Computer-Based Patient Records: Sound Planning and Project	 
Management Are Needed to Achieve a Two-Way Exchange of VA and DOD
Health Data (17-MAR-04, GAO-04-402T).				 
                                                                 
A critical component of the Department of Veterans Affairs' (VA) 
information technology program is its ongoing work with the	 
Department of Defense (DOD) to achieve the ability to exchange	 
patient health care data and create electronic records for use by
veterans, active military personnel, and their health care	 
providers. GAO testified before Congress last November that	 
one-way sharing of data, from DOD to VA medical facilities, had  
been realized. At the Congress's request, GAO assessed, among	 
other matters, VA's and DOD's progress since that time toward	 
defining a detailed strategy for and developing the capability of
a twoway exchange of patient health information.		 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-04-402T					        
    ACCNO:   A09511						        
  TITLE:     Computer-Based Patient Records: Sound Planning and       
Project Management Are Needed to Achieve a Two-Way Exchange of VA
and DOD Health Data						 
     DATE:   03/17/2004 
  SUBJECT:   Information systems				 
	     Information technology				 
	     Interagency relations				 
	     Medical records					 
	     Military personnel 				 
	     Performance measures				 
	     Standards and standardization			 
	     Strategic planning 				 
	     Systems design					 
	     Veterans						 
	     DOD Composite Health Care System II		 
	     Federal Health Information Exchange		 
	     Program						 
                                                                 
	     VA/DOD HealthePeople Strategy			 

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GAO-04-402T

United States General Accounting Office

GAO Testimony

Before the Subcommittee on Oversight and Investigations, Committee on
Veterans' Affairs, House of Representatives

For Release on Delivery

Expected at 10:00 a.m. EST COMPUTER-BASED

Wednesday, March 17, 2004

PATIENT RECORDS

 Sound Planning and Project Management Are Needed to Achieve a Two-Way Exchange
                           of VA and DOD Health Data

Statement of Linda D. Koontz
Director, Information Management Issues

GAO-04-402T

Highlights of GAO-04-402T, testimony before the Subcommittee on Oversight
and Investigations, House Committee on Veterans' Affairs

A critical component of the Department of Veterans Affairs' (VA)
information technology program is its ongoing work with the Department of
Defense (DOD) to achieve the ability to exchange patient health care data
and create electronic records for use by veterans, active military
personnel, and their health care providers.

GAO testified before the Subcommittee last November that one-way sharing
of data, from DOD to VA medical facilities, had been realized. At the
Subcommittee's request, GAO assessed, among other matters, VA's and DOD's
progress since that time toward defining a detailed strategy for and
developing the capability of a twoway exchange of patient health
information.

March 17, 2004

COMPUTER-BASED PATIENT RECORDS

Sound Planning and Project Management Are Needed to Achieve a Two-Way Exchange
of VA and DOD Health Data

Since November, VA and DOD have made little progress in determining their
approach for achieving the two-way exchange of patient health data.
Department officials recognize the importance of an architecture to
articulate how they will electronically interface their health systems,
but continue to rely on a nonspecific, high-level strategy-in place since
September 2002-to guide their development and implementation of this
capability (see figure).

High-Level Strategy Intended To Allow Two-Way Exchange of Health Data

Under Development

Developed

Source: VA and DOD

VA officials stated that an initiative begun this month to satisfy a
mandate of the Bob Stump National Defense Authorization Act for Fiscal
Year 2003 will be used to better define the electronic interface needed to
exchange patient health data. However, this project is at an early stage,
and the departments have not yet fully identified the approach or
requirements for this undertaking. Given these uncertainties, there is
little evidence of how this project will contribute to defining a specific
architecture and technological solution for achieving the two-way health
data exchange.

These uncertainties are further complicated by the absence of sound
project management to guide the departments' actions. At present, neither
department has the authority to make final decisions binding on the other,
and day-to-day oversight of the joint initiative to develop an electronic
interface is limited. Progress toward defining data standards continues,
but delays have occurred in the development and deployment of the
agencies' individual health information systems.

www.gao.gov/cgi-bin/getrpt?GAO-04-402T.

To view the full product, including the scope and methodology, click on
the link above. For more information, contact Linda D. Koontz at (202)
512-6240 or [email protected].

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here today to participate in continuing discussions of
the Department of Veterans Affairs' (VA) information technology program.
My testimony focuses on a critical aspect of that program-VA's work with
the Department of Defense (DOD) to achieve the ability to exchange patient
health care data and create an electronic medical record for veterans and
active duty military personnel. As you are well aware, having readily
accessible medical data on these individuals-many of whom are highly
mobile and may have health records at multiple medical facilities within
and outside of the United States-is important to providing highquality
health care to them and to adjudicating any disability claims that they
may have. VA and DOD have been pursuing ways to share data in their health
information systems and create electronic records since 1998, yet
accomplishing a two-way health data exchange has been elusive.

