health
information systems is crucial to achieving the goals of HealthePeople
(Federal). Yet successfully sharing patient health information via a
secure electronic interface between each of their data repositories can
be complex and challenging, and depends on their having a clearly
articulated architecture, or blueprint, defining how specific
technologies will be used to achieve the interface. Developing,
maintaining, and using an architecture is a best practice in
engineering information systems and other technological solutions. An
architecture would articulate, for example, the system requirements and
design specifications, database descriptions, and software
descriptions that define the manner in which the departments will
electronically store, update, and transmit their data.
Equally critical is an established project management structure to
guide project development. Industry best practices and information
technology project management principles[Footnote 12] stress the
importance of accountability and sound planning for any project,
particularly an interagency effort of the magnitude and complexity of
this one. Inherent in such planning is the development and use of a
project management plan that describes, among other factors, the
project's scope, implementation strategy, lines of responsibility,
security requirements, resources, and estimated schedule for
development and implementation.
As was the situation when we testified last November, VA and DOD
continue to lack an explicit architecture detailing how they intend to
achieve the data exchange capability, or just what they will be able to
exchange by the end of 2005--their projected time frame for putting
this capability into operation. VA officials stated that they recognize
the importance of a clearly defined architecture, but acknowledged that
the departments' actions were continuing to be driven by the less-
specific, high-level strategy that has been in place since September
2002.
The officials added that just this month, the departments had taken a
first step toward trying to determine how their separate data
repositories would interface to enable the two-way exchange of patient
health records. Specifically, officials in both departments pointed to
a project that they are undertaking in response to requirements of the
National Defense Authorization Act for Fiscal Year 2003, which mandated
that VA and DOD develop a real-time interface, data exchange, and
capability to check prescription drug data for outpatients by October
1, 2004.[Footnote 13] VA's Deputy Chief Information Officer for Health
stated that they hope to determine from a prototype planned for
completion by next September whether the interface technology developed
to meet this mandate can be used to facilitate the exchange of data
between the health information systems that they are currently
developing.
By late February, VA had hired a supporting contractor to develop the
planned prototype, but the departments had not yet fully defined their
approach or requirements for developing and demonstrating its
capabilities. DOD officials stated that the departments would rely on
the contractor to more fully define the technical requirements for the
prototype. Further, according to VA officials, since the departments'
new health information systems that are intended to be used under
HealthePeople (Federal) have not yet been completed, the demonstration
may only test the ability to exchange data in VA's and DOD's existing
health systems--the Veterans Information Systems and Technology
Architecture and the Composite Health Care System, respectively. Thus,
given the early stage of the prototype and the uncertainties regarding
what capabilities it will demonstrate, there is little evidence and
assurance as to how or whether this project will contribute to defining
the architecture and technological solution for the two-way exchange of
patient health information.
Further compounding the challenges and uncertainty that VA and DOD face
is the lack of a fully established project management structure to
ensure the necessary day-to-day guidance of and accountability for the
departments' investments in and implementation of the electronic
interface between their systems. Officials in both departments maintain
that they are collaborating on this initiative through a joint working
group and with oversight provided by the Joint Executive Council and
VA/DOD Health Executive Council.[Footnote 14] However, neither
department has had the authority to make final project decisions
binding on the other, and there has been a visible absence of
day-to-day project oversight for the joint initiative to develop an
electronic interface between the departments' planned information
systems. Further, VA and DOD are operating without a project management
plan describing the overall development and implementation of the
interface, including the specific roles and responsibilities of each
department in developing, testing, and deploying the interface and
addressing security requirements. In discussing these matters last
week, VA officials stated that the departments had recently designated
a program manager for the planned prototype. Further, VA and DOD
officials added that they had begun discussions to establish an overall
project plan and finalize roles and responsibilities for managing the
joint initiative to develop an electronic interface. Until these
essential project management elements are fully established, VA and DOD
will lack assurance that they can successfully develop and implement an
electronic interface and the associated capability for exchanging
health information within the time frames that they have established.
