Information Technology: DOD and VA Have Increased Their Sharing of Health Information, but Further Actions Are Needed
Published: 2008-09-24T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The National Defense Authorization Act for Fiscal Year 2008 required the Department of Defense (DOD) and the Department of Veterans Affairs (VA) to accelerate the exchange of health information between the departments and to develop systems or capabilities that allow for full interoperability (generally, the ability of systems to use data that are exchanged) and that are compliant with federal standards. The act also established an interagency program office to function as a single point of accountability for the effort and whose role is to implement such systems or capabilities by September 30, 2009. Further, the act required that GAO semi-annually report on the progress made in achieving these goals; its first report was issued in July 2008. In that report, GAO described the departments' progress in sharing electronic health information, developing electronic health records that comply with federal standards, and establishing the interagency program office. In this testimony, GAO discusses its July 2008 report and updated information obtained from the departments.
section_title: What GAO Found
paragraphs: DOD and VA are sharing some, but not all, electronic health information. This includes exchanging some information in computable form, which is the highest level of interoperability. In other cases, data can be viewed only--a lower level of interoperability that still provides clinicians with important information. The departments have undertaken a number of initiatives, resulting in varied sharing capabilities. However, information is still being captured in paper records at many DOD medical facilities, and not all electronic health information is being shared. Further enhancing sharing and interoperability depends on adherence to common standards. The two departments have agreed on numerous common standards and are working with federal groups and each other to ensure adherence to such standards and to align their initiatives with emerging standards. These efforts, led by the Office of the National Coordinator for Health Information Technology (within the Department of Health and Human Services), include identifying relevant existing standards, identifying and addressing overlaps and gaps in the standards, and developing interoperability specifications and certification criteria based on these standards. The departments are also in the process of setting up a new interagency program office that will play a crucial role in accelerating their efforts to achieve electronic health records and capabilities that allow for full interoperability. However, the program office is not expected to be fully operational until the end of the year, which will allow the departments only 9 months to meet the deadline for full interoperability between the departments by September 2009. While DOD and VA have produced a plan for achieving interoperability within this time period, many milestones have yet to be determined. In view of the short timeframe and without a fully established program office and a complete plan with fully established milestones, the departments may be challenged in achieving interoperable electronic health records and capabilities that most effectively serve military service members and veterans.

section_title: Letter
paragraphs: I am pleased to participate in today’s hearing on the exchange of  electronic medical information between the Department of Defense  (DOD) and the Department of Veterans Affairs (VA). As you know,  the two departments have been pursuing initiatives to share data  between their health information systems for the last decade.  However, while progress has been made, questions have remained  concerning when and to what extent the intended electronic sharing  capabilities will be fully achieved.
To expedite the departments’ efforts to exchange electronic medical  information, the National Defense Authorization Act for Fiscal Year  2008 included provisions directing DOD and VA to jointly develop  and implement, by September 30, 2009, electronic health record  systems or capabilities. The act required that these systems or  capabilities be compliant with applicable interoperability standards,  and it established an interagency program office to be a single point  of accountability for the departments’ efforts.
Further, the act directed GAO to assess DOD’s and VA’s progress in  implementing the electronic health record systems and to report  semi-annually its results to the appropriate congressional  committees. Accordingly, on July 28, 2008, we issued the first of our  reports in response to the act, in which we highlighted the  departments’ progress in (1) sharing electronic health information,  (2) developing electronic records that comply with national  standards, and (3) establishing the interagency program office. At  your request, my testimony today summarizes our findings in these  three areas, as presented in that report.
In developing this testimony, we relied largely on our previous work  supporting the July 2008 report. Where available, we also obtained  and analyzed updated information about the departments’ exchange  activities. We conducted our work in support of this testimony  during August 2008 and September 2008, in Washington, D.C. 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.
subsections: section_title: Background
paragraphs: 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 critical 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.
