Wounded warriors' care impeded by incompatible systems

Lack of data sharing between VA and DOD causing gaps, duplications in care

The two agencies most closely involved in providing medical care for severely wounded combat personnel are faltering because of a lack of compatibility in their information systems, according to a new report from the Government Accountability Office.

The Veterans Affairs and Defense departments' care coordinators cannot readily identify eligible patients for their jointly operated Federal Recovery Coordination Program using existing data sources, states the report issued March 23. In addition, incompatible information systems mean that some patient data is not being shared, resulting in “duplication of services and enrollee confusion,” the GAO said.

“Although the ultimate solution to information system incompatibility is beyond the capacity of the Federal Recovery Coordination Program to resolve, the program has initiated an effort to improve information exchange,” GAO concluded.


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Four years ago, after a series of media reports about ongoing gaps in care at the Walter Reed Medical Center, the VA and DOD created the recovery coordination program to improve their case management of severely wounded service members, including those with traumatic brain injuries and orthopedic injuries.

The goal was to assign care coordinators to ensure that the enrollees were receiving all needed services in transitioning from hospitals to outpatient settings, without gaps in care. About 600 patients were enrolled in the program in 2010.

However, shortcomings in VA and DOD information systems and in their ability to share data has created problems, GAO said.

For example, current systems are unable to identify individuals eligible for the program. New enrollees are identified through referrals only. Another problem is the inability of VA care coordinators to automatically determine if a service member is enrolled in separate DOD care management programs; DOD case managers are also unable to automatically determine enrollment in the recovery program.

In some cases, lack of such data has resulted in a service member having two separate case managers working on his or her case and preparing separate plans for care. Data incompatibilities also make it difficult for the care coordination program to manage and plan for its caseload, and to monitor performance, the report added.

To improve information sharing, the VA created a new system of records within the Veterans Tracking Application and began sharing with DOD certain enrollment information, such as the names of enrollees, in January 2011, the report states.

In addition, the federal recovery coordination program has started an Information Sharing Initiative to develop plans for direct sharing of data between DOD and VA systems in the future.

“The FRCP executive director explained that this initiative primarily includes identifying the data that need to be exchanged as well as identifying the data systems where these data originate and subsequently developing a technical solution to electronically exchange this information,” the GAO report states.

GAO made several recommendations, including the recording of data in the Veterans Tracking Application to identify factors used in making enrollment decisions.

VA and DOD officials said they generally agreed with the recommendations.

The VA said it anticipates that an initial set of data will be available for exchange between VA and DOD’s wounded warrior information systems by the end of fiscal 2011. The departments plan to expand the exchange of data to support improved collaboration on care plans in fiscal 2012.

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