United States Government Accountability Office

Washington, DC 20548 

April 30, 2007 

The Honorable Ike Skelton 

Chairman 

The Honorable Duncan Hunter 

Ranking Member 

Committee on Armed Services 

House of Representatives 

The Honorable Vic Snyder 

Chairman 

The Honorable John M. McHugh 

Ranking Member 

Subcommittee on Military Personnel 

Committee on Armed Services 

House of Representatives 

Subject: DOD and VA Outpatient Pharmacy Data: Computable Data Are 

Exchanged for Some Shared Patients, but Additional Steps Could 

Facilitate Exchanging These Data for All Shared Patients

Since 1998, the Department of Defense (DOD) and the Department of Veterans

Affairs (VA) have been working to electronically exchange patient health data, 

including outpatient pharmacy data,1

 across their electronic health information

systems. Exchanging outpatient pharmacy data is important for DOD and VA because 

certain DOD and VA patients, known as shared patients, receive health care from 

both agencies. Clinicians’ access to complete health information from both agencies’ 

health information systems could assist clinicians in making more informed medical 

decisions and help prevent adverse medication reactions—which include detrimental 

or unintended reactions when multiple medications are taken together and allergic 

reactions to a medication. In March 2004, DOD and VA began collaborating on a longterm initiative to make their outpatient pharmacy data computable. Computable data 

refer to data that are in a format that a computer application can act on: for example, 

to provide automatic checks for adverse medication reactions or to plot graphs of 

changes in vital signs such as blood pressure. 

 1

Patient health data also include demographic, radiology, laboratory, and allergy data. Outpatient pharmacy data refer to

information on medications dispensed and medication allergies.

GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
In reporting on this initiative in the past, we have noted that the agencies have 

experienced delays in their efforts to begin exchanging computable outpatient 

pharmacy data.2

 Concerned about DOD’s and VA’s progress in this effort, you asked 

us to examine the initiative that the agencies have under way to make their outpatient 

pharmacy data computable. In this report, we provide information on 

• DOD's and VA's expectations of what the exchange of computable outpatient 

pharmacy data will provide in safeguards against adverse medication reactions 

for shared patients. 

• The status of DOD’s and VA’s initiative for attaining computable outpatient 

pharmacy data. 

To address the objectives, we analyzed documents and interviewed officials from 

DOD and VA about the agencies’ efforts to exchange computable outpatient 

pharmacy data for shared patients. We also viewed a demonstration of DOD’s and 

VA’s exchange of computable outpatient pharmacy data in El Paso, Texas, where 

DOD and VA first exchanged these data for shared patients. We conducted our work 

from July 2006 through April 2007 in accordance with generally accepted government 

auditing standards. 

On April 3, 2007, we provided a briefing to your offices on the results of this work. 

The briefing slides, included as enclosure I, have been updated to include more 

current information. This report summarizes the information presented in the briefing 

and officially transmits our recommendations to the Secretary of Defense and the 

Secretary of Veterans Affairs. 

Results in Brief

DOD and VA expect the exchange of computable outpatient pharmacy data to 

provide each agency with seamless access to shared patients’ medication histories 

and more complete electronic checks for adverse medication reactions. Officials 

expect information on outpatient medications dispensed by either agency’s health 

care system to be stored in each agency’s repository in the standardized vocabulary 

each agency uses, following translation from a standardized set of terms, which will 

allow either agency’s electronic health information system to include the other 

agency’s data in its automatic checks. According to DOD and VA officials, having 

pharmacy data from both DOD and VA, rather than data from a single agency, could 

reduce adverse medication reactions by providing more complete checks for shared 

patients. 

DOD and VA are exchanging computable outpatient pharmacy data for some shared 

patients, but have not completed steps important for exchanging these data for all 

shared patients. DOD and VA developed an electronic interface—Clinical Data 

Repository/Health Data Repository (CHDR)—that links DOD’s and VA’s health data 

repositories and allows for the exchange of computable data between them. Before 

 2

GAO, Information Technology: VA and DOD Face Challenges in Completing Key Efforts, GAO-06-905T (Washington, D.C.: 

June 22, 2006).

