GAO: Better management needed for e-health project

The Defense and Veterans Affairs departments have made progress in meeting a Sept. 30 deadline for having interoperable electronic health record systems, according to the Government Accountability Office. However, GAO said the interagency office that oversees the program needs to improve its capabilities.

In a recent study, GAO investigators found that although the departments have made progress in creating the DOD/VA Interagency Program Office, that office is not effectively positioned to be accountable for the project. The study, conducted from April to July, showed that the office isn’t executing key information technology management responsibilities for planning, scheduling and measuring the project's performance.

In a hearing before the House Veterans’ Affairs Committee’s Oversight and Investigations Subcommittee, Valerie Melvin, GAO’s director of information management and human capital issues, summarized the findings of GAO’s upcoming report on the study.

The National Defense Authorization Act for fiscal 2008 directed DOD and VA to jointly develop EHR systems or capabilities that are fully interoperable with each other by the end of fiscal 2009. The law also established the interagency program office.

As part of putting the program in place, a group of clinicians from VA and DOD established six interoperability objectives:

• Sharing histories captured in DOD electronic records.
• Sharing physical exam data.
  
• Demonstrating secure and expanded bandwidth for sharing health information.
  
• Exchanging all periodic DOD health assessment data.
  
• Expanding DOD’s inpatient medical records system.
  
• Demonstrating DOD’s initial capability to scan service members’ medical documents.

GAO said the first three goals had been met, but the departments have only partially achieved their objectives for exchanging health assessment data, expanding DOD’s inpatient system and demonstrating initial document-scanning capabilities.

In addition, GAO said, VA and DOD have not made enough progress in establishing the IT management capabilities that are the specific responsibility of the interagency program office.

"Although the departments have generally made progress toward making the program office operational, the absence of performance metrics, and a complete integrated master schedule and a project plan, limits the office’s ability to effectively manage and provide meaningful progress reporting on the delivery of interoperable capabilities that are deemed critical to improving the quality of health care for our nation’s veterans,” Melvin said.

Meanwhile, in prepared remarks, the interagency program office’s acting director, Navy Rear Adm. Gregory Timberlake, said that although much progress had been made, key challenges remain. Specifically, he said the program needed to:

• Develop, adopt and mature standards nationally to ensure efficient operational use.
  
• Update capabilities, systems, infrastructure and technology in a manner consistent with emerging standards.
  
• Identify and prioritize information requirements for sequential upgrade to new technologies.

However, Timberlake said that in spite of those challenges, the interagency program office and the departments are on track to achieve full interoperability, as defined by senior clinical leaders from each department, by the Sept. 30 deadline.