When we testified on this initiative last November,1 VA and DOD had
achieved a measure of success in sharing data through the one-way transfer
of health information from DOD to VA health care facilities.2 Yet VA and
DOD faced significant challenges and were far from realizing a longer term
objective: providing a virtual medical record based on the twoway exchange
of data, as part of their HealthePeople (Federal) initiative. The
departments had not clearly articulated a common health information
architecture, and lacked the details and specificity essential to
determining how they would achieve this capability.

At your request, my testimony will discuss our review of VA's and DOD's
actions since November toward defining a detailed strategy and developing
the capability for a two-way exchange of patient health information. In
addition, I will provide an update on actions that the departments have
taken to address recommendations resulting from prior

1U.S. General Accounting Office, Computer-Based Patient Records:
Short-Term Progress Made, but Much Work Remains to Achieve a Two-Way Data
Exchange Between VA and DOD Health Systems, GAO-04-271T (Washington, D.C.:
November 19, 2003).

2The one-way transfer of health care data from DOD to VA is being
accomplished as part of the Federal Health Information Exchange
initiative.

reviews of their efforts to share medical data,3 including those
articulated in the May 2003 report of the President's task force on the
development of electronic medical records.4

In conducting this work, we analyzed key documentation supporting VA's and
DOD's strategy for developing and implementing the two-way electronic
exchange of health data, including deployment and conversion plans,
project schedules, and status reports for their individual health
information systems. In addition, we reviewed documentation to identify
the costs incurred by VA and DOD in developing technology to support the
sharing of health data, including costs associated with the government
computer-based patient record and federal health information exchange
initiatives, and with VA's and DOD's ongoing projects to develop new
health information systems. We supplemented our analyses with interviews
of VA and DOD officials responsible for key decisions and actions on the
initiatives. Further, we analyzed documentation and interviewed relevant
VA and DOD officials to determine actions that have been taken to address
our previous recommendations related to the government computer-based
patient record initiative and those contained in the President's task
force report. We did not verify the departments' reported actions in
response to the President's task force recommendations. We performed our
work in accordance with generally accepted government auditing standards,
from December 2003 through March of this year.

Since November, VA and DOD have made little progress toward defining how
they intend to achieve the two-way exchange of patient health data under
the HealthePeople (Federal) initiative. Although VA officials recognize
the importance of having an architecture to describe in detail how they
plan to develop an electronic interface between their health information
systems, they acknowledged that the departments' actions are continuing to
be driven by a less-specific, high-level strategy that has been in place
since September 2002. VA and DOD officials stated that they

3U.S. General Accounting Office, Veterans Affairs: Sustained Management
Attention Is Key to Achieving Information Technology Results, GAO-02-703
(Washington, D.C.: June 12, 2002) and Computer-Based Patient Records:
Better Planning and Oversight By VA, DOD, and IHS Would Enhance Health
Data Sharing, GAO-01-459 (Washington, D.C.: April 30, 2001).

4President's Task Force to Improve Health Care Delivery For Our Nation's
Veterans, Final Report (Washington, D.C.: May 26, 2003).

  Results in Brief

intend to rely on an initiative being undertaken this month to satisfy a
mandate of the Bob Stump National Defense Authorization Act for Fiscal
Year 20035 to better define the electronic interface needed to exchange
patient health information. However, this project is at an early stage,
and the departments have not yet fully determined the approach or
requirements for this undertaking. Given these uncertainties, there is
little evidence as to whether and how this project will contribute to
defining an explicit architecture and technological solution for achieving
the two-way exchange of patient health information.

Adding to the challenge and uncertainties of developing the electronic
interface is that VA and DOD have not fully established a project
management structure to ensure the necessary day-to-day guidance of and
accountability for the departments' investment in and implementation of
this capability. Although maintaining that they are collaborating on this
initiative through a joint working group and receiving oversight from
executive-level councils, neither department has had the authority to make
final project decisions binding on the other. Further, the departments are
operating without a project management plan describing the specific
responsibilities of VA and DOD in developing, testing, and deploying the
interface. In the absence of an explicit architecture and critical project
management, VA and DOD are progressing slowly in their development of this
important technology. The departments have continued to define data
standards that are essential to facilitating the exchange of data, but
have experienced delays in key milestones associated with the development
and deployment of their individual health information systems. Such delays
call into question the departments' ability to meet their target date for
beginning to exchange patient health information in 2005.

Both the President's task force and we have made multiple recommendations
aimed at improving VA's and DOD's success in undertaking projects intended
to achieve the electronic exchange of patient health records. For example,
the task force recommended developing and deploying, by fiscal year 2005,
electronic medical records that are interoperable, bidirectional, and
standards-based. The departments reported that they are currently in
various stages of acting on the specific recommendations that the task
force made for providing timely, high-quality care through effective
electronic sharing of health information. Beyond this, we previously
recommended that, among other

5P.L. 107-314, sec. 724 (2002).

