VA, DOD two-way medical data exchange uncertain, GAO says

The Veterans Affairs and Defense departments are proceeding with development of their own computer-based patient records systems but lack a clear strategy as to how to build electronic data exchange capability between the two, a General Accounting Office official told lawmakers Wednesday.

VA’s HealtheVet VistA and DOD’s Composite Health Care Systems are critical components for the eventual exchange of medical data as part of the HealthePeople initiative. The departments have adopted data and message standards that are necessary for exchanging health information between their systems.

And a pharmacy data prototype that VA started in March and expects to complete in September should define the technology for the two-way data exchange, the department has told GAO. VA plans to start exchanging data in late 2005.

“There continues to be no clear vision of how this capability will be achieved, and in what time period,” Linda Koontz, director, GAO Information Management Issues, told the House Veterans’ Affairs Subcommittee on Oversight and Investigations yesterday.

VA and DOD have failed to initiate a defined architecture and project management to guide development of interoperability and explain how the pharmacy prototype would contribute to the technical solution, GAO said Wednesday and in a report released earlier this week. (Click for GCN coverage)

Data standards, electronic health records and clinical management promise to improve veterans’ health care and disability claims processing, reduce medical mistakes and costs. Currently, the departments can share data through a one-way transfer of health information from DOD to VA health care facilities.

Under the HealthePeople initiative, both a service member’s health record stored in DOD’s CHCS II clinical data repository and, when they separate, the health record created by and stored in VA’s system would be accessible by both DOD and VA facilities when the veteran seeks medical care. VA officials anticipate being able to exchange four categories of health information, including outpatient pharmacy data, laboratory results, allergies and patient demographics, through an interface between the two data depositories by yearend 2005, Koontz said.

“VA’s and DOD’s approach to meeting this HealthePeople goal is fraught with uncertainty and lacks a solid foundation for ensuring that this mission can be successfully accomplished,” she said.

VA is working toward completing a prototype for its health data repository at the end of June. DOD plans to deploy its first release of the CHCS II functionality, a capability for integrating DOD clinical outpatient processes into a single patient record, in June 2006.

VA and DOD will take an incremental approach to determine the architecture and technology for the data exchange capability, Koontz said VA told her. VA hopes that the pharmacy data prototype project will provide an understanding of what technology is needed and how it should be implemented to enable the two-way data exchange. DOD and VA reported approval of the contractor’s technical requirements for the prototype last month and have a draft architecture for the prototype.

VA and DOD are developing a final architecture for the electronic interface between the agencies’ health information systems, said VA Acting Under Secretary for Health Dr. Jonathan Perlin. The departments have also assembled a joint project management structure, which includes a program manager from VA and a deputy program manager from DOD, who provide joint accountability and day-to-day responsibility.

(Updated 11:54 a.m.)

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