Report: DOD, VA need better planning for e-health records interoperability

The operators of two of the largest health care systems in the world are making progress in sharing patients’ electronic health records, but they lack a clear plan for meeting a September deadline for fully interoperable systems, according to the Government Accountability Office.

The Defense and Veterans Affairs departments provide medical services to millions of Americans. All of VA’s patients come from DOD, and some are treated simultaneously in both systems. The departments have a mandate to establish an interoperable electronic system for handling patient records and exchanging information by the end of the fiscal year. The number of patients whose records the departments are sharing is growing, but it remains a small percentage of the overall patient population. Furthermore, VA and DOD have yet to establish a joint office to oversee the project.

The absence of clearly defined goals and milestones limits the departments’ ability to measure their progress and ensure success, GAO auditors wrote in a report titled “Electronic Health Records: DOD’s and VA’s Sharing of Information Could Benefit from Improved Management.”

GAO did not fault the program or its progress but instead highlighted the lack of results-oriented goals and performance measures.

“DOD and VA have continued to make progress toward increased interoperability through ongoing initiatives and activities documented in their plans related to increasing information-sharing efforts,” the report states. “Also, the departments recently expanded the number of standards and specifications with which they expect their interoperability initiatives will comply. However, the departments’ plans lack results-oriented (i.e., objective, quantifiable and measurable) performance goals and measures that are characteristic of effective planning.”

Efforts to create an electronic system for sharing patient data at the two departments go back more than 10 years. After problems were identified in a 1996 report on Persian Gulf War veterans’ illnesses, a 1998 presidential directive called for developing a computer-based patient record system for exchanging data. The goal was included in the Defense Authorization Act for fiscal 2008, which called for the establishment of a system that complies with federal standards by Sept. 30, 2009.

“Electronic health records are particularly crucial for optimizing the health care provided to military personnel and veterans,” the GAO report states. “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.”

The departments began the program with separate systems. VA had a departmentwide system -- the Veterans Health Information Systems and Technology Architecture -- for in-house access to records. DOD relied on a number of agency-level systems. But they have begun sharing outpatient pharmacy and drug allergy information on patients. Clinicians identified those areas as ones in which automated alerts would be most valuable.

In the past six months, the departments have increased the number of patients covered by that system by 2,700, to about 21,000. In addition, DOD’s system for sharing the data has been certified as complying with standards established under the Health and Human Services Department’s Office of the National Coordinator for Health Information Technology.

The departments have also published a set of interoperability standards, the Target DOD/VA Standards Profile, which is being updated with standards the national coordinator’s office is developing.

The act also established a joint interagency program office to oversee the effort. The office was slated to be established in December 2008, but although a charter and organizational plan have been developed, key positions have not been filled.

“Steps have been taken to set up the DOD/VA Interagency Program Office, but it is not positioned to function as a single point of accountability,” GAO auditors wrote.

Both departments responded to the report by pledging to make it a priority to establish the type of results-oriented approach GAO recommended.

About the Author

William Jackson is a Maryland-based freelance writer.

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