Electronic health records are particularly crucial for optimizing the  health care provided to military personnel and veterans. While in  military status and later as veterans, many DOD and VA patients  tend to be highly mobile and may have health records residing at  multiple medical facilities within and outside the United States.  Making such records electronic can help ensure that complete  health care information is available for most military service  members and veterans at the time and place of care, no matter  where it originates.
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. (Paper-based  health records—if available—also provide necessary information,  but unlike electronic health records, do not provide decision  support capabilities, such as automatic alerts about a particular  patient’s health, or other advantages of automation.)
Interoperability can be achieved at different levels. 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. The value of data at  this level is that they are structured so that data of interest to users  are easier to find. 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 can also be considered interoperable (at the lowest level)  because they allow data to be shared, read, and interpreted by  human beings. However, my discussion today focuses only on the  three levels of electronic interoperability. Figure 1 shows the  distinction between the various levels of interoperability and  examples of the types of data that can be shared at each level.
It is important to note that not all data require the same level of  interoperability. For example, in their initial efforts to implement  computable data, DOD and VA focused on outpatient pharmacy and  drug allergy data because clinicians gave priority to the need for  automated alerts to help medical personnel avoid administering  inappropriate drugs to patients. On the other hand, for such  narrative data as clinical notes, unstructured, viewable data may be  sufficient. Achieving even a minimal level of electronic  interoperability is valuable for potentially making all relevant  information available to clinicians.
subsections: section_title: Efforts to Adopt and Implement Federal Interoperability Standards Are Ongoing
paragraphs: Any level of interoperability depends on the use of agreed-upon  standards to ensure that information can be shared and used. In the  health IT field, standards govern areas ranging from technical  issues, such as file types and interchange systems, to content issues,  such as medical terminology. Developing, coordinating, and  agreeing on standards are only part of the processes involved in  achieving interoperability for electronic health records systems or  capabilities. In addition, specifications are needed for implementing  the standards, as well as criteria and a process for verifying  compliance with the standards.
The President’s executive order of April 2004 that called for  widespread adoption of interoperable electronic health records by  2014, established the Office of the National Coordinator for Health  Information Technology within the Department of Health and  Human Services (HHS) to, among other things, develop, maintain,  and direct the implementation of a strategic plan to guide the  nationwide implementation of interoperable health IT in both the  public and private health care sectors. Under the direction of HHS  (through the Office of the National Coordinator), three primary  organizations were designated to play major roles in expanding the  implementation of health IT:   ●  The American Health Information Community was created by the  Secretary of Health and Human Services as a federal advisory body  to make recommendations on how to accelerate the development  and adoption of health IT, including advancing interoperability,  identifying health IT standards, advancing nationwide health  information exchange, and protecting personal health information.  Formed in September 2005, the community is made up of  representatives from both the public and private sectors, including  high-level DOD and VA officials. The community determines specific  health care areas of high priority and develops “use cases” for these  areas, which provide the context in which standards would be  applicable. The use cases convey how health care professionals  would use such records and what standards would apply.  ●  The Healthcare Information Technology Standards Panel, sponsored  by the American National Standards Institute and funded by the  Office of the National Coordinator, was established in October 2005  as a public-private partnership to identify competing standards for  the use cases being developed by the American Health Information  Community and to “harmonize” the standards. The panel also  develops the interoperability specifications that are needed for  implementing the standards. Interoperability specifications were  developed for each of the seven use cases developed by the  American Health Information Community in 2006 and 2007. The  community is also developing six use cases for 2008 for which  interoperability specifications have not yet been released. The  Healthcare Information Technology Standards Panel is made up of  representatives from both the public and private sectors, including  DOD and VA officials who serve as members and are actively  working on several committees and groups within the panel. This  panel is the successor to the Consolidated Health Informatics  initiative, which was dissolved and absorbed into the panel on  September 30, 2006.   ●  The Certification Commission for Healthcare Information  Technology is an independent, nonprofit organization that certifies  health IT products. HHS entered into a contract with the  commission in October 2005 to develop and evaluate the  certification criteria and inspection process for electronic health  records. According to HHS, certification is to be the process by  which the IT systems of federal health contractors are established to  meet federal interoperability standards. Certification helps assure  purchasers and other users of health IT systems that the systems  will provide needed capabilities (including ensuring security and  confidentiality) and will work with other systems without  reprogramming. Certification also encourages adoption of health IT  by assuring providers that their systems can participate in  nationwide health information exchange in the future. In 2006, the  commission certified the first 37 ambulatory—or clinician office- based—electronic health record products as meeting baseline  criteria for functionality, security, and interoperability. In 2007, the  commission expanded certification to inpatient—or hospital— electronic health record products, which could significantly  increase patients’ and providers’ access to the health information  generated during a hospitalization. To date, the commission has  certified over 100 electronic health record products.