2 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
computable data can be exchanged, patients who use both DOD’s and VA’s health 

care systems must be identified as shared patients and then activated, which refers to 

shared patients being matched on certain identifiers—first name, last name, date of 

birth, Social Security Number—in both agencies’ health information systems and 

established as “active” shared patients. DOD and VA have begun exchanging 

computable outpatient pharmacy data through CHDR for patients activated at seven 

locations as of March 2007.3

 In addition, DOD officials indicated that all 1174 DOD 

sites in the continental United States, Alaska, and Hawaii will be able to activate 

shared patients by the end of June 2007; VA indicated that all 128 VA sites will be able 

to activate shared patients by mid-September 2007. DOD and VA have been 

addressing three issues that hinder their ability to exchange computable outpatient 

pharmacy data for all shared patients. 

• DOD and VA officials have identified two problems that prevent them from 

activating some shared patients. In some cases, patient information does not 

match exactly on all identifiers. In addition, VA patients who were discharged 

from active duty before 1997 may not have a unique identification number that 

DOD assigns to its beneficiaries, and without this number, these patients 

cannot be activated. According to DOD and VA, the agencies are working to 

resolve these problems. DOD stated that in February 2007 it completed a 

software upgrade to help resolve problems with matching patients’ identifying 

information. Similarly, VA officials told us that VA is developing a software 

upgrade, but could not provide a date for when its upgrade would be 

operational. In addition, DOD reported that it is working with a VA-provided 

list of patients who are receiving care from VA and were discharged from 

active duty before 1997. DOD reported that it will create unique identification 

numbers for these patients and anticipates this effort will be completed by the 

end of September 2007. 

• VA must expand to all its 128 sites the capability to automatically check DOD 

data that are exchanged through CHDR. VA officials said this capability was in 

place at 10 sites as of March 2007 and expect it to be in place at all VA sites by 

the end of July 2007. 

• While DOD and VA officials told us that guidelines for identifying shared 

patients would help sites determine which patients should be activated, the 

agencies have not established written guidelines, including criteria to define 

shared patients and procedures to identify shared patients, for all sites to use. 

DOD expects the guidelines to be completed by the end of June 2007. 

 3

Each location includes one DOD site and one VA site at the same location or in close proximity. A site represents 

one or more facilities—medical centers, hospitals, or outpatient clinics—that store their electronic health data in 

a single database. 

4

According to DOD officials, there are a total of 138 sites, 21 of which are located outside the United States and 

will likely not activate patients.

3 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Until DOD and VA take additional steps to ensure all shared patients benefit from the 

exchange of computable pharmacy data, many shared patients will not receive the 

benefit of more complete automatic electronic checks for adverse medication 

reactions. To meet the timelines for resolving the three issues identified, it will be 

important for the agencies to make these efforts a priority, given previous delays in 

developing the capability to exchange computable data.

To help ensure that all shared patients benefit from the exchange of computable 

outpatient pharmacy data, the Secretary of Defense and the Secretary of Veterans 

Affairs should expedite certain ongoing efforts. Specifically, we recommend that 

(1) the Secretary of Defense and the Secretary of Veterans Affairs expedite efforts to 

develop a solution for activating shared patients when patients’ identifying 

information does not match exactly, (2) the Secretary of Defense expedite efforts to 

assign a unique DOD identification number to VA patients who were discharged from 

active duty before 1997, (3) the Secretary of Veterans Affairs expedite efforts to

expand to all VA sites the capability to automatically check DOD data that are 

exchanged through CHDR, and (4) the Secretary of Defense and the Secretary of 

Veterans Affairs expedite the development of written guidelines for all sites to use for 

defining and identifying shared patients. 

Agency Comments 

In commenting on a draft of this report, DOD and VA concurred with our findings and 

recommendations. (DOD’s and VA’s comments are reprinted in enclosures II and III, 

respectively.) DOD stated that it will expedite efforts for the identified 

recommendations to be completed by the specified time frames. VA stated that the 

two agencies are taking the necessary steps to overcome issues that have hindered 

their ability to exchange computable outpatient pharmacy data for all shared 

patients. DOD and VA provided updated information on their efforts and DOD 

provided technical comments. We incorporated updated information and technical 

comments where appropriate. 

- - - - - 

We are sending copies of this report to the Secretary of Defense, the Secretary of 

Veterans Affairs, and appropriate congressional committees. We will also provide 

copies to others upon request. In addition, the report is available at no charge on 

GAO’s Web site at http://www.gao.gov. 

