Electronic Health Records
Program Office Improvements Needed to Strengthen Management of VA and DOD Efforts to Achieve Full Interoperability Gao ID: GAO-09-895T July 14, 2009For over a decade, the Department of Veterans Affairs (VA) and the Department of Defense (DOD) have been working on initiatives to share electronic health information. To expedite their efforts, Congress mandated in the National Defense Authorization Act for Fiscal Year 2008 that VA and DOD establish a joint interagency program office to act as a single point of accountability in the development of electronic health records systems or capabilities that allow for full interoperability (generally, the ability of systems to exchange data) by September 30, 2009. In this statement, GAO summarizes findings from its upcoming report, focusing on progress in setting up the interagency program office and the departments' actions to achieve fully interoperable capabilities by September 30, 2009. To do so, GAO analyzed agency documentation on project status and conducted interviews with agency officials.
VA and DOD have made progress in setting up the interagency program office; however, the office is not yet effectively positioned to be accountable for the departments' efforts to achieve fully interoperable electronic health record systems or capabilities. The departments have taken the important steps of completing personnel descriptions and hiring necessary staff to perform the office's functions, but key leadership positions (for the Director and Deputy Director) continue to be filled on an interim basis. In addition, the office has established a charter and begun to demonstrate responsibilities outlined within this document. Nonetheless, the office is not yet fulfilling key information technology management responsibilities in the areas of performance measurement, project planning, and scheduling--all of which are essential to establishing the office as a single point of accountability for the departments' interoperability efforts. VA and DOD continue to take steps toward achieving full interoperability by the September deadline. In this regard, the departments have achieved planned capabilities for three of six interoperability objectives (see table) that they identified to meet their data sharing needs--refine social history data, share physical exam data, and demonstrate initial network gateway operation. For the remaining three objectives--expand questionnaires and self assessment tools, expand DOD inpatient medical records system, and demonstrate initial document scanning--the departments have partially achieved planned capabilities, with additional work needed to fully meet clinicians' needs for health information.
GAO-09-895T, Electronic Health Records: Program Office Improvements Needed to Strengthen Management of VA and DOD Efforts to Achieve Full Interoperability
This is the accessible text file for GAO report number GAO-09-895T
entitled 'Electronic Health Records: Program Office Improvements Needed
to Strengthen Management of VA and DOD Efforts to Achieve Full
Interoperability' which was released on July 14, 2009.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
United States Government Accountability Office:
GAO:
Testimony:
Before the Subcommittee on Oversight and Investigations, House
Veterans‘ Affairs Committee:
For Release on Delivery:
Expected at 10:00 a.m. EDT:
Tuesday, July 14, 2009:
Electronic Health Records:
Program Office Improvements Needed to Strengthen Management of VA and
DOD Efforts to Achieve Full Interoperability:
Statement of Valerie C. Melvin, Director:
Information Management and
Human Capital Issues:
GAO-09-895T:
GAO Highlights:
Highlights of GAO-09-895T, a testimony to Subcommittee on Oversight and
Investigations; House Committee on Veterans' Affairs.
Why GAO Did This Study:
For over a decade, the Department of Veterans Affairs (VA) and the
Department of Defense (DOD) have been working on initiatives to share
electronic health information. To expedite their efforts, Congress
mandated in the National Defense Authorization Act for Fiscal Year 2008
that VA and DOD establish a joint interagency program office to act as
a single point of accountability in the development of electronic
health records systems or capabilities that allow for full
interoperability (generally, the ability of systems to exchange data)
by September 30, 2009.
In this statement, GAO summarizes findings from its upcoming report,
focusing on progress in setting up the interagency program office and
the departments‘ actions to achieve fully interoperable capabilities by
September 30, 2009. To do so, GAO analyzed agency documentation on
project status and conducted interviews with agency officials.
What GAO Found:
VA and DOD have made progress in setting up the interagency program
office; however, the office is not yet effectively positioned to be
accountable for the departments' efforts to achieve fully interoperable
electronic health record systems or capabilities. The departments have
taken the important steps of completing personnel descriptions and
hiring necessary staff to perform the office's functions, but key
leadership positions (for the Director and Deputy Director) continue to
be filled on an interim basis. In addition, the office has established
a charter and begun to demonstrate responsibilities outlined within
this document. Nonetheless, the office is not yet fulfilling key
information technology management responsibilities in the areas of
performance measurement, project planning, and scheduling--all of which
are essential to establishing the office as a single point of
accountability for the departments' interoperability efforts.