section_title: DOD and VA Have Been Pursuing Efforts to Exchange Health Information for a Decade
paragraphs: DOD and VA have been working to electronically exchange patient  health data since 1998. As we have reported previously, their  efforts have included both short-term initiatives to share  information in existing (legacy) systems, as well as a long-term  initiative to develop modernized health information systems— replacing their legacy systems—that would be able to share data  and, ultimately, use interoperable electronic health records.
In their short-term initiatives to share information from existing  systems, the departments began from different positions. VA has  one integrated medical information system—the Veterans Health  Information Systems and Technology Architecture (VistA)—which  uses all electronic records and was developed in-house by VA  clinicians and IT personnel. All VA medical facilities have access to  all VistA information.
In contrast, DOD uses multiple legacy medical information systems,  all of which are commercial software products that are customized  for specific uses. For example, the Composite Health Care System  (CHCS) which was formerly DOD’s primary health information  system is still in use to capture pharmacy, radiology, and laboratory  information. In addition, the Clinical Information System (CIS), a  commercial health information system customized for DOD, is used  by some facilities for inpatients.
The departments’ short-term initiatives to share information in their  existing systems have included several projects:  ●  The Federal Health Information Exchange (FHIE), completed in  2004, enables DOD to electronically transfer service members’  electronic health information to VA when the members leave active  duty.  ●  The Laboratory Data Sharing Interface (LDSI), a project established  in 2004, allows DOD and VA facilities to share laboratory resources.  This interface, now deployed at nine locations, allows the  departments to communicate orders for lab tests and their results  electronically.  ●  The Bidirectional Health Information Exchange (BHIE), also  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). The interface also  allows DOD sites to see previously inaccessible data at other DOD  sites.
As part of the long-term initiative, each of the departments aims to  develop a modernized system in the context of a common health  information architecture that would allow a two-way exchange of  health information. The common architecture is to include  standardized, computable data; communications; security; and high- performance health information systems: DOD’s Armed Forces  Health Longitudinal Technology Application (AHLTA) and VA’s  HealtheVet. The departments’ modernized systems are to store  information (in standardized, computable form) in separate data  repositories: DOD’s Clinical Data Repository (CDR) and VA’s Health  Data Repository (HDR). For the two-way exchange of health  information, the two repositories are to be linked through an  interface named CHDR, which the departments began developing  in March 2004 (with implementation beginning in September 2006).
Beyond these initiatives, in January 2007, the departments  announced an addition to their information-sharing strategy: their  intention to jointly determine an approach for inpatient health  records. On July 31, 2007, they awarded a contract for a feasibility  study and exploration of alternatives. According to the  departments, one of the options would be adopting a joint solution,  which would be expected to facilitate the seamless transition of  active-duty service members to veteran status, and make inpatient  health care data on shared patients more readily accessible to both  DOD and VA. In addition, the departments believe that a joint  development effort could enable them to realize cost savings.  However, no decision on a joint inpatient health records system has  yet been made. The departments’ officials stated that they received  recommendations from the contractor on the possible approaches  for the joint inpatient electronic health record in August, but added   that they would not be prepared to release the findings from the  study until senior leadership has fully reviewed and considered the  recommendations—a step for which no date was provided.