Progress Toward Achieving a Two-Way Data Exchange Has Been Limited:
In the absence of an architecture and project management structure for
the initiative, VA and DOD have continued to make only limited progress
toward developing the technological solution essential to interfacing
their patient health information. To their credit, the departments have
continued essential steps toward standardizing clinical data--
important for exchanging health information between disparate systems.
The Institute of Medicine's Committee on Data Standards for Patient
Safety has reported the lack of common data standards as a key factor
preventing information sharing within the health care industry. Over
the past 4 months, VA and DOD have agreed to adopt additional data
standards[Footnote 15] for uniformly presenting in any system data
related to demographics, immunizations, medications, names of
laboratory tests ordered, and laboratory result contents.
Nonetheless, as reflected in figure 1, the technology needed to achieve
a two-way exchange of patient health information remains far from
complete, with only DOD's data repository having been fully developed.
Figure 1: VA/DOD High-level Strategy for the Two-Way Exchange of Health
Data:
[See PDF for image]
Source: VA and DOD:
[End of figure]
Since November, both departments have delayed key milestones associated
with the development and deployment of their individual health
information systems. VA program officials told us that completion of a
prototype for the department's health data repository has been delayed
approximately a year, until the end of this June. The officials
explained that earlier testing of the prototype had slowed clinicians'
use of the clinical applications, necessitating a revised approach to
populating the repository. In addition, while DOD officials previously
stated that the department planned to complete the deployment of its
first release of CHCS II functionality (a capability for integrating
DOD clinical outpatient processes into a single patient record) in
September 2005, the agency has now extended its completion date to June
2006. According to DOD officials, the schedule for completing this
deployment was revised because of a later than anticipated decision on
when the department could proceed with its worldwide deployment.
Collectively, the lack of an architecture and project management
structure, coupled with delays in the departments' completion of key
projects, places VA and DOD at increased risk of being unable to
successfully accomplish the HealthePeople (Federal) initiative and the
overall goal of more effectively meeting service members' and veterans'
health care and disability needs.
VA AND DOD COULD BENEFIT FROM CURRENT AND PAST RECOMMENDATIONS ON
SHARING ELECTRONIC MEDICAL RECORDS:
Mr. Chairman, as part of our review, you asked that we update the
status of VA's and DOD's actions to address prior recommendations
related to sharing electronic medical information. In this regard, both
the President's task force and we have made a number of recommendations
to VA and DOD for improving health care delivery to beneficiaries
through better coordination and management of their electronic health
sharing initiatives. In its final report of May 2003,[Footnote 16] the
President's task force recommended specific actions for providing
timely, high-quality care through effective electronic sharing of
health information, such as the development and deployment, by fiscal
year 2005, of electronic medical records that are interoperable,
bidirectional, and standards-based. The departments reported that they
are in various stages of acting on these recommendations, with
anticipated completion dates ranging from June of this year to
September 2005. Our attachment to this statement summarizes these
specific recommendations, and the departments' reported actions to
address them. Giving full consideration to these recommendations could
provide VA and DOD with relevant information for determining how to
proceed with the HealthePeople (Federal) initiative.
Also, as mentioned earlier, our prior reviews of the departments'
project to develop a government computer-based patient record
determined that the lack of a lead entity, clear mission, and detailed
planning to achieve that mission had made it difficult to monitor
progress, identify project risks, and develop appropriate contingency
plans. As a result, in reporting on this initiative in April 2001 and
again in June 2002, we made several recommendations to help strengthen
the management and oversight of this project. VA and DOD have taken
specific measures in response to our recommendations for enhancing
overall management and accountability of the project, with demonstrated
improvements and outcomes. Extending these practices to current
activities supporting the development of HealthePeople (Federal) could
strengthen the departments' approach to successfully accomplishing a
two-way health information exchange.