Background

actions, VA and DOD designate a lead entity with final decisionmaking
authority and establish a clear line of authority for the earlier,
near-term government computer-based patient record project. In line with
our recommendations, VA and DOD made overall management and accountability
enhancements that could provide lessons learned for improving the
departments' approach to successfully accomplishing the longer term
initiative to develop a two-way health information exchange.

In 1998 VA and DOD, along with the Indian Health Service (IHS), began an
initiative to share patient health care data, called the government
computer-based patient record (GCPR) project. At that time, each agency
collected and maintained patient health information in separate systems,
and their health facilities could not electronically share patient health
information across agency lines. GCPR was envisioned as an electronic
interface that would allow physicians and other authorized users at VA,
DOD, and IHS health facilities to access data from any of the other
agencies' health facilities. The interface was expected to compile
requested patient information in a "virtual" record that could be
displayed on a user's computer screen.

In reporting on the initiative in April 2001,6 we raised doubts about
GCPR's ability to provide expected benefits. We noted that the project was
experiencing schedule and cost overruns and was operating without clear
goals, objectives, and consistent leadership. We recommended that the
participating agencies (1) designate a lead entity with final
decisionmaking authority and establish a clear line of authority for the
GCPR project, and (2) create comprehensive and coordinated plans that
included an agreedupon mission and clear goals, objectives, and
performance measures, to ensure that the agencies could share
comprehensive, meaningful, accurate, and secure patient health care data.
VA, DOD, and IHS agreed with our findings and recommendations.

In March 2002, however, we again reported that the project was continuing
to operate without clear lines of authority or a lead entity responsible
for final decisionmaking.7 Further, the project continued to move forward

6GAO-01-459.

7U.S. General Accounting Office, VA Information Technology: Progress Made,
but Continued Management Attention Is Key to Achieving Results,
GAO-02-369T (Washington, D.C.: March 13, 2002).

without comprehensive and coordinated plans and an agreed-upon mission and
clear goals and measures. In addition, the participating agencies had
announced a revised strategy that was considerably less encompassing than
the project was originally intended to be. For example, rather than serve
as an interface to allow data sharing across the three agencies' disparate
systems, as originally envisioned, the revised strategy initially called
only for a one-way transfer of data from DOD's current health care
information system to a separate database that VA hospitals could access.
In further reporting on this initiative in June 2002, we recommended that
VA, DOD, and IHS revise the original goals and objectives of the project
to align with their current strategy, commit the executive support
necessary to adequately manage the project, and ensure that it followed
sound project management principles.8

In September 2002 we reported that VA and DOD had made some progress
toward electronically sharing patient health data.9 The two departments
had renamed the project the Federal Health Information Exchange (FHIE)
program and, consistent with our prior recommendation, had finalized a
memorandum of agreement designating VA as the lead entity for implementing
the program. With this agreement, FHIE became a joint effort between VA
and DOD to achieve the exchange of health care information in two phases.
The first phase, completed in mid-July 2002, enabled the one-way transfer
of data from DOD's existing health information system to a separate
database that VA hospitals could access. A second phase, finalized earlier
this month, completed VA's and DOD's efforts to add to the base of patient
health information available to VA clinicians via this one-way sharing
capability. VA and DOD reported total FHIE costs of about $85 million
through fiscal year 2003.

The revised strategy also envisioned VA and DOD pursuing a longer term,
two-way exchange of health information. This initiative, known as
HealthePeople (Federal), is premised upon the departments' development of
a common health information architecture comprising standardized data,
communications, security, and high-performance health information systems.
The joint effort is expected to result in the secured sharing of health
data required by VA's and DOD's health care providers between

8GAO-02-703.

9U.S. General Accounting Office, VA Information Technology: Management
Making Important Progress In Addressing Key Challenges, GAO-02-1054T
(Washington, D.C.: September 26, 2002).

systems that each department is currently developing-DOD's Composite
Health Care System II (CHCS II) and VA's HealtheVet VistA.

DOD began developing CHCS II in 1997 and has completed its associated
clinical data repository that is key to achieving an electronic interface.
DOD expects to complete deployment of all of its major system capabilities
by September 2008.10 The department reported expenditures of about $464
million for the system through fiscal year 2003. VA began work on
HealtheVet VistA and its associated health data repository in 2001, and
expects to complete all six initiatives that make up this system in
2012.11 VA reported spending about $120 million on HealtheVet VistA
through fiscal year 2003.