If you and your staff have any questions or need additional information, please 

contact Laurie Ekstrand at (202) 512-7101 or ekstrandl@gao.gov or Valerie Melvin at 

(202) 512-6304 or melvinv@gao.gov. Contact points for our Offices of Congressional 

Relations and Public Affairs may be found on the last page of this report. Major 

4 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
contributors to this report were James Musselwhite, Assistant Director; Barbara 

Oliver, Assistant Director; Janina Austin; Jacqueline Bauer; Manuel Buentello;

Christina C. Serna; and Eric Trout. 

Laurie E. Ekstrand 

Director, Health Care 

Valerie C. Melvin 

Acting Director, Information Technology 

 Human Capital and Management Issues 

Enclosures – 3 

5 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

1

DOD and VA Outpatient Pharmacy Data: Computable 

Data Are Exchanged for Some Shared Patients, but 

Agencies Have Not Completed Steps Important for 

Exchanging These Data for All Shared Patients

Briefing to Congressional Staff

Updated

6 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

2

DOD and VA Outpatient Pharmacy Data: Computable 

Data Are Exchanged for Some Shared Patients, but 

Agencies Have Not Completed Steps Important for 

Exchanging These Data for All Shared Patients

Congressional Requesters:

Chairman, Honorable Ike Skelton

Ranking Member, Honorable Duncan Hunter

House Committee on Armed Services

Chairman, Honorable Vic Snyder

Ranking Member, Honorable John M. McHugh

Subcommittee on Military Personnel 

House Committee on Armed Services

7 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

3

Overview

• Introduction

• Objectives

• Scope and Methodology

• Background

• Findings

8 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

4

Introduction

• For decades, Congress has encouraged the Department of Defense (DOD) 

and the Department of Veterans Affairs (VA) to increase their resourcesharing activities to help clinicians—physicians and pharmacists—deliver 

health care services more efficiently and increase the quality of care

provided to those who receive care from both DOD and VA. 

• Since 1998, DOD and VA have been working to electronically exchange 

patient health data, including outpatient pharmacy data,1 for active duty 

military personnel and veterans. 

• Exchanging outpatient pharmacy data is important for DOD and VA because 

certain DOD and VA patients, known as shared patients, receive health care 

from both agencies. 

1Patient health data also include demographic, radiology, laboratory, and allergy data. Outpatient pharmacy data refer to information on

medications dispensed and medication allergies.

9 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

5

Introduction

• There are two ways shared patients may receive care from both DOD and 

VA health care systems. 

1. Through local agreements between DOD and VA, some patients may be 

referred from one agency’s facility to the other’s for care that the

referring facility does not provide.

2. Based on DOD’s and VA’s respective criteria for health care eligibility, 

some patients may be eligible for care under both systems (for example, 

many military retirees are eligible for both DOD and VA health care).

• Clinicians’ access to complete health information from both agencies’ health 

information systems could assist clinicians in making more informed medical 

decisions.

• Exchange of pharmacy data for shared patients could help prevent adverse

medication reactions—including detrimental or unintended reactions when 

multiple medications are taken together and allergic reactions to a 

medication.

10 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

6

Introduction

• The Bob Stump National Defense Authorization Act for Fiscal Year 2003 

required DOD and VA to develop outpatient pharmacy data systems that provide 

a real-time interface, data exchange, and checking of prescription drug data 

using national standards by October 1, 2004.2

• In March 2004, DOD and VA began collaborating on a long-term initiative to 

make their patient health data, including outpatient pharmacy data, computable. 

Computable data refer to data that are in a format that a computer application 

can act on: for example, to provide automatic checks for adverse medication 

reactions or to plot graphs of changes in vital signs such as blood pressure.

• In reporting on this long-term initiative in the past, we have noted that the 

agencies have experienced delays in their efforts to begin exchanging 

computable outpatient pharmacy data.3 We reported that DOD and VA originally 

planned to begin exchanging computable outpatient pharmacy data by October 

2005.

2Pub. L. No. 107-314, § 724, 116 Stat. 2458, 2598 (2002). In September 2004, the agencies completed testing of a prototype that allowed 

their systems to demonstrate these capabilities. 3GAO, Information Technology: VA and DOD Face Challenges in Completing Key Efforts, GAO-06-905T (Washington, D.C.: June 22, 2006).