VA and DOD continue to take steps toward achieving full
interoperability by the September deadline. In this regard, the
departments have achieved planned capabilities for three of six
interoperability objectives (see table) that they identified to meet
their data sharing needs--refine social history data, share physical
exam data, and demonstrate initial network gateway operation. For the
remaining three objectives--expand questionnaires and self assessment
tools, expand DOD inpatient medical records system, and demonstrate
initial document scanning--the departments have partially achieved
planned capabilities, with additional work needed to fully meet
clinicians' needs for health information.
Table: Description of VA and DOD Interoperability Objectives:
Objective: Refine social history data;
Description: DOD will begin sharing with VA social history data
currently captured in the DOD electronic health record. Such data
describe, for example, patients‘ involvement in hazardous activities
and tobacco and alcohol use.
Objective: Share physical exam data;
Description: DOD will provide an initial capability to share with VA
its electronic health record information that supports the physical
exam process when a service member separates from active military duty.
Objective: Demonstrate initial network gateway operation; Description:
DOD and VA will demonstrate the operation of secure network gateways
that provide expanded bandwidth to support information sharing between
DOD and VA healthcare facilities.
Objective: Expand questionnaires and self assessment tools;
Description: DOD will provide all periodic health assessment data
stored in its electronic health record to the VA such that
questionnaire responses are viewable with the questions that elicited
them.
Objective: Expand DOD inpatient medical records system;
Description: DOD will expand its inpatient medical records system to at
least one additional site in each military medical department (one
Army, one Air Force, and one Navy for a total of three sites).
Objective: Demonstrate initial document scanning;
Description: DOD will demonstrate an initial capability for scanning
service members‘ medical documents into its electronic health record
and sharing the documents electronically with the VA.
Source: GAO based on VA and DOD data.
[End of table]
What GAO Recommends:
GAO‘s draft report recommends that the Secretaries of Defense and
Veterans Affairs emphasize the interagency program office‘s
establishment of a project plan and integrated master schedule to guide
their interoperability activities.
View [hyperlink, http://www.gao.gov/products/GAO-09-895T] or key
components. For more information, contact Valerie Melvin at (202) 512-
6304 or melvinv@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
I am pleased to be here today to discuss the Departments of Veterans
Affairs' (VA) and Defense's (DOD) interagency program office and
efforts toward advancing the use of health information technology to
achieve interoperable electronic health records. As you know, VA and
DOD have been working for over a decade on initiatives to share data
between their health information systems; yet, while they have made
progress in a number of areas, questions have persisted concerning when
and to what extent the intended electronic sharing capabilities of the
two departments will be fully achieved. To expedite their efforts, the
National Defense Authorization Act for Fiscal Year 2008[Footnote 1]
included provisions directing VA and DOD to jointly develop and
implement, by September 30, 2009, fully interoperable electronic health
record systems or capabilities that are compliant with applicable
federal interoperability[Footnote 2] standards. It further established
an interagency program office to be a single point of accountability
for the departments' efforts.
Also, the act directed us to report semiannually on VA's and DOD's
progress in implementing their electronic health record systems. In
this regard, we have previously issued two reports (in July 2008 and
January 2009). We plan to issue a third report near the end of this
month--a draft of which is currently with the departments for their
review and comments. At your request, my testimony today summarizes
findings from this latest draft report, focusing on the departments'
progress in setting up the interagency program office as a point of
accountability for the implementation of interoperable electronic
health records, and actions being taken to achieve these capabilities
by September 30, 2009.