Under the HealthePeople (Federal) strategy, VA and DOD envision that, upon
entering military service, a health record for the service member will be
created and stored in DOD's CHCS II clinical data repository. The record
will remain in the clinical data repository and be updated as the service
member receives medical care. When the individual separates from active
duty and, if eligible, seeks medical care at a VA facility, VA will then
create a medical record for the individual, which will be stored in its
health data repository. Upon viewing the medical record, the VA clinician
would be alerted and provided access to clinical information on the
individual also residing in DOD's repository. In the same manner, when a
veteran seeks medical care at a military treatment facility, the attending
DOD clinician would be alerted and provided with access to the health
information existing in VA's repository. According to VA and DOD, the
planned approach would make virtual medical records displaying all
available patient health information from the two repositories accessible
to both departments' clinicians. VA officials have stated that they
anticipate being able to exchange some degree of health information
through an interface of their health data repository with DOD's clinical
data repository by the end of calendar year 2005.

10DOD's CHCS II capabilities are being deployed in blocks. Block 1
provides a graphical user interface for clinical outpatient processes;
block 2 supports general dentistry; block 3 provides pharmacy, laboratory,
radiology, and immunizations capabilities; block 4 provides inpatient and
scheduling capabilities; and block 5 will provide additional capabilities
as defined.

11The six initiatives that make up HealtheVet VistA are health data
repository, billing replacement, laboratory, pharmacy, imaging, and
appointment scheduling replacement.

  Lacking A Defined Strategy, VA And DOD Have Made Limited Progress Toward A
  Common Health Information Exchange

VA's and DOD's ability to exchange data between their separate health
information systems is crucial to achieving the goals of HealthePeople
(Federal). Yet successfully sharing patient health information via a
secure electronic interface between each of their data repositories can be
complex and challenging, and depends on their having a clearly articulated
architecture, or blueprint, defining how specific technologies will be
used to achieve the interface. Developing, maintaining, and using an
architecture is a best practice in engineering information systems and
other technological solutions. An architecture would articulate, for
example, the system requirements and design specifications, database
descriptions, and software descriptions that define the manner in which
the departments will electronically store, update, and transmit their
data.

Equally critical is an established project management structure to guide
project development. Industry best practices and information technology
project management principles12 stress the importance of accountability
and sound planning for any project, particularly an interagency effort of
the magnitude and complexity of this one. Inherent in such planning is the
development and use of a project management plan that describes, among
other factors, the project's scope, implementation strategy, lines of
responsibility, security requirements, resources, and estimated schedule
for development and implementation.

As was the situation when we testified last November, VA and DOD continue
to lack an explicit architecture detailing how they intend to achieve the
data exchange capability, or just what they will be able to exchange by
the end of 2005-their projected time frame for putting this capability
into operation. VA officials stated that they recognize the importance of
a clearly defined architecture, but acknowledged that the departments'
actions were continuing to be driven by the less-specific, high-level
strategy that has been in place since September 2002.

The officials added that just this month, the departments had taken a
first step toward trying to determine how their separate data repositories
would interface to enable the two-way exchange of patient health records.
Specifically, officials in both departments pointed to a project that they
are undertaking in response to requirements of the National Defense
Authorization Act for Fiscal Year 2003, which mandated that VA and DOD

12Institute of Electrical and Electronics Engineers, IEEE/EIA Guide for
Information Technology (IEEE/EIA 12207.1-1997), April 1998.

develop a real-time interface, data exchange, and capability to check
prescription drug data for outpatients by October 1, 2004.13 VA's Deputy
Chief Information Officer for Health stated that they hope to determine
from a prototype planned for completion by next September whether the
interface technology developed to meet this mandate can be used to
facilitate the exchange of data between the health information systems
that they are currently developing.

By late February, VA had hired a supporting contractor to develop the
planned prototype, but the departments had not yet fully defined their
approach or requirements for developing and demonstrating its
capabilities. DOD officials stated that the departments would rely on the
contractor to more fully define the technical requirements for the
prototype. Further, according to VA officials, since the departments' new
health information systems that are intended to be used under
HealthePeople (Federal) have not yet been completed, the demonstration may
only test the ability to exchange data in VA's and DOD's existing health
systems-the Veterans Information Systems and Technology Architecture and
the Composite Health Care System, respectively. Thus, given the early
stage of the prototype and the uncertainties regarding what capabilities
it will demonstrate, there is little evidence and assurance as to how or
whether this project will contribute to defining the architecture and
technological solution for the two-way exchange of patient health
information.

Further compounding the challenges and uncertainty that VA and DOD face is
the lack of a fully established project management structure to ensure the
necessary day-to-day guidance of and accountability for the departments'
investments in and implementation of the electronic interface between
their systems. Officials in both departments maintain that they are
collaborating on this initiative through a joint working group and with
oversight provided by the Joint Executive Council and VA/DOD

13Sec. 724 of