11 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

7

Introduction

• In 2004, DOD and VA also began a separate initiative to electronically 

exchange read-only health data in near real-time for shared patients, which 

would allow DOD and VA clinicians to view data from each other’s health 

information system. As of March 2007, all 128 VA sites and 22 of 138 DOD

sites had the capability to electronically view data.4

• While DOD and VA officials said the capability to electronically view patients’ 

health data from both agencies’ systems has improved the quality of the 

health care they provide, agency officials expect computable data to further

enhance the quality of health care provided.

• The capability of electronic health information systems to check and provide 

alerts for adverse medication reactions supplements, but does not replace,

clinicians’ standard practices of medical care, which include asking patients

about their medication and medication-allergy histories and reviewing 

patients’ medical files for their medication histories. 4A site represents one or more facilities—medical centers, hospitals, or outpatient clinics—that store their electronic health data in a single 

database.

12 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

8

Objectives

1. To describe DOD's and VA's expectations of what the exchange of 

computable outpatient pharmacy data will provide in safeguards against 

adverse medication reactions for shared patients.

2. To provide the status of DOD’s and VA’s initiative for attaining computable

outpatient pharmacy data.

13 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

9

Scope and Methodology

• Analyzed documents and interviewed officials from DOD and VA about the 

agencies’ efforts to exchange computable outpatient pharmacy data for 

shared patients.

• Viewed demonstrations at medical facilities in the Washington, D.C. area of

the capabilities of DOD’s and VA’s electronic health information systems. 

These demonstrations included how clinicians view a patient’s medication 

history and are alerted to adverse medication reactions, but did not involve 

computable data.

• Viewed a demonstration in El Paso, Texas of DOD’s and VA’s initiative to 

exchange computable pharmacy data for shared patients at two co-located

sites—William Beaumont Army Medical Center and the El Paso VA Health

Care System—where DOD and VA first exchanged computable pharmacy

data for shared patients.

• Conducted our work from July 2006 through April 2007 in accordance with 

generally accepted government auditing standards.

14 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

10

Background

DOD patients may receive health care and get medications from several 

points of service.

• DOD patients can receive health care from

• DOD military treatment facilities (MTF) at 138 sites, which include over 

70 hospitals and 400 clinics

• Private physicians (network and nonnetwork).

5

• DOD patients can get medications from

• MTF pharmacies

• DOD’s mail order pharmacy

• Private pharmacies (network and nonnetwork). 

5Network refers to TRICARE’s network—a regionally structured program that uses civilian contractors to maintain provider and pharmacy 

networks to complement health care services provided at MTFs.

15 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

11

Background

VA patients may receive health care and get medications from the VA 

health care system.

• VA patients can receive health care from facilities at 128 VA sites, which 

include 155 hospitals and 881 clinics.

• VA patients can obtain medications from VA-facility pharmacies and VA’s 

seven mail order pharmacies.

• In some cases, VA uses private physicians to provide care to patients 

who are in need of a service that VA is unable to provide. If one of these 

private physicians prescribes a medication, the medication is filled at a VA 

pharmacy.

16 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

12

Background

DOD and VA have each developed a repository—centralized electronic 

storage—for health data, including data on medications dispensed and 

patients’ allergies to medications. 

• Patient health data from DOD’s and VA’s health care facilities and 

pharmacies are aggregated in local databases maintained at DOD and VA 

sites, respectively.

• Patient data are transferred from DOD sites’ local databases to DOD’s 

Clinical Data Repository (CDR)6 and from VA sites’ local databases to VA’s 

Health Data Repository (HDR).

• For example, the El Paso, Texas location has one DOD site and one VA 

site. Patient health data from the DOD site, composed of one medical 

center and two clinics, and the VA site, composed of three clinics, are 

aggregated in each site’s database and then transferred to the 

corresponding agency’s data repository. 6Information on medications dispensed is aggregated and transferred to CDR by DOD’s Pharmacy Data Transaction Service (PDTS). DOD

also uses PDTS for pharmacy billing and for verifying whether patients are eligible for DOD pharmacy benefits.

17 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

13

Background

DOD and VA clinicians can electronically view the medications

dispensed to patients at any facility in their respective health care 

systems and, in certain cases, view medications dispensed to shared

patients in the other agency’s system. 