In developing this testimony, we relied on our previous work supporting
the draft report. We conducted our work from April 2009 through July
2009, in the Washington, D.C. metropolitan area. All work on which this
testimony is based was performed in accordance with generally accepted
government auditing standards. Those standards require that we plan and
perform the audit to obtain sufficient, appropriate evidence to provide
a reasonable basis for our findings and conclusions based on our audit
objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
Background:
The use of information technology (IT) to electronically collect,
store, retrieve, and transfer clinical, administrative, and financial
health information has great potential to help improve the quality and
efficiency of health care and is important to improving the performance
of the U.S. health care system. Historically, patient health
information has been scattered across paper records kept by many
different caregivers in many different locations, making it difficult
for a clinician to access all of a patient's health information at the
time of care. Lacking access to these critical data, a clinician may be
challenged to make the most informed decisions on treatment options,
potentially putting the patient's health at greater risk. The use of
electronic health records can help provide this access and improve
clinical decisions.[Footnote 3]
Key to making health care information electronically available is
interoperability--that is, the ability to share data among health care
providers. Interoperability enables different information systems or
components to exchange information and to use the information that has
been exchanged. This capability is important because it allows
patients' electronic health information to move with them from provider
to provider, regardless of where the information originated. If
electronic health records conform to interoperability standards, they
can be created, managed, and consulted by authorized clinicians and
staff across more than one health care organization, thus providing
patients and their caregivers the necessary information required for
optimal care. In the health IT field, standards may govern areas
ranging from technical issues, such as file types and interchange
systems, to content issues, such as medical terminology. Unlike paper-
based documents, electronic health records can also provide automatic
alerts about a particular patient's health, or other advantages of
automation.
In prior reports, we have discussed the different levels of
interoperability that agencies can achieve.[Footnote 4] At the highest
level, electronic data are computable (that is, in a format that a
computer can understand and act on to, for example, provide alerts to
clinicians on drug allergies). At a lower level, electronic data are
structured and viewable, but not computable. At still a lower level,
electronic data are unstructured and viewable, but not computable. With
unstructured electronic data, a user would have to find needed or
relevant information by searching uncategorized data. Beyond these,
paper records also can be considered interoperable (at the lowest
level) because they allow data to be shared, read, and interpreted by
human beings. According to VA and DOD officials, not all data require
the same level of interoperability, nor is interoperability at the
highest level achievable in all cases. For example, unstructured,
viewable data may be sufficient for such narrative information as
clinical notes.
VA and DOD Are Required by Law to Establish an Interagency Program
Office and Achieve Full Interoperability:
As previously noted, the National Defense Authorization Act for Fiscal
Year 2008[Footnote 5] called for VA and DOD to jointly develop and
implement fully interoperable electronic health record systems or
capabilities by September 30, 2009, and established an interagency
program office to be accountable for the departments' efforts in this
regard. The departments have been working to set up this office since
April 2008. In January 2009, the office completed its charter,
articulating, among other things, its mission and functions with
respect to attaining interoperable electronic health data. The charter
further identified the office's responsibilities in carrying out its
mission, in areas such as oversight and management, stakeholder
communication, and decision-making.
Further, to help meet the intent of the act, the Interagency Clinical
Informatics Board,[Footnote 6] made up of senior clinical leaders from
both departments who represent the user community, began establishing
priorities for health data sharing between VA and DOD. The board
subsequently identified six interoperability objectives for meeting the
departments' data sharing needs, as reflected in table 1.
Table 1: Description of VA and DOD Interoperability Objectives:
Objective: Refine social history data;
Description: DOD will begin sharing with VA the social history data
that is currently captured in the DOD electronic health record. Such
data describe, for example, patients' involvement in hazardous
activities and tobacco and alcohol use;
Associated interoperability level: Structured, viewable electronic data.
Objective: Share physical exam data;
Description: DOD will provide an initial capability to share with VA
its electronic health record information that supports the physical
exam process when a service member separates from active military duty;
Associated interoperability level: Structured, viewable electronic data.
Objective: Demonstrate initial network gateway operation;
Description: VA and DOD will demonstrate the operation of the secure
network gateways[A] to support joint DOD-VA health information sharing;
Associated interoperability level: There is no interoperability level
associated with this objective.
Objective: Expand questionnaires and self assessment tools;
Description: DOD will provide all periodic health assessment data
stored in its electronic health record to the VA in such a fashion that
questionnaire responses are viewable with the questions that elicited
them;
Associated interoperability level: Structured, viewable electronic data.
Objective: Expand DOD inpatient medical records system;
Description: DOD will expand its inpatient medical records system
(CliniComp's Essentris[B] product suite), also called the clinical
information system, to at least one additional site in each military
medical department (one Army, one Air Force, and one Navy for a total
of three sites);
Associated interoperability level: Unstructured, viewable electronic
data.