We have previously pointed out that the many tasks and challenges  associated with the departments’ long-term goal of seamless sharing  of health information made it essential that the departments develop  a comprehensive project plan to guide these efforts to completion.  Therefore, in 2004, we recommended that the departments develop  such a plan for the CHDR interface and that it include a work  breakdown structure and schedule for all development, testing, and  implementation tasks. Further, as the departments undertook work  on their short-term initiatives, we raised concerns regarding how all  of these initiatives were to be incorporated into an overall strategy  toward achieving the departments’ goal of a comprehensive,  seamless exchange of health information.
In response to our concerns, the departments began developing a  comprehensive plan, which they called the DOD/VA Information  Interoperability Plan. To provide input to the plan and determine  priorities, in December 2007, the departments established the Joint  Clinical Information Board, made up of senior clinical leaders from  both departments. The board is responsible for establishing clinical  priorities for electronic data sharing between the departments,  determining essential health information to be shared, and further  identifying and prioritizing data that should be viewable and data  that should be computable.
The departments produced the DOD/VA Information  Interoperability Plan (Version 1.0) this month. While the scope of  the plan includes health information interoperability, it also  addresses interoperability of personnel and benefits information.  According to the plan, it describes the scope and milestones  necessary to achieve and measure progress toward interoperability  goals. To this end, the plan identifies over 20 initiatives, including,  for example, enhancing health information exchange between  clinical information systems. The plan also incorporates information  intended to address requirements in the National Defense  Authorization Act for Fiscal Year 2008 that require schedules for  establishing the interagency program office; establishing  requirements for electronic health record systems; and acquiring,  testing, and implementing electronic health record systems.
section_title: DOD and VA Are Sharing Some, but Not All, Health Information at Different Levels of Interoperability
paragraphs: DOD and VA are electronically sharing health information as a result  of their long- and short-term initiatives to achieve interoperability;  some of this information is exchanged in computable form, while  other information is viewable only. However, not all electronic  health information is yet shared. Further, although VA’s health  information is all captured electronically, not all health data  collected by DOD are electronic—many DOD medical facilities use  paper-based health records.
Data in computable form are exchanged as a result of the  departments’ long-term initiative to develop the CHDR interface,  which links the modernized health data repositories for the new  systems that each department is developing. Implementing the  interface required the departments to agree on standards for various  types of data, put the data into the agreed standard formats, and  populate the repositories with the standardized data. Currently, the  types of computable health data being exchanged are limited to  outpatient pharmacy and drug allergy data. According to the  departments, the next type of data to be standardized, included in  the repositories, and exchanged in computable form is laboratory  data (i.e., chemistry and hematology laboratory results). However,  DOD and VA officials told us that this data exchange is expected to  be achieved by October 31, 2009.
Currently, these computable data are not shared for all patients— rather only for those who are seen at both DOD and VA medical  facilities, identified as shared patients, and then “activated.” Once a  patient is activated, all DOD and VA sites can access information on  that patient and receive alerts on allergies and drug interactions for  that patient. According to DOD and VA officials, outpatient  pharmacy and drug allergy data were being exchanged on almost  19,000 shared patients as of July 31, 2008; however, officials stated  that they are unable to track the number of shared patients currently  receiving care from both departments, so the number of patients for  whom data could potentially be shared is unknown.
Data in viewable form are shared as a result of the various short- term initiatives previously mentioned. Through BHIE, clinicians can  query selected health information on patients from all DOD and VA  sites and view current data onscreen almost immediately. Because  the BHIE interface provides access to up-to-date information,  clinicians at both departments have expressed strong interest in  expanding its use, and DOD and VA have taken steps in this regard.  For example, the departments completed a BHIE interface with  DOD’s Clinical Data Repository in July 2007, and they began sharing  viewable patient vital signs information through BHIE in June 2008.  Extending BHIE connectivity could provide both departments with  the ability to view additional data in DOD’s legacy systems, until  such time as the departments’ modernized systems are fully  developed and implemented. According to a DOD/VA annual report  and program officials, the departments now consider BHIE an  interim step in their overall strategy to create a two-way exchange  of electronic health records.