• MTF physicians and MTF pharmacists can view information identifying 

medications dispensed at all MTF pharmacies, DOD’s mail order

pharmacy, private network pharmacies, and at private nonnetwork

pharmacies if a claim for reimbursement is submitted. 

• However, private physicians and private pharmacists (network and

nonnetwork) and DOD’s mail order pharmacy are unable to electronically 

view information identifying DOD patients’ medications.

18 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

14

Background

DOD and VA clinicians can electronically view the medications

dispensed to patients at any facility in their respective health care 

systems and, in certain cases, view medications dispensed to shared

patients in the other agency’s system (cont.).

• In addition, DOD physicians at the facilities associated with the 22 DOD 

sites capable of exchanging shared patient data can view medications 

dispensed to shared patients at all VA facility pharmacies. These data are 

not computable.

• VA physicians and pharmacists at all VA facilities can electronically view 

medications dispensed from all VA facility pharmacies, VA’s mail order 

pharmacies, and those MTF pharmacies that exchange shared patient 

data.

19 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

15

Background

DOD and VA have developed automatic checks and alerts for their 

respective health information systems. 

• DOD can perform automatic checks and provide alerts to MTF clinicians if 

a new medication order will have an adverse medication reaction with 

medications previously dispensed within DOD’s health care system7—

global checks—and medication allergies recorded at all MTFs.

• VA can perform automatic checks and provide alerts to VA clinicians if a

new medication order will have an adverse medication reaction with

medications ordered and dispensed and medication allergies recorded at

facilities associated with the same VA site—local checks.

• As of March 2007, health care facilities at 10 VA sites could perform 

global checks on medications ordered and dispensed and medication 

allergies recorded at all VA facilities.

7Medications previously dispensed within DOD’s health care system include medications dispensed at MTFs, DOD’s mail order pharmacy,

private network pharmacies, and at private nonnetwork pharmacies if a claim for reimbursement is submitted.

20 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

16

Background

Exchanging computable data between agencies’ health information 

systems requires that the agencies adopt common standards for clinical 

terminologies and for the transmission of information across systems. 

• In 2001, the Office of Management and Budget began the Consolidated 

Health Informatics (CHI) initiative, which was a collaborative agreement 

among federal agencies, including DOD and VA, to adopt a common set 

of health information standards for the electronic exchange of clinical 

health information.8

• As part of the CHI initiative, DOD and VA began to adopt standard 

medication terminologies.

• CHI did not identify common standards for medication allergies.

8According to DOD and VA officials, on September 30, 2006, the CHI initiative was dissolved and will be integrated with the Health

Information Technology Standards Panel, a public-private collaborative effort.

21 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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17

Findings

DOD and VA Expect Computable Outpatient Pharmacy Data to Allow 

Seamless Access to Shared Patients’ Medication Histories and More 

Complete Electronic Checks for Adverse Medication Reactions

DOD and VA Are Exchanging Computable Outpatient Pharmacy Data for 

Some Shared Patients, but Have Not Completed Steps Important for

Exchanging These Data for All Shared Patients

22 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

18

DOD and VA Expect Computable Outpatient Pharmacy Data to 

Allow Seamless Access to Shared Patients’ Medication 

Histories and More Complete Electronic Checks for Adverse 

Medication Reactions

DOD and VA officials expect information on outpatient medications 

dispensed to shared patients by either agency’s health care system to 

be stored in both agencies’ health data repositories, which would 

expand the data included in agencies’ electronic checks for adverse 

medication reactions.

• Shared patients’ health data, including medication and medication-allergy 

data, are to be stored in each agency’s repository in the standardized 

vocabulary each agency uses, following translation from a standardized 

set of terms, thus allowing either agency’s electronic health information 

system to process the other agency’s data as if the data had originated in

its own system.

• According to DOD and VA officials, this capability is expected to enable 

automatic checks for adverse medication reactions and to enable 

clinicians to receive automatic alerts for any adverse medication reactions 

that have been identified, regardless of which agency’s facility dispensed 

the medication or recorded the medication-allergy information.

23 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

19

DOD and VA officials expect information on outpatient medications 

dispensed to shared patients by either agency’s health care system to 

be stored in both agencies’ health data repositories, which would 

expand the data included in agencies’ electronic checks for adverse 

medication reactions (cont.).

