GAO: Health IT Contractor Lags

A major U.S. Department of Health and Human Services contractor has fallen behind in its efforts to promote electronic health records, concluded the General Accountability Office in a Jan. 13 report.

The contractor, the not-for-profit National Quality Foundation, or NQF, failed to deliver five of eight projects related to electronic health records activity on time, according to the report, "Health Care Quality Measurement: HHS Should Address Contractor Performance and Plan for Needed Measures."

NQF converted existing quality measures to an electronic format compatible with EHRs -- 113 measures, according to the report. The retooling will allow data from EHRs to be exchanged and used for measuring quality of health care. The project deadline was September 2011, but the project was not completed until December, GAO said.

NQF also was required to convene an expert review panel to examine the retooled measures to ensure proper formatting and correct logic. The panel was convened in June, five months later than required.

As of August 2011, NQF had failed to meet timelines on 18 of 26 projects in nine contract categories during the first two years of the four-year HHS contract, the report said.

HHS and NQF officials listed several factors that they said contributed to the extended project timeframes. According to HHS, the first set of 44 retooled measures had errors requiring correction, including errors in electronic coding. Both organizations also said the estimated timeframes were "overly ambitious, given the scope and complexity of the work." HHS officials said "the technical complexity and labor required to complete the project were greater than anticipated."

NQF officials said HHS also modified the scope of work, requiring the company to hire extra staff to handle the work.

HHS officials told the auditors that they rely on NQF to inform them of problems in its monthly progress reports, but the GAO said the agency did not use available monitoring tools required under its contract with NQF. "These tools could have helped to provide an opportunity for HHS to make any appropriate changes to NQF's projects," the GAO said.

The GAO recommended that HHS:

• Use monitoring tools required under the NQF contract to obtain detailed and timely information on the company's performance and use that information to inform changes to timeframes, projects and cost estimates through the remainder of the contract.
• Ensure that testing of the electronic versions of the measures retooled by NQF to be used in the Medicare and Medicaid EHR incentive programs be completed in a timely manner to identify potential errors and address implementation issues.
• Develop a comprehensive plan that identifies the quality-measurement needs of HHS programs and initiatives and provides a strategy for using NQF's work product to meet those needs.