Objective: Demonstrate initial document scanning;
Description: DOD will demonstrate an initial capability for scanning
service members' medical documents into its electronic health record
and sharing the documents electronically with the VA;
Associated interoperability level: Unstructured, viewable electronic
data.
Source: GAO Analysis of VA and DOD data.
[A] Secure network gateways provide expanded bandwidth to support
information sharing and ensure secure and reliable data communications
between VA and DOD health care facilities.
[B] Essentris is a commercial health information system customized to
support inpatient treatment at military medical facilities.
[End of table]
According to the former acting director of the interagency program
office, VA and DOD consider achievement of these six objectives, in
conjunction with data sharing capabilities previously achieved (e.g.,
the Federal Health Information Exchange ([Footnote 7]FHIE), the
Bidirectional Health Information Exchange [Footnote 8](BHIE), and the
interface between DOD's Clinical Data Repository (CDR) and VA's Health
Data Repository (HDR), known a[Footnote 9]s CHDR), to be sufficient to
satisfy the requirement for full interoperability by September 2009.
DOD/VA Interagency Program Office Has Made Progress in Becoming
Operational, but Is Not Fully Functioning as a Single Point of
Accountability:
As our report later this month will note, VA and DOD have taken
important steps to make the interagency program office operational.
However, more work is needed to solidify its leadership and management
capabilities if the office is to effectively function as a single point
of accountability for achieving interoperable electronic health data.
In particular, the departments have completed personnel descriptions
and recruited and hired staff for government positions and obtained
necessary contractor staff to perform the office's functions. As of
early July, the departments reported that they had selected staff
members for 10 of 14 government positions and that recruitment efforts
were underway to fill the remaining 4 positions by late September 2009.
Further, all of the 16 designated contractor positions had been filled.
Nonetheless, VA and DOD continue to fill the office's key leadership
positions--that of director and deputy director--on an interim basis.
To their credit, the departments have taken steps to hire a full-time
permanent director and a deputy director to lead the office. Earlier
this month, DOD selected a candidate for the director position, VA
concurred with the selection, and the candidate's application was sent
to the Office of Personnel Management for approval. In the meantime,
the departments requested and received an extension of the interim
director's appointment until September 30, 2009, or until a permanent
official is hired. Further, as of late June, interagency program
officials stated that actions were underway to fill the deputy director
position and that VA was interviewing candidates for this position. The
interim director stated that the departments anticipate making a
selection for the deputy director position by the end of this month.
Beyond the need to appoint these key permanent leaders, the office
needs to fulfill a number of responsibilities identified in its January
2009 charter that are critical to its effectiveness. To this end, the
office has taken several steps. For example, it submitted its first
annual report to Congress that summarized the departments' efforts
toward achieving full interoperability and the status of key activities
completed to set up the office. Further, the office developed 11
standard operating procedures in areas such as program management
oversight, strategic communications, and process improvement.
However, the office has not yet carried out other key responsibilities
identified in its charter that are fundamental to effective IT program
management and that would be essential to effectively serving as the
single point of accountability. For example, the office has not yet
established results-oriented (i.e., objective, quantifiable, and
measurable) goals and performance measures for all six of the
interoperability objectives discussed previously.
In particular, early development and use of results-oriented metrics is
an important IT program management activity. Performance goals and
measures, if effectively implemented, can provide a meaningful baseline
against which to measure the progress of a program and the outcomes
associated with its implementation. VA and DOD agreed with our previous
recommendation calling for the development of such goals and measures.
[Footnote 10] Further, the interagency program office charter
identified the development of metrics to monitor the departments'
performance against interoperability objectives as a responsibility of
the office. Nevertheless, the office has developed performance goals
for only one of the six identified interoperability objectives--the
expansion of DOD's medical records system (Essentris) to share
inpatient discharge summaries with VA. Department officials have stated
that results-oriented goals and measures for the other five
interoperability objectives will be included in the next version of the
DOD/VA Joint Executive Council Joint Strategic Plan, expected to be
completed by December 2009. To the extent that the departments
establish and effectively use results-oriented goals and measures for
their interoperability objectives, they will be better positioned to
gauge their progress toward achieving fully interoperable capabilities
and improving veterans' health care.
