Computer-Based Patient Records
Improved Planning and Project Management Are Critical to Achieving Two-Way VA-DOD Health Data Exchange Gao ID: GAO-04-811T May 19, 2004Providing readily accessible health information on veterans and active duty military personnel is highly essential to ensuring that these individuals are given quality health care and assistance in adjudicating disability claims. Moreover, ready access to health information is consistent with the President's recently announced intention to provide electronic health records for most Americans within 10 years. In an attempt to improve the sharing of health information, the Departments of Veterans Affairs (VA) and Defense (DOD) have been working, since 1998, toward the ability to exchange electronic health records for use by veterans, military personnel, and their health care providers. In testimony before Congress last November and again this past March, GAO discussed the progress being made by the departments in this endeavor. While a measure of success has been achieved--the one-way transfer of health data from DOD to VA health care facilities--identifying the technical solution for a two-way exchange, as part of a longer term HealthePeople (Federal) initiative, has proven elusive. At Congress's request, GAO reported on its continuing review of the departments' progress toward this goal of an electronic two-way exchange of patient health records.
VA and DOD are continuing with activities to support the sharing of health data; nonetheless, achieving the two-way electronic exchange of patient health information, as envisioned in the HealthePeople (Federal) strategy, remains far from being realized. Each department is proceeding with the development of its own health information system--VA's HealtheVet VistA and DOD's Composite Health Care System (CHCS) II; these are critical components for the eventual electronic data exchange capability. The departments are also proceeding with the essential task of defining data and message standards that are important for exchanging health information between their disparate systems. In addition, a pharmacy data prototype initiative begun this past March, which the departments stated is an initial step to defining the technology for the two-way data exchange, is ongoing. However, VA and DOD have not yet defined an architecture to guide the development of the electronic data exchange capability, and lack a strategy to explain how the pharmacy prototype will contribute toward determining the technical solution for achieving HealthePeople (Federal). As such, there continues to be no clear vision of how this capability will be achieved, and in what time period. Compounding the challenge faced by the departments is that they continue to lack a fully established project management structure for the HealthePeople (Federal) initiative. As a result, the relationships between the departments' managers is not clearly defined, a lead entity with final decision-making authority has not been designated, and a coordinated, comprehensive project plan that articulates the joint initiative's resource requirements, time frames, and respective roles and responsibilities of each department has not yet been established. In discussing the need for these components, VA and DOD program officials stated this week that the departments had begun actions to develop a project plan and define the management structure for HealthePeople (Federal). In the absence of such components, the progress that VA and DOD have achieved is at risk of compromise, as is assurance that the ultimate goal of a common, exchangeable two-way health record will be reached. Given the importance of readily accessible health data for improving the quality of health care and disability claims processing for military members and veterans, we currently have a draft report at the departments for comment, in which we are making recommendations to the Secretaries of Veterans Affairs and Defense for addressing the challenges to, and improving the likelihood of successfully achieving the electronic two-way exchange of patient health information.
GAO-04-811T, Computer-Based Patient Records: Improved Planning and Project Management Are Critical to Achieving Two-Way VA-DOD Health Data Exchange
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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. EDT:
Wednesday, May 19, 2004:
COMPUTER-BASED PATIENT RECORDS:
Improved Planning and Project Management Are Critical to Achieving Two-
Way VA-DOD Health Data Exchange:
Statement of Linda D. Koontz:
Director, Information Management Issues:
GAO-04-811T:
GAO Highlights:
Highlights of GAO-04-811T, testimony before the Subcommittee on
Oversight and Investigations, House Committee on Veterans' Affairs
Why GAO Did This Study:
Providing readily accessible health information on veterans and active
duty military personnel is highly essential to ensuring that these
individuals are given quality health care and assistance in
adjudicating disability claims. Moreover, ready access to health
information is consistent with the President‘s recently announced
intention to provide electronic health records for most Americans
within 10 years. In an attempt to improve the sharing of health
information, the Departments of Veterans Affairs (VA) and Defense (DOD)
have been working, since 1998, toward the ability to exchange
electronic health records for use by veterans, military personnel, and
their health care providers.
In testimony before the Subcommittee last November and again this past
March, GAO discussed the progress being made by the departments in this
endeavor. While a measure of success has been achieved”the one-way
transfer of health data from DOD to VA health care facilities”
identifying the technical solution for a two-way exchange, as part of a
longer term HealthePeople (Federal) initiative, has proven elusive.
At the Subcommittee‘s request, GAO reported on its continuing review of
the departments‘ progress toward this goal of an electronic two-way
exchange of patient health records.
What GAO Found:
VA and DOD are continuing with activities to support the sharing of
health data; nonetheless, achieving the two-way electronic exchange of
patient health information, as envisioned in the HealthePeople
(Federal) strategy, remains far from being realized. Each department is
proceeding with the development of its own health information system”
VA‘s HealtheVet VistA and DOD‘s Composite Health Care System (CHCS) II;
these are critical components for the eventual electronic data exchange
capability. The departments are also proceeding with the essential task
of defining data and message standards that are important for
exchanging health information between their disparate systems. In
addition, a pharmacy data prototype initiative begun this past March,
which the departments stated is an initial step to defining the
technology for the two-way data exchange, is ongoing. However, VA and
DOD have not yet defined an architecture to guide the development of
the electronic data exchange capability, and lack a strategy to explain
how the pharmacy prototype will contribute toward determining the
technical solution for achieving HealthePeople (Federal). As such,
there continues to be no clear vision of how this capability will be
achieved, and in what time period.
Compounding the challenge faced by the departments is that they
continue to lack a fully established project management structure for
the HealthePeople (Federal) initiative. As a result, the relationships
between the departments‘ managers is not clearly defined, a lead entity
with final decision-making authority has not been designated, and a
coordinated, comprehensive project plan that articulates the joint
initiative‘s resource requirements, time frames, and respective roles
and responsibilities of each department has not yet been established.
In discussing the need for these components, VA and DOD program
officials stated this week that the departments had begun actions to
develop a project plan and define the management structure for
HealthePeople (Federal). In the absence of such components, the
progress that VA and DOD have achieved is at risk of compromise, as is
assurance that the ultimate goal of a common, exchangeable two-way
health record will be reached.
Given the importance of readily accessible health data for improving
the quality of health care and disability claims processing for
military members and veterans, we currently have a draft report at the
departments for comment, in which we are making recommendations to the
Secretaries of Veterans Affairs and Defense for addressing the
challenges to, and improving the likelihood of successfully achieving
the electronic two-way exchange of patient health information.
www.gao.gov/cgi-bin/getrpt?GAO-04-811T.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Linda Koontz at (202)
512-6240 or koontzl@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
I am pleased to participate in today's continuing discussion of
electronic health records and the Department of Veterans Affairs' (VA)
and Department of Defense's (DOD) actions toward developing the
capability to electronically exchange patient health information. In
the face of terrorism, related military responses, and a general call
for improved health care delivery, providing readily accessible medical
data on active duty military personnel and veterans is more essential
than ever to ensuring that these individuals receive high-quality
health care and assistance in adjudicating any disability claims that
they may have. The President's recently announced proclamation to
provide electronic health records for most Americans within the next 10
years further highlights the significance and potential contributions
of the departments' actions in pointing the way toward the delivery of
more effective health care services.
For the past 6 years, VA and DOD have been working to achieve an
electronic medical record and patient health information-sharing
capability, beginning with a joint project in 1998 to develop a
government computer-based patient record. As we noted in previous
testimony,[Footnote 1] the departments have achieved a measure of
success in sharing data through the one-way transfer of health
information from DOD to VA health care facilities. However, they have
been severely challenged in their pursuit of a longer term objective--
providing a virtual medical record based on the two-way exchange of
patient health care information, as part of their HealthePeople
(Federal) initiative. This past March, we reported that VA and DOD had
made little progress in identifying a technological solution for
achieving a two-way exchange of patient health data and lacked
discipline in their approach to managing this initiative.
At your request, my testimony today will discuss our continuing
assessment of VA's and DOD's progress in realizing the HealthePeople
(Federal) goal of an electronic patient health record and two-way data
exchange capability. In conducting this work, we reviewed the
departments' documentation describing VA's and DOD's actions to develop
new health information systems and determine a strategy for developing
a secure, electronic two-way data exchange capability, including
project schedules, project status reports, and conversion and
deployment plans. We also reviewed documentation identifying the costs
that the departments have incurred in developing technology to support
the sharing of health data, including costs associated with achieving
the one-way transfer of data from DOD to VA health care facilities, and
ongoing projects to develop new health information systems. We did not
audit the reported costs, and thus cannot attest to their accuracy or
completeness. We supplemented our analyses of the agencies'
documentation with interviews of VA and DOD officials responsible for
key decisions and actions on the health data-sharing initiatives. We
conducted our work in accordance with generally accepted government
auditing standards, during May of this year.
Results In Brief:
VA and DOD are proceeding with actions intended to support the sharing
of health data, but continue to be far from achieving the two-way
electronic data exchange capability envisioned in the HealthePeople
(Federal) strategy. The departments are continuing to take actions to
develop their individual health information systems that are critical
to exchanging patient health information and to define data standards
that are essential to the common sharing of health information. In
addition, department officials stated that they are proceeding with a
pharmacy data prototype initiative, begun in March, to satisfy a
mandate of the Bob Stump National Defense Authorization Act for Fiscal
Year 2003,[Footnote 2] as an initial step toward achieving
HealthePeople (Federal). At this stage, however, they have not
developed a strategy to explain how this project will contribute to
defining the technological solution for the data exchange capability.
As such, VA and DOD continue to lack a clearly defined architecture and
technological solution for developing the electronic interface and
associated capability for exchanging patient health information between
their new systems. Moreover, the departments remain challenged to
articulate a clear vision of how this capability will be achieved, and
in what time frame.
Further compounding the challenge and uncertainty that VA and DOD face
is that they continue to lack a fully established project management
structure for this undertaking. The relationships among management
entities involved with the HealthePeople (Federal) initiative have not
been clearly established and the departments have not designated a lead
entity with final decision-making authority for the initiative to
ensure that decision making and oversight will not be blurred across
management entities. In addition, while the departments have designated
a manager for the pharmacy data prototype project that they view as an
initial step toward defining electronic data exchange technology, they
do not yet have a comprehensive and coordinated project plan for the
HealthePeople (Federal) initiative to articulate the time frames,
resource requirements, and roles and responsibilities of VA and DOD
officials charged with designing, developing, and implementing the
electronic interface capability. The departments also have not
instituted project review milestones and measures that provide a basis
for comprehensive management, progressive decision making, and
authorization of funding for each step in the development process. In
discussing their management of HealthePeople (Federal), VA and DOD
program officials stated this week that the departments had begun
developing a project plan and defining the management structure for
this initiative.
Absent a comprehensive and coordinated approach to implementing and
conveying information about HealthePeople (Federal), VA and DOD risk
compromising their progress and lack assurance that the goals of this
initiative will be successfully realized. Given the importance of
readily accessible health data for improving the quality of health care
and disability claims processing for military members and veterans, we
currently have a draft report at the departments for comment, in which
we are making recommendations to the Secretaries of Veterans Affairs
and Defense for addressing the challenges to and improving the
likelihood of successfully achieving the electronic two-way exchange of
patient health information.
Background:
In 1998, following a Presidential call for VA and DOD to start
developing a "comprehensive, life-long medical record for each service
member," the two departments began a joint course of action toward
achieving the capability to share patient health information for active
duty military personnel and veterans.[Footnote 3] As their first
initiative, undertaken in that year, the Government Computer-Based
Patient Record (GCPR) project was envisioned as an electronic interface
that would allow physicians and other authorized users at VA and DOD
health facilities to access data from any of the other agencies' health
information systems. The interface was expected to compile requested
patient information in a virtual record that could be displayed on a
user's computer screen.
Our prior reviews of the GCPR project determined that the lack of a
lead entity, clear mission, and detailed planning to achieve that
mission made it difficult to monitor progress, identify project risks,
and develop appropriate contingency plans. Accordingly, reporting on
this project in April 2001 and again in June 2002,[Footnote 4] we made
several recommendations to help strengthen the management and oversight
of GCPR. Specifically, in 2001 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. In 2002 we
recommended that the participating agencies 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. VA and DOD took specific measures in response to our
recommendations for enhancing overall management and accountability of
the project.
By July 2002, VA and DOD had revised their strategy and had made
progress toward electronically sharing patient health data. 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. This agreement also established
FHIE as a joint activity that would allow 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 (the Composite Health Care System) to a separate
database that VA clinicians could access. A second phase, finalized
this past March, 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. According to program officials, FHIE is now fully
operational and is showing positive results by providing a wide range
of health care information to enable clinicians to make more informed
decisions regarding the care of veterans and to facilitate processing
disability claims. The officials stated that the departments have now
begun leveraging the FHIE infrastructure to achieve interim exchanges
of health information on a limited basis, using existing health systems
at joint VA/DOD facilities.[Footnote 5] The departments reported total
GCPR/FHIE costs of about $85 million through fiscal year 2003.
The revised strategy also envisioned achieving a longer term, two-way
exchange of health information between DOD and VA. Known as
HealthePeople (Federal), this initiative 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 (CHCS) II and VA's
HealtheVet VistA.
DOD began developing CHCS II in 1997 and has completed its associated
clinical data repository--a key component for the planned electronic
interface. The department expects to complete deployment of all of its
major system capabilities by September 2008.[Footnote 6] It 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
comprising this system in 2012.[Footnote 7] VA reported spending about
$120 million on HealtheVet VistA through fiscal year 2003.
Under the HealthePeople (Federal) initiative, 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 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 with access to the individual's clinical information 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 in
VA's repository. According to the departments, this planned approach
would make virtual medical records displaying all available patient
health information from the two repositories accessible to both
departments' clinicians. VA officials anticipated 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 2005.
Progress Toward Achieving HealthePeople (Federal) Faces Continued
Challenges and Risks:
As we have noted,[Footnote 8] achieving the longer term capability to
exchange health data in a secure, two-way electronic format between new
health information systems that VA and DOD are developing is a
challenging and complex undertaking, in which success depends on having
a clearly articulated architecture, or blueprint, defining how specific
technologies will be used to deliver the capability. Developing,
maintaining, and using an architecture is a best practice in
engineering information systems and other technological solutions,
articulating, for example, the systems and interface requirements,
design specifications, and database descriptions for the manner in
which the departments will electronically store, update, and transmit
their data.
Successfully carrying out the initiative also depends on the
departments' instituting a highly disciplined approach to the project's
management. Industry best practices and information technology project
management principles stress the importance of accountability and sound
planning for any project, particularly an interagency effort of the
magnitude and complexity of this one. Such planning involves developing
and using a project management plan that describes, among other
factors, the project's scope, implementation strategy, lines of
responsibility, resources, and estimated schedules for development and
implementation.
Currently, VA and DOD are proceeding with the development of their new
health information systems and with the identification of standards
that are essential to sharing common health data. DOD is deploying its
first release of CHCS II functionality (a capability for integrating
DOD clinical outpatient processes into a single patient record), with
scheduled completion in June 2006. For its part, VA continues to work
toward completing a prototype for the department's health data
repository, scheduled for completion at the end of next month. In
addition, as we reported in March, the departments have continued
essential steps toward standardizing clinical data, having adopted data
and message standards that are important for exchanging health
information between disparate systems.[Footnote 9] Department
officials also stated that they were proceeding with a pharmacy data
prototype initiative, begun in March to satisfy a mandate of the Bob
Stump National Defense Authorization Act for Fiscal Year 2003,[Footnote
10] as an initial step toward achieving HealthePeople (Federal). The
officials maintain that they expect to be positioned to begin
exchanging patient health information between their new systems on a
limited basis in the fall of 2005, identifying four categories of data
that they expect to be able to exchange: outpatient pharmacy data,
laboratory results, allergies, and patient demographics.
However, VA's and DOD's approach to meeting this HealthePeople
(Federal) goal is fraught with uncertainty and lacks a solid foundation
for ensuring that this mission can be successfully accomplished. As we
reported in March, the departments continue to lack an architecture
detailing how they intend to use technology to achieve the two-way
electronic data exchange capability. In discussing their intentions for
developing such an architecture, VA's Deputy Chief Information Officer
for Health stated last week that the departments do not expect to have
an established architecture until a future unspecified date. He added
that VA and DOD planned to take an incremental approach to determining
the architecture and technological solution for the data exchange
capability. He explained, for example, that they hope to gain from the
pharmacy data prototype project an understanding of what technology is
necessary and how it should be deployed to enable the two-way exchange
of patient health records between their data repositories. VA and DOD
reported approval of the contractor's technical requirements for the
prototype last month and have a draft architecture for the prototype.
They expect to complete the prototype in mid-September of this year.
Although department officials consider the pharmacy data prototype to
be an initial step toward achieving HealthePeople (Federal), how and to
what extent the prototype will contribute to defining the electronic
interface for a two-way data exchange between VA's and DOD's new health
information systems are unclear. Such prototypes, if accomplished
successfully, can offer valuable contributions to the process of
determining the technological solution for larger, more encompassing
initiatives. However, ensuring the effective application of lessons
learned from the prototype requires that VA and DOD have a well-defined
strategy to show how this project will be integrated with the
HealthePeople (Federal) initiative. Yet VA and DOD have not developed a
strategy to articulate the integration approach, time frames, and
resource requirements associated with implementing the prototype
results to define the technological features of the two-way data
exchange capability under HealthePeople (Federal). Until VA and DOD are
able to determine the architecture and technological solution for
achieving a secure electronic systems interface, they will lack
assurance that the capability to begin electronically exchanging
patient health information between their new systems in 2005 can be
successfully accomplished.
In addition to lacking an explicit architecture and technological
solution to guide the development of the electronic data exchange
capability, VA and DOD continue to be challenged in ensuring that this
undertaking will be managed in a sound, disciplined manner. As was the
situation in March, VA and DOD continue to lack a fully established
project management structure for the HealthePeople (Federal)
initiative. The relationships among the management entities involved
with the initiative have not been clearly established, and no one
entity has authority to make final project decisions binding on the
other. As we noted during the March hearing, the departments'
implementation of our recommendation that it establish a lead entity
for the Government Computer-Based Patient Record project helped
strengthen the overall accountability and management of that project
and contributed to its successful accomplishment.
Further, although the departments have designated a project manager and
established a project plan defining the work tasks and management
structure for the pharmacy prototype, they continue to lack a
comprehensive and coordinated project plan for HealthePeople (Federal),
to explain the technical and managerial processes that have been
instituted to satisfy project requirements for this broader initiative.
Such a plan would include, among other information, details on the
authority and responsibility of each organizational unit; the work
breakdown structure and schedule for all of the tasks to be performed
in developing, testing, and deploying the electronic interface; as well
as a security plan. The departments also have not instituted necessary
project review milestones and measures to provide a basis for
comprehensive management of the project at critical intervals,
progressive decision making, or authorization of funding for each step
in the development process. As a result, current plans for the
development of the electronic data exchange capability between VA's and
DOD's new health information systems do not offer a clear vision for
the project or demonstrate sufficient attention to the effective day-
to-day guidance of and accountability for the investments in and
implementation of this capability. In discussing their management of
HealthePeople (Federal), VA and DOD program officials stated this week
that the departments had begun actions to develop a project plan and
define the management structure for this initiative.
Given the significance of readily accessible health data for improving
the quality of health care and disability claims processing for
military members and veterans, we currently have a draft report at the
departments for comment, in which we are recommending to the
Secretaries of Veterans Affairs and Defense, a number of actions for
addressing the challenges to, and improving the likelihood of,
successfully achieving the electronic two-way exchange of patient
health information.
In summary, VA's and DOD's pursuit of various initiatives to achieve
the electronic sharing of patient health data represents an important
step toward providing more high-quality health care for active duty
military personnel and veterans. Moreover, in undertaking HealthePeople
(Federal), the departments have an opportunity to help lead the nation
to a new frontier of health care delivery. However, the continued
absence of an architecture and defined technological solution for an
electronic interface for their new health information systems, coupled
with the need for more comprehensive and coordinated management of the
projects supporting the development of this capability, elevates the
uncertainty about how VA and DOD intend to achieve this capability and
in what time frame. Until these critical components have been put into
place, the departments will continue to lack a convincing position
regarding their approach to and progress toward achieving the
HealthePeople (Federal) goals and, ultimately, risk jeopardizing the
initiative's overall success.
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 Barbara S. Oliver, J. Michael
Resser, and Eric L. Trout.
(310716):
FOOTNOTES
[1] U.S. General Accounting Office, Computer-Based Patient Records:
Sound Planning and Project Management Are Needed to Achieve a Two-Way
Exchange of VA and DOD Health Data, GAO-04-402T (Washington, D.C.:
March 17, 2004) and 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] P.L. 107-314, sec. 724 (2002).
[3] Initially, the Indian Health Service (IHS) also was a party to this
effort, having been included because of its population-based research
expertise and its long-standing relationship with VA. However, IHS was
not included in a later revised strategy for electronically sharing
patient health information.
[4] 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).
[5] VA and DOD officials stated that these efforts were not expected to
contribute to determining the technological solution for a two-way data
exchange between VA's and DOD's new health information systems but,
instead, constituted attempts toward facilitating the sharing of health
data in the absence of the longer term capabilities that HealthePeople
(Federal) is expected to provide.
[6] 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.
[7] The six initiatives that make up HealtheVet VistA are health data
repository, billing replacement, laboratory, pharmacy, imaging, and
appointment scheduling replacement.
[8] GAO-04-402T.
[9] VA and DOD, along with the Department of Health and Human Services,
have been active participants in the Consolidated Health Informatics
initiative. As part of this initiative, the Secretary of Health and
Human Services announced in early May the adoption of 15 new standards
to enable the exchange of health information.
[10] 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.
