GAO says VA, DOD e-health data interface lacks detailed plan

The Veterans Affairs and Defense departments have failed to initiate a defined architecture and project management to develop a two-way electronic exchange of patient health data, the General Accounting Office said in a report released today.

The agencies have made little progress in defining the technology for developing the electronic interface that is required to exchange data between the two health IT systems for the HealthePeople initiative, the GAO said.

The report answered additional questions following a March hearing of the House Veterans’ Affairs Committee oversight and investigations subcommittee. (Click for GCN story)

Data standards, electronic health records and clinical management promise to improve veterans’ health care, reduce medical mistakes and costs.

VA and DOD are expected to make their health information systems interoperable by next year with common standards, interoperable health information software and data repositories.

So far, the departments support one-way transfer of pre-separation data on all retired and separated service members and reservists from the DOD Composite Health Care System in a secure repository where it is available for viewing clinicians using the VA computerized patient record system.

This data, under the Federal Health Information Exchange, includes admission, laboratory, allergy and pharmacy data. The Veterans Benefit Administration can access this information also to determine disability claims.

VA and DOD said a pharmacy prototype has been under way, in which the agencies have developed a real-time interface, data exchange and capability to check prescription drug data for outpatients by Oct. 1.

The departments will determine in September, when the testing is completed, whether the interface technology for the pharmacy data can be used to exchange patient health data between the VA and DOD systems.

"The early stage of the prototype and the uncertainties regarding what capabilities it would demonstrate provided little evidence or assurance as to how or whether the project would contribute to defining the architecture and technological solution for a two-way exchange of patient health information," said Linda Koontz, director, GAO Information Management Issues.

"Specifically, VA and DOD lacked a clearly defined architecture to describe how they planned to develop the electronic interface needed to exchange data between their health information systems," she said.

VA and DOD said they had begun discussions to establish an overall project plan and finalize role and responsibilities for managing the joint initiative to develop an electronic interface.

The agencies said they have designated a single manager for the electronic interface initiative, but GAO said they have yet to document the project management structure and the manager’s roles and responsibilities. The pharmacy prototype would help determine the architecture for the electronic interface, VA said in response to GAO.

Other projects that contribute to the electronic interface initiative are progressing, including the Consolidated Health Informatics initiative in the Health and Human Services Department, which is promoting health care standards setting across government, VA said. The two agencies also have advanced a project designed to automatically send to VA relevant electronic health information for patients sent to DOD for VA-paid care as veterans and a data-sharing interface project involving VA’s and DOD’s existing health information systems.

The two agencies also have formed the VA/DOD Health Executive Council with decision-making authority, the VA said. But GAO said this entity worked from a department-wide perspective and did not have day-to-day responsibility for the electronic interface initiative.

GAO recommended that the VA and DOD:
  • Develop an architecture for the electronic interface that articulates system requirements, design specification and software descriptions;

  • Select a decision-making authority with day-to-day responsibility for the initiative;

  • establish a project management structure, including a project manager and supporting staff to provide daily guidance and accountability;

  • develop and implement a comprehensive plan that defines the technical and managerial processes necessary to satisfy project requirements that include the authority and responsibility of each organizational unit; a work breakdown structure and schedule for all the tasks to be performed to develop, test and deploy the electronic interface, and a security plan.


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