• Automated alerts are intended to inform physicians and pharmacists when 

a newly prescribed medication is potentially adversely reactant to a 

medication previously dispensed or whether a patient has an identified 

allergy to the newly prescribed medication.

• According to DOD and VA officials, using pharmacy data from both DOD 

and VA, rather than data from a single agency, could reduce adverse 

medication reactions by providing more complete checks for shared 

patients.

24 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

20

DOD officials also expect computable outpatient pharmacy data to

increase the checking capabilities of private pharmacists in DOD’s 

network.

• According to DOD officials, the medications that private pharmacists in 

DOD’s network dispense are expected to be checked for detrimental or 

unintended reactions to medications previously dispensed within VA’s 

system; the pharmacist is to receive an alert if a potential adverse

reaction is found.

25 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

21

DOD and VA Are Exchanging Computable Outpatient Pharmacy 

Data for Some Shared Patients, but Have Not Completed Steps 

Important for Exchanging These Data for All Shared Patients

DOD and VA have developed the capability to exchange computable 

outpatient pharmacy data.9

• DOD and VA have developed an electronic interface—Clinical Data 

Repository/Health Data Repository (CHDR)—that links DOD’s CDR and 

VA’s HDR and allows for the exchange of computable data between the 

two data repositories.

• Before computable data can be exchanged, patients who use both DOD’s 

and VA’s health care systems must be identified as shared patients and 

then activated, which refers to shared patients being matched on certain 

identifiers—first name, last name, date of birth, Social Security Number—

in both agencies’ health information systems and established as “active” 

shared patients. 

9DOD and VA envision exchanging other computable patient health data through CHDR. Agency officials indicated that they also have efforts

underway to develop the capability to exchange computable clinical laboratory data.

26 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

22

DOD and VA are currently exchanging computable outpatient pharmacy 

data through CHDR for patients activated at seven locations.10

• DOD and VA officials said that, as of March 2007, the agencies had 

exchanged computable outpatient pharmacy data for about 4,000 patients 

activated at the seven locations.

• We viewed a successful demonstration of the exchange of computable 

outpatient pharmacy data at one location in El Paso, Texas—the William 

Beaumont Army Medical Center and the El Paso VA Health Care System. 

10Each location represents one DOD site and one VA site in the same location or in close proximity.

27 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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23

DOD and VA are currently exchanging computable outpatient pharmacy 

data through CHDR for patients activated at seven locations (cont.). 

• In addition to El Paso, DOD and VA have begun exchanging computable 

outpatient pharmacy data for patients activated at six other locations:

• Eisenhower Army Medical Center and Augusta VA Medical Center

• Madigan Army Medical Center and VA Puget Sound Health Care 

System

• Mike O’Callaghan Federal Hospital and VA Southern Nevada Health

Care System

• Naval Health Clinic, Great Lakes and North Chicago VA Medical Center

• Naval Hospital Pensacola and VA Gulf Coast Veterans Health Care 

System 

• Naval Medical Center San Diego-Balboa and VA San Diego Health 

Care System

28 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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24

Locations of Sites Activating Shared Patients, March 2007

29 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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25

DOD and VA officials anticipate that all sites in the continental United 

States, Alaska, and Hawaii will activate shared patients.

• DOD officials expect that all 11711 DOD sites in the continental United

States, Alaska, and Hawaii will be able to activate shared patients by the 

end of June 2007.

• VA officials expect that all 12812 VA sites will be able to activate shared 

patients by mid-September 2007.

• Although all sites are not currently activating shared patients, officials 

indicated that all DOD and VA sites can exchange computable pharmacy 

data for patients previously activated at other sites. 

11According to DOD officials, 21 of the agency’s 138 sites are outside the United States and will likely not activate patients.

12According to VA officials, all of the agency’s 128 sites are within the United States.

30 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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26

DOD and VA have been addressing issues that the agencies 

acknowledge have hindered their ability to exchange all computable 

outpatient pharmacy data for activated shared patients. 

• Because a national standard does not exist for medication-allergy data, 

DOD and VA have agreed on and adopted a standard for exchanging 

these data. 

• Adopted standard medication terminologies do not include terminologies 

for all medications.