DOD has been using another short-term initiative, FHIE, to transfer  information to VA since 2002, allowing VA clinicians to view service  members’ electronic health information when the members leave  active duty. Among the data elements transferred are laboratory  results, radiology results, outpatient pharmacy data, allergy  information, consultation reports, and demographic data. Further,  since July 2005, FHIE has been used to transfer pre- and post- deployment health assessment and reassessment data. Transfers are  done in batches once a month, or weekly for veterans who have  been referred to VA treatment facilities.
Another initiative that provides viewable data, LDSI, is deployed  when local agencies have a business case for its use and sign an  agreement to share laboratory resources. LDSI currently supports a  variety of chemistry, hematology, toxicology, and serology  laboratory results. If a test is not performed at a DOD or VA doctor’s  home facility, the doctor can order the test, the order is transmitted  electronically to the appropriate lab (the other department’s facility  or in some cases a local commercial lab), and the results are  returned electronically. Among the benefits of LDSI, according to  DOD and VA, are increased speed in receiving laboratory results and  decreased errors from manual entry of orders.
Attachment 1 summarizes the types of health data currently shared  via the DOD and VA initiatives, as well as additional types of data  that are currently planned for sharing via these initiatives.
While DOD and VA are sharing or plan to share a wide range of  health information, questions nonetheless exist regarding when and  to what extent electronic sharing capabilities will be fully achieved.   Beyond the initiatives and types of data already discussed, the  electronic sharing of health information between the departments  has not been fully addressed. Although VA’s health information is all  captured electronically, many DOD medical facilities continue to  rely on paper records. Also, clinical encounters for those enrolled in  the military’s TRICARE health care program are not captured in  DOD’s electronic health system unless care is received at a military  treatment facility. Addressing these conditions will be important to  determining the outcome of the departments’ joint efforts.
section_title: DOD and VA Have Adopted Standards to Allow Sharing and Are Engaged in Efforts to Establish Standards
paragraphs: As previously discussed, interoperability standards are an essential  element in the exchange of electronic health information. In this  regard, DOD and VA have agreed upon numerous common  standards that allow them to share health data, which include  standards that are part of current and emerging federal  interoperability specifications. The foundation built by this  collaborative process has allowed the two departments to begin  sharing computable health data (the highest level of  interoperability).
The standards agreed to by the two departments are listed in a  jointly published common set of interoperability standards called  the Target DOD/VA Health Standards Profile. The current version  of the profile, dated September 2007, includes federal standards  (such as data standards established by the Food and Drug  Administration and security standards established by the National  Institute of Standards and Technology); industry standards (such as  wireless communications standards established by the Institute of  Electrical and Electronics Engineers and Web file sharing standards  established by the American National Standards Institute);  international standards (such as the Systematized Nomenclature of  Medicine Clinical Terms, or SNOMED CT, and security standards  established by the International Organization for Standardization).  According to the departments, they anticipate continued updates  and revisions to the profile as additional federal standards emerge.
For the two kinds of data now being exchanged in computable form  through CHDR (pharmacy and drug allergy data), DOD and VA  adopted the National Library of Medicine data standards for  medications and drug allergies, as well as the SNOMED CT codes  for allergy reactions. This standardization was a prerequisite for  exchanging computable medical information—an accomplishment  that, according to the Department of Health and Human Services’  National Coordinator for Health IT, has not been widely achieved.
