Computer-Based Patient Records: Subcommittee Questions Concerning VA and DOD Efforts to Achieve a Two-Way Exchange of Health Data.
This letter responds to a request by the Chairman of the Subcommittee on Oversight and Investigations, House Committee on Veterans' Affairs, that we provide answers to questions relating to our March 17, 2004, testimony. At that hearing, we discussed the Department of Veterans Affairs' (VA) and Department of Defense's (DOD) progress toward defining a detailed strategy and developing the capability for a two-way exchange of patient health information.
In the last 10 years we have testified seven times on matters pertaining to VA's and DOD's efforts toward achieving the capability to electronically exchange patient health information. Our statements have highlighted significant challenges that VA and DOD have faced in pursuing ways to share data in their health information systems and create electronic medical records. VA and DOD have taken action on several recommendations that we have made over the past 3 years. These recommendations were aimed at improving the coordination and management of the departments' initial efforts to achieve electronic information sharing via the Government Computer-Based Patient Record (GCPR) project, and furthering DOD's development of its new health information system, the Composite Health Care System II. VA and DOD agreed with and took actions that addressed all of these recommendations. In addition, in September 2002 we reported on DOD's acquisition of the Composite Health Care System II. However, our review of the initiative noted, among other concerns, DOD's limited progress during early stages of the system's development that led to a change in its redesign and development/deployment schedule. We recommended five actions aimed at increasing the project's likelihood of success, three of which have been implemented. DOD is in various stages of implementing the remaining two recommendations. From fiscal year 1998 through fiscal year 2003, the departments reported spending a total of about $670 million on their individual and collective efforts. However, through fiscal year 2003, VA and DOD did not report any costs associated with the critical tasks of defining and developing the electronic interface. In discussing with VA and DOD their actions since last November toward achieving a two-way exchange of patient health information under the HealthePeople (Federal) initiative, officials in both departments expressed their belief that progress was being made. However, as our testimony noted, the departments had not fully defined their approach or requirements for developing and demonstrating the capabilities of the planned prototype. The early stage of the prototype and the uncertainties regarding what capabilities it will demonstrate provided little evidence or assurance as to how or whether this project would contribute to defining the architecture and technological solution. The information collected during our review of the HealthePeople (Federal) initiative suggests that the Subcommittee's scheduled hearing may have provided an incentive for VA and DOD to move forward on this issue. At the time of our testimony, critical project components were absent from VA's and DOD's initiative. The top five priorities that VA and DOD need to address in 2004 to increase the likelihood of a successful outcome are (1) development of an architecture for the electronic interface that articulates system requirements, design specifications, and software descriptions; (2) selection of a lead entity with final decision-making authority for the initiative; (3) establishment of a project management structure to provide day-to-day guidance of and accountability for the investments in and implementation of the electronic interface capability; (4) development and implementation of a comprehensive and coordinated project plan; and (5) implementation of project review milestones and measures to provide the basis for comprehensive management, progressive decision making, and authorization of funding for each step in the development process. Based on our work, we cannot point to any instances in which either department has initiated a major information technology project with a clearly defined architecture and sound project management having been established. We did see evidence that implementing critical project management processes after a project has been undertaken can positively affect its outcome.