In summary, Mr. Chairman, achieving an electronic interface to enable
VA and DOD to exchange patient medical records between their health
information systems is an important goal, with substantial implications
for improving the quality of health care and disability claims
processing for our nation's military members and veterans. However, in
seeking a virtual medical record based on the two-way exchange of data
between their separate health information systems, VA and DOD have
chosen an approach that necessitates the highest levels of project
discipline, including a well-defined architecture for describing the
interface for a common health information exchange and an established
project management structure to guide the investment in and
implementation of this electronic capability. At this time, the
departments lack these critical components, and thus risk investing in
a capability that could fall short of their intended goals. The
continued absence of a clear approach and sound planning for the design
of this new electronic capability elevates concerns and skepticism
about exactly what capabilities VA and DOD will achieve as part of
HealthePeople (Federal), and in what time frame.
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 about this testimony, please contact Linda D. Koontz,
Director, Information Management Issues, at (202) 512-6240 or at
koontzl@gao.gov, or Valerie C. Melvin, Assistant Director, at (202)
512-6304 or at melvinv@gao.gov. Other individuals making key
contributions to this testimony include Nabajyoti Barkakati, Michael P.
Fruitman, Carl L. Higginbotham, Barbara S. Oliver, J. Michael Resser,
Sylvia L. Shanks, and Eric L. Trout.
Appendix: VA's and DOD's Reported Actions to Address Recommendations in
the President's Task Force Report of May 26, 2003:
Recommendations;
1. VA and DOD should develop and deploy by fiscal year 2005 electronic
medical records that are interoperable, bi-directional, and standards-
based;
Reported Actions;
Department of Veterans Affairs (VA): The VA/DOD Joint Strategic Plan
and the Joint Electronic Health Records Plan have set September 2005 as
the target date by which VA and DOD will achieve interoperability of
health data. The VA/DOD Health Executive Council Information
Management/Information Technology Work Group is on track to complete
this capability by the end of fiscal year 2005. In March 2004, the
departments awarded a contract to develop a bi-directional pharmacy
solution that will demonstrate interoperability in a prototype
environment. The departments are on track to complete the prototype by
October 2004;
Reported Actions; Department of Defense (DOD): Operational
interoperability is planned for fiscal year 2005.The pharmacy prototype
is the initial effort within the Clinical Health Data Repositories
(CHDR) framework. This framework is the effort to develop software
component services that will be used by the VA and DOD data
repositories. The prototype has a planned completion date of October
2004.
Recommendations;
2. The Administration should direct the Department of Health and Human
Services to declare the two departments to be a single health care
system for purposes of implementing the Health Insurance Portability
and Accountability Act (HIPAA) regulations;
Reported Actions;
Department of Veterans Affairs (VA): This issue remains under review by
the Veterans Health Administration's HIPAA Program Office. It is VA's
understanding that VA and DOD have concluded that this is not necessary
in order to share information on patients that both departments are
treating;
Reported Actions; Department of Defense (DOD): DOD believes that it and
VA can achieve the appropriate sharing of protected health information
within the guidelines of the current regulations. The HIPAA privacy
rule has a specific exception authorizing one-way sharing of health
data at the time of a service members' separation. This supports the
"seamless transition to veteran status."
Recommendations;
3. The departments should implement by fiscal year 2005 a mandatory
single separation physical as a prerequisite of promptly completing the
military separation process. Upon separation, DOD should transmit an
electronic Department of Defense (DD) 214 (discharge paperwork) to VA;
Reported Actions; Department of Veterans Affairs (VA): The Joint
Strategic Plan has set June 2004 as the target date for the departments
to develop an implementation plan for the one physical exam protocol.
VA and DOD are currently piloting the single separation physical exam
that meets DOD needs and VA's rating criteria at 16 Benefits Delivery
at Discharge sites;
Reported Actions; Department of Defense (DOD): The departments are
currently testing an advanced technological demonstration project that
transfers images of paper personnel documents to VA from official
military personnel file repositories in the Army, Navy, and Marine
Corps, with Air Force integration into the program in process
(including the DD214). When fully operational, this system will send
digital images of any personnel record to the VA within 48 hours of the
request.