Further, DOD and VA are continuing their historical involvement in  efforts to agree upon standards for the electronic exchange of  clinical health information by participating in ongoing initiatives led  by the Office of the National Coordinator that are aimed at  promoting the adoption of federal standards and broader use of  electronic health records. Health officials from both departments  participate as members of the American Health Information  Community and the Healthcare Information Technology Standards  Panel. For example, high-level representatives of the 18-member  Community include the Assistant Secretary of Defense for Health  Affairs and the Director, Health Data and Informatics, Veterans  Health Administration. DOD and VA are also members of the  Healthcare Information Technology Standards Panel Board and are  actively working on several committees and groups, including the  Provider Perspective Technical Committee; Population Perspective  Technical Committee; and Security, Privacy and Infrastructure  Domain Technical Committee. The National Coordinator indicated  that such participation is important and stated it would not be  advisable for DOD and VA to move significantly ahead of the  national standards initiative; if they did, the departments might have  to change the way their systems share information by adjusting  them to the national standards later, as the standards continue to  evolve.
In addition, according to DOD officials, their department is taking  steps to ensure that the electronic health records produced by its  modernized health information system, AHLTA (which is a  customized commercial software application), are compliant with  standards by arranging for certification through the Certification  Commission for Healthcare Information Technology. AHLTA  version 3.3 has been installed at three DOD locations for beta  testing and has met specific functionality, interoperability, and  security requirements. However, the officials stated that the  commission cannot fully certify this version of AHLTA until it has  verified that the system has been in operational use at a medical  site.
The departments’ efforts to share data and to be involved in  standardization activities are important mechanisms for ensuring  that their electronic health records are both interoperable and  aligned with emerging standards.
section_title: Further Actions Needed to Fully Establish the Interagency Program Office
paragraphs: To accelerate the departments’ ongoing interoperability efforts,  Congress included in the National Defense Authorization Act for  Fiscal Year 2008 provisions establishing an interagency program  office. Under the act, the Secretary of Defense and the Secretary of  Veterans Affairs were required to jointly develop schedules and  benchmarks for setting up the DOD/VA Interagency Program Office,  and for other activities to achieve interoperable health information  (that is, establishing system requirements, acquisition and testing,  and implementation of interoperable electronic health records or  capabilities). The schedules and benchmarks were due 30 days after  passage of the act, or the end of February 2008.
The departments did not meet the February 2008 date; however, just  this month they produced the DOD/VA Information Interoperability  Plan, which incorporates fiscal year 2008 and 2009 schedules and  milestones that DOD and VA previously referred to in a draft  implementation plan. Further, in an effort to set up the program  office, the departments appointed an Acting Director from DOD and  an Acting Deputy Director from VA. According to the Acting  Director, the departments also have detailed staff and provided  temporary space and equipment to a transition team. The official  stated that, through the efforts of the transition team, the  departments are currently developing a charter for the office,  defining and approving an organizational structure, and preparing to  begin recruiting permanent staff for the office, which is expected to  number about 30. According to the plan, the departments expect to  appoint a permanent Director and Deputy Director and begin  recruiting staff by October 2008. The Acting Director added that  program staff are expected to be in place, and the office is expected  to be fully operational by December 2008. To fund the office, the  departments have reported requesting $4.94 million for fiscal year  2008 and $6.94 million for fiscal year 2009.
Within the plan, milestones and schedules have been included for  achieving interoperable health information in two stages. The first  stage—Interoperability I— is to be completed this month and is to  make available those health data most commonly required by health  care providers, as validated by the Joint Clinical Information  Board, which sets the clinical priorities for what electronic health  information should be shared. The first milestone for this stage,  sharing vital signs information, was already achieved this past June  as part of the BHIE initiative. According to department officials, the  remaining milestones related to sharing questionnaires and forms,  family history, social history, and other history are all due during  this month.
The second stage—Interoperability II— is to be completed by  September 2009, and is to address additional health information  enhancements. Department officials stated that the information to  be covered by these enhancements is being defined, and that  validation of the requirements for the enhancements by the Joint  Clinical Information Board was completed in July 2008.