Further, development of an integrated master schedule is a key IT
program management activity, especially given the magnitude and
complexity of the departments' efforts to achieve full
interoperability. According to DOD guidance,[Footnote 11] an integrated
master schedule should identify detailed project tasks and the
associated start, completion, and interim milestone dates; resource
needs; and relationships (e.g., sequence and dependencies) between
tasks.
While the program office has begun to develop an integrated master
schedule as required by its charter, the current version does not
include the attributes of an effective schedule. For example, the
schedule included limited information--only the name of the objective
and a completion date of September 30, 2009--for three of the six
interoperability objectives (i.e., refine social history data, share
physical exam data, and expand questionnaires and self assessment
tools). The schedule did not include information on tasks to be
performed to meet the objectives, nor start dates, resource needs, or
relationships between tasks for any of the six objectives. Without a
complete and detailed integrated master schedule, the departments are
devoid of critical information that could be vital to their ability to
appropriately respond to project needs and guide project efforts.
Similarly, development of a project plan is an important activity for
IT program management. Industry best practices and IT program
management principles stress the importance of sound planning for any
project. Inherent in such planning is the development and use of a
project management plan that describes, among other things, the
project's scope, resource needs, and key milestones. The interagency
program office charter identified the need to develop a project plan
but, as of late June, the office had not yet done so. As we have noted
in our prior work,[Footnote 12] without a project plan, the departments
lack a key tool that could be used to guide their efforts in achieving
full interoperability.
In discussing these activities, the interagency program office's
interim director and former acting director cited three reasons for why
performance measurement, scheduling, and project planning
responsibilities had not been accomplished. First, they stated that
because it has taken longer than anticipated to hire staff, the office
has not been able to perform all of its responsibilities. Second, the
office's interim leadership and staff have focused their efforts on
providing interested parties (e.g., federal agencies and military
organizations) with briefings, presentations, and status information on
activities the office is undertaking to achieve interoperability, in
addition to participating in efforts to develop a strategy for
implementation of the Virtual Lifetime Electronic Record, which the
President announced in April 2009. Finally, according to the officials,
the office waited until June to begin the process of developing
performance metrics so that it could do so in conjunction with the
departments' annual update to the Joint Strategic Plan that is
scheduled for completion in December 2009.
In the absence of sufficient metrics to monitor progress, a complete
integrated master schedule, and a project plan, the interagency program
office's ability to effectively provide oversight and management,
including meaningful reporting on the progress and delivery of
interoperable capabilities, is jeopardized. As importantly, the absence
of these critical management tools calls into question the
effectiveness of this office in functioning as the single point of
accountability for achieving full interoperability, and the
departments' overall success in meeting this goal.
VA and DOD Are Taking Steps to Meet their Objectives, but Activities to
Meet Clinicians' Needs Are Expected to Remain After the Deadline for
Achieving Full Interoperability:
VA and DOD continue to take steps toward achieving full
interoperability by September 30, 2009. In this regard, the departments
have achieved planned capabilities for three of the objectives--refine
social history data, share physical exam data, and demonstrate initial
network gateway operation. Specifically, with regard to these
objectives, the departments have accomplished the following
capabilities:
* The sharing of viewable social history data captured in DOD's
electronic health record, thus providing VA with additional clinical
information on shared patients that clinicians could not previously
view. These data describe, for example, patients' involvement in
hazardous activities and tobacco and alcohol use.
* The sharing of physical exam data, allowing VA to view DOD's medical
exam data through the BHIE interface, which supports the physical exam
process when a service member separates from active military duty. VA
clinicians are able to view outpatient treatment records, pre-and post-
deployment health assessments, and post deployment health reassessments.
* The operation of secure network gateways to support health
information sharing between the departments, thus facilitating future
growth in data sharing. As of early July, the departments reported that
five network gateways were operational and that data migration to two
of the operational gateways had begun.[Footnote 13] The departments
believed these five gateways satisfy the intent of the objective and
will provide sufficient capacity to support health information sharing
between VA and DOD as of September 2009.
For the remaining three objectives--expand questionnaires and self
assessment tools, expand Essentris in DOD, and demonstrate initial
document scanning--the departments have partially achieved planned
capabilities, with additional work needed to fully meet clinicians'
needs.