4. By fiscal year 2004, VA and DOD should initiate a process for
routine sharing of each service member's assignment history, location,
occupational exposure, and injuries information;
Reported Actions; Department of Veterans Affairs (VA): Both the Health
Executive Council (through the Deployment Health Work Group) and the
VA/DOD Benefits Executive Council are currently developing and
implementing processes to address these issues;
Reported Actions; Department of Defense (DOD): DOD is already providing
VA with daily information on personnel separating from active duty,
which includes assignment history, location, and occupational duties
through the DD214. DOD's TRICARE On Line provides health care
professionals with access to the individual service member's pre-and
post-deployment health assessments The Defense Occupational and
Environmental Health Readiness System with CHCS II, is capturing data
on occupational exposures and transferring it to the clinical data
repository. When these systems are fully operational, appropriate
information will be able to be shared via a two-way exchange with VA.
Source: VA and DOD.
[End of table]
(310701):
FOOTNOTES
[1] U.S. General Accounting Office, 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-04-271T
(Washington, D.C.: November 19, 2003).
[2] The one-way transfer of health care data from DOD to VA is being
accomplished as part of the Federal Health Information Exchange
initiative.
[3] 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) and Computer-
Based Patient Records: Better Planning and Oversight By VA, DOD, and
IHS Would Enhance Health Data Sharing, GAO-01-459 (Washington, D.C.:
April 30, 2001).
[4] President's Task Force to Improve Health Care Delivery For Our
Nation's Veterans, Final Report (Washington, D.C.: May 26, 2003).
[5] P.L. 107-314, sec. 724 (2002).
[6] GAO-01-459.
[7] U.S. General Accounting Office, VA Information Technology: Progress
Made, but Continued Management Attention Is Key to Achieving Results,
GAO-02-369T (Washington, D.C.: March 13, 2002).
[8] GAO-02-703.
[9] U.S. General Accounting Office, VA Information Technology:
Management Making Important In Addressing Key Challenges, GAO-02-1054T
(Washington, D.C.: September 26, 2002).
[10] DOD's CHCS II capabilities are being deployed in blocks. Block 1
provides a graphical user interface for clinical outpatient processes;
block 2 supports general dentistry; block 3 provides pharmacy,
laboratory, radiology, and immunizations capabilities; block 4 provides
inpatient and scheduling capabilities; and block 5 will provide
additional capabilities as defined.
[11] The six initiatives that make up HealtheVet VistA are health data
repository, billing replacement, laboratory, pharmacy, imaging, and
appointment scheduling replacement.
[12] Institute of Electrical and Electronics Engineers, IEEE/EIA Guide
for Information Technology (IEEE/EIA 12207.1-1997), April 1998.
[13] Sec. 724 of the act mandates that the Secretaries of Veterans
Affairs and Defense seek to ensure that, on or before October 1, 2004,
the two departments' pharmacy data systems are interoperable for VA and
DOD beneficiaries by achieving real-time interface, data exchange, and
checking of prescription drug data of outpatients and using national
standards for the exchange of outpatient medication information. The
act further states that if the specified interoperability is not
achieved by that date, then the Secretary of Veterans Affairs shall
adopt DOD's Pharmacy Data Transaction System for VA's use.
[14] The Joint Executive Council is composed of the Deputy Secretary of
Veterans Affairs, the Undersecretary of Defense for Personnel and
Readiness, and the cochairs of joint councils on health, benefits, and
capital planning. The council meets on a quarterly basis to recommend
strategic direction of joint coordination and sharing efforts. The VA/
DOD Health Executive Council is composed of senior leaders from VA and
DOD, who work to institutionalize sharing and collaboration of health
services and resources. The council is cochaired by the VA
Undersecretary for Health and DOD Assistant Secretary of Defense for
Health Affairs, and meets on a bimonthly basis.
[15] When we testified last November, VA and DOD had agreed to four
standards to allow the transmission of messages and one standard
allowing laboratory results.
[16] President's Task Force, Final Report, May 26, 2003.