Nevertheless, milestones for this stage have not been fully  established. Specifically, of 52 activities identified for  Interoperability II, 11 do not yet have defined milestones. For  example, milestones have not been identified for completing  requirements validation, acquisition, and testing for the scanning of  service members’ paper medical records into DOD’s electronic  health record system in order to share these records electronically  with VA; a capability expected to be implemented by September 30,  2009. Department officials stated that decisions on these milestones  will depend on clinical priorities, technical considerations, and  policy decisions. Further, according to the plan, it is intended to  serve as a “living document” that will be updated and refined as  more detailed information becomes known on planned fiscal year  2008 and fiscal year 2009 initiatives, and as health care information  needs change. However, although the plan (as a planning tool) is a  living document, it is nonetheless important to complete the  planning and make the decisions needed to finalize the plan,  particularly in view of the fast approaching September 2009  deadline.
In addition, according to department officials, the interagency  program office will play a crucial role in coordinating the  departments’ efforts to accelerate their interoperability efforts. An  important aspect of this coordination will be managing  implementation of the DOD/VA Information Interoperability Plan,  which the departments recently finalized. According to these  officials, having a centralized office to take on this role will be a  primary benefit. However, the effort to set up the program office is  still in its early stages. As has been noted, the positions of Director  and Deputy Director are not yet permanently filled, permanent staff  have not yet been hired, and facilities have not yet been designated  for housing the office. In addition, the departments have not  completed an interagency program office charter because the  departments’ leadership broadened its scope to include sharing of  personnel and benefits data instead of only health information. Until  the program office is fully established, it will not be able to play this  crucial role effectively. Thus, it remains vital that the Secretaries of  Defense and Veterans Affairs fully establish the Interagency  Program Office by expediting efforts to put in place permanent  leadership, staff, and facilities.
To better ensure that the effort by DOD and VA to achieve fully  interoperable electronic health record systems or capabilities is  accelerated, our July report included recommendations that the  departments give priority to fully establishing the interagency  program office and finalizing the implementation plan. Prompt  action by the departments to address these recommendations is  critical to developing and implementing electronic health record  systems or capabilities that allow for full interoperability of personal  health care information by September 30, 2009, as specified in the  National Defense Authorization Act for Fiscal Year 2008.  In their  comments on our report, both departments concurred with these  recommendations.
In summary, through numerous efforts, DOD and VA are sharing  electronic health information at different levels of interoperability.  Moreover, as a result of their efforts, the departments are sharing  more data than ever before. However, significant work remains to  plan and implement new capabilities that could further increase the  sharing of electronic health information between the departments  and to determine the desired level of data interoperability.  Recognizing the importance of timely implementation of such  capabilities, Congress established a requirement for an interagency  program office as a single point of accountability, and a deadline of  about one year from now to achieve full interoperability of personal  health care information between the departments. In view of this  short timeframe and as we have recommended, a fully functioning  program office and a finalized plan with set milestones are critical  steps toward achieving interoperable electronic health records and  capabilities. Although completion of the DOD/VA Information  Interoperability Plan is an important and positive accomplishment,  without permanent program office leadership, staff, and facilities or  fully established milestones, the departments may nonetheless  remain challenged in achieving interoperable electronic health  information to the extent and in the manner that most effectively  serves military service members and veterans.
Mr. Chairman, this concludes my statement. I would be pleased to  respond to any questions that you or other members of the  committee may have.
section_title: Contacts and Acknowledgements
paragraphs: If you have any questions on matters discussed in this testimony,  please contact Valerie C. Melvin, Director, Human Capital and  Management Information Systems Issues, at (202) 512-6304 or  melvinv@gao.gov. Other individuals who made key contributions to  this testimony are Mark Bird, Assistant Director; Barbara Collier;  Neil Doherty; Rebecca LaPaze; Lee McCracken; Barbara Oliver;  Kelly Shaw; Eric Trout; and Robert Williams, Jr.
section_title: Attachment 1: Current and Planned Health Data Sharing
paragraphs: Table 1 summarizes the types of health data currently shared  through the long- and short-term initiatives we have described, as  well as types of data that are currently planned for addition.