Specifically, for the objective to expand questionnaires and self
assessment tools, the departments intend to provide all periodic health
assessment data stored in the DOD electronic health record to VA in a
format that associates questions with responses. Health assessment data
is collected from two sources: questionnaires administered at military
treatment facilities and a DOD health assessment reporting tool that
enables patients to answer questions about their health upon entry into
the military. Questions relate to a wide range of personal health
information, such as dietary habits, physical exercise, and tobacco and
alcohol use. While the departments have established the capability for
VA to view questions and answers from the questionnaires collected by
DOD at military treatment facilities, they have not yet established the
additional capability for VA to view information from DOD's health
assessment reporting tool. Department officials stated that they intend
to provide this capability by September 2009.
However, the other two objectives--expand Essentris in DOD and
demonstrate initial document scanning--are expected to require
substantial additional work beyond September to meet clinicians' needs.
By September 30, DOD intends to expand its Essentris system to at least
one additional site for each military medical service and to increase
the percentage of inpatient discharge summaries that it shares
electronically with VA to 70 percent. According to the interim director
of the interagency program office, as of late June 2009, the
departments had expanded the system to two Army sites (but not yet to
an Air Force or Navy site) and were sharing 58 percent of inpatient
discharge summaries. The interim director stated that the departments
expect to share 70 percent of inpatient discharge summaries and expand
the system to an Air Force and a Navy site by the September deadline.
Nevertheless, the official added that to better meet clinicians' needs,
DOD will need to further expand the inpatient medical records system.
In this regard, the department has established a future goal of making
the inpatient system operational for 92 percent of DOD's inpatient beds
by September 2010.
The departments also expect to demonstrate an initial capability to
scan service members' medical documents into the DOD electronic health
record and share the documents electronically with VA by September
2009. According to the program office interim director, the departments
were in the process of setting up an interagency test environment to
test the initial capability to query medical documents associated with
specific patients as of late June 2009. He stated that the departments
expect to begin user testing at up to nine sites by September 2009.
According to this official, these activities are expected to
demonstrate an initial document scanning capability. However, after
September 2009, the departments anticipate needing to perform
additional work to expand their initial document scanning capability
(e.g., completion of user testing and establishment of the scanning
capability at all DOD sites).
In conclusion, VA and DOD have continued to increase electronic health
information interoperability, and have taken steps to meet the six
objectives that they identified as necessary to achieve full
interoperability by September 30, 2009. However, for two of the six
interoperability objectives, the departments subsequently plan to
perform significant additional activities that are necessary to meet
clinicians' needs. Further, the departments' lack of progress in
establishing fundamental IT management capabilities that are the
specific responsibilities of the interagency program office contributes
to uncertainty about the extent to which they will achieve full
interoperability by the deadline. Although the departments have
generally made progress toward making the program office operational,
the absence of performance metrics, and a complete integrated master
schedule and a project plan, limits the office's ability to effectively
manage and provide meaningful progress reporting on the delivery of
interoperable capabilities that are deemed critical to improving the
quality of health care for our nation's veterans.
To better improve the management of VA's and DOD's efforts to achieve
fully interoperable electronic health record systems, our draft report
recommends that the Secretaries of Defense and Veterans Affairs
emphasize the interagency program office's establishment of a project
plan and a complete and detailed integrated master schedule.
Mr. Chairman, this concludes my prepared statement. I would be pleased
to respond to any questions that you or other members of the
subcommittee may have.
Contact and Acknowledgments:
If you have any questions on matters discussed in this testimony,
please contact Valerie C. Melvin, Director, Information Management and
Human Capital Issues, at (202) 512-6304 or melvinv@gao.gov. Other
individuals who made key contributions to this testimony are Mark Bird,
Assistant Director; Rebecca Eyler; Michael Redfern; J. Michael Resser;
Kelly Shaw; Eric Trout; and Merry Woo.
[End of section]
Footnotes:
[1] Pub. L. No. 110-181, § 1635 (2008).
[2] Interoperability is the ability of two or more systems or
components to exchange information and to use the information that has
been exchanged. Further discussion of levels of interoperability is
provided later in this testimony.
[3] An electronic health record is a collection of information about
the health of an individual or the care provided, including patient
demographics, progress notes, problems, medications, vital signs, past
medical history, immunizations, laboratory data, and radiology reports.