• Standard medication terminologies must be continuously updated as new 

medications become available.

• DOD and VA have developed a team to review data that cannot be 

exchanged13 and to work toward improving the percentage of data that

can be exchanged.

13Data may not be exchanged for reasons other than lack of standards, including formatting errors.

31 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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27

DOD and VA have been exchanging computable outpatient pharmacy 

data.

Percentage of Data Exchanged on Medications Dispensed and on Medication-allergies for 

Shared Patients Activated as of December 2006

65

78

93

90

DOD to VA

VA to DOD

Data Medications dispensed Medication allergies

Source: DOD and VA officials.

Note: According to DOD and VA officials, approximately 3,500 shared patients were activated as of December 2006.

Data may not exchange for several reasons, including lack of standard terminologies and formatting errors.

32 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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28

DOD and VA have been addressing issues that the agencies 

acknowledged have hindered their ability to activate all shared patients. 

• According to DOD and VA officials, in some cases, patient information 

does not match exactly on all identifiers. 

• For example, patients may present themselves using a nickname for one 

system and a full name for the other system. In these instances, DOD and

VA cannot activate these patients. 

• DOD assigns a unique number to DOD beneficiaries, which is needed to 

activate shared patients. However, VA patients who were discharged from

active duty before 1997 may not have this unique number.

• Without this unique number, patients cannot be recognized by DOD’s 

PDTS and therefore cannot be activated as shared patients. 

33 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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29

DOD and VA have been addressing issues that the agencies 

acknowledged have hindered their ability to activate all shared patients 

(cont.).

• To help resolve problems with matching patients’ identifying information, 

DOD reported that in February 2007 it completed a software upgrade that 

officials expect will reduce DOD’s error rate for activating shared patients 

to less than 5 percent. Similarly, VA officials told us that VA is developing 

a software upgrade, but could not provide a date for when the upgrade 

would be operational.

• For VA patients lacking a unique DOD number, DOD reported that it is 

working with a VA-provided list of patients who are receiving care from VA 

and were discharged from active duty before 1997. DOD reported that it 

will create unique identification numbers for these patients and anticipates 

this effort will be completed by the end of September 2007.

34 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

30

VA must expand its current capability to conduct global automatic 

checks to all VA sites before all sites can benefit from automatic checks 

allowed by computable outpatient pharmacy data.14

• The capability for VA sites to conduct global automatic checks of

medications ordered and dispensed and medication allergies recorded at

all VA facilities is needed for all VA sites to conduct more comprehensive 

checks across all VA sites and to automatically check DOD data that are

exchanged through CHDR.

• The capability allows VA’s health information system to process data 

originating from DOD as though the data originated from another VA site. 

14All DOD sites currently have the capability to conduct global automatic checks. 

35 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

31

VA must expand its current capability to conduct global automatic 

checks to all VA sites before all sites can benefit from automatic checks 

allowed by computable outpatient pharmacy data (cont.).

• VA officials told us that until the capability for global automatic checks is in

place at a VA site, the VA site will likely not activate shared patients.

• VA officials said that as of March 2007 this capability is in place at 10 

sites and expect it to be in place at all VA sites by the end of July 2007.

36 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure I Enclosure I 

32

According to DOD and VA officials, the agencies have not established 

written guidelines for all sites to use for identifying shared patients.

• DOD and VA officials told us they instructed the seven locations that are 

currently activating patients to identify shared patients as those who have

previously received care from both agencies. 

• DOD and VA officials told us that guidelines for all sites to use for 

identifying shared patients, including criteria defining a shared patient and 

procedures for identifying shared patients, would help sites determine

which patients should be activated. However, the agencies have not 

established written guidelines for all sites.

• Agency officials stated that the development of guidelines for all sites to 

use are under way and DOD expects the guidelines to be completed by 

the end of June 2007. Officials said that customization of the guidelines

may be necessary because of site-specific situations, such as local 

agreements.

37 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure II Enclosure II 

Comments from the Department of Defense 

38 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure II Enclosure II 

39 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure III Enclosure III 

Comments from the Department of Veterans Affairs 

40 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure III Enclosure III 

41 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
Enclosure III Enclosure III 

(290552) 

42 GAO-07-554R DOD and VA Exchange of Computable Pharmacy Data
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