[4] These levels were identified by the Center for Information
Technology Leadership, which was chartered in 2002 as a research
organization to help guide the health care community in making more
informed strategic IT investment decisions. According to VA and DOD,
the different levels of interoperability have been accepted for use by
the Office of the National Coordinator for Health Information
Technology.
[5] Pub. L. No. 110-181, § 1635 (2008).
[6] This board was originally named the Joint Clinical Information
Board.
[7] FHIE, enhanced through its completion in 2004, provides a one-way
transfer of data that enables DOD to electronically transfer service
members' electronic health information to VA when the members leave
active duty.
[8] BHIE, established in 2004, was aimed at allowing clinicians at both
departments viewable access to records on shared patients--that is,
those who receive care from both departments. For example, veterans may
receive outpatient care from VA clinicians and be hospitalized at a
military treatment facility. To create BHIE, the departments drew on
the architecture and framework of the information transfer system
established by the FHIE project. Unlike FHIE, BHIE is a two-way
interface that allows clinicians in both departments to view, in real
time, limited health data (in text form) from the departments' existing
health information systems. The interface also allows DOD sites to see
previously inaccessible data at other DOD sites.
[9] Combining the names of the two repositories, the Clinical Data
Repository/Health Data Repository (CHDR) interface, pronounced
"cheddar," implemented in September 2006, linked the department's
separate repositories of standardized data to enable a two-way exchange
of computable health information. These repositories are a part of the
modernized health information systems that the departments have been
developing--DOD's AHLTA and VA's HealtheVet.
[10] GAO, Electronic Health Records: DOD's and VA's Sharing of
Information Could Benefit from Improved Management, [hyperlink,
http://www.gao.gov/products/GAO-09-268] (Washington, D.C.: Jan. 28,
2009).
[11] DOD Integrated Master Plan and Integrated Master Schedule
Preparation and Use Guide, Version 0.9, October 21, 2005.
[12] GAO, Computer-Based Patient Records: VA and DOD Efforts to
Exchange Health Data Could Benefit from Improved Planning and Project
Management, [hyperlink, http://www.gao.gov/products/GAO-04-687]
(Washington, D.C.: June 7, 2004).
[13] The five operational gateways are located in Dallas, Texas;
Reston, Virginia; Kansas City, Missouri; North Chicago, Illinois; and
Santa Clara, California.
[End of section]
GAO's Mission:
The Government Accountability Office, the audit, evaluation and
investigative arm of Congress, exists to support Congress in meeting
its constitutional responsibilities and to help improve the performance
and accountability of the federal government for the American people.
GAO examines the use of public funds; evaluates federal programs and
policies; and provides analyses, recommendations, and other assistance
to help Congress make informed oversight, policy, and funding
decisions. GAO's commitment to good government is reflected in its core
values of accountability, integrity, and reliability.
Obtaining Copies of GAO Reports and Testimony:
The fastest and easiest way to obtain copies of GAO documents at no
cost is through GAO's Web site [hyperlink, http://www.gao.gov]. Each
weekday, GAO posts newly released reports, testimony, and
correspondence on its Web site. To have GAO e-mail you a list of newly
posted products every afternoon, go to [hyperlink, http://www.gao.gov]
and select "E-mail Updates."
Order by Phone:
The price of each GAO publication reflects GAO‘s actual cost of
production and distribution and depends on the number of pages in the
publication and whether the publication is printed in color or black and
white. Pricing and ordering information is posted on GAO‘s Web site,
[hyperlink, http://www.gao.gov/ordering.htm].
Place orders by calling (202) 512-6000, toll free (866) 801-7077, or
TDD (202) 512-2537.
Orders may be paid for using American Express, Discover Card,
MasterCard, Visa, check, or money order. Call for additional
information.
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: [hyperlink, http://www.gao.gov/fraudnet/fraudnet.htm]:
E-mail: fraudnet@gao.gov:
Automated answering system: (800) 424-5454 or (202) 512-7470:
Congressional Relations:
Ralph Dawn, Managing Director, dawnr@gao.gov:
(202) 512-4400:
U.S. Government Accountability Office:
441 G Street NW, Room 7125:
Washington, D.C. 20548:
Public Affairs:
Chuck Young, Managing Director, youngc1@gao.gov:
(202) 512-4800:
U.S. Government Accountability Office:
441 G Street NW, Room 7149:
Washington, D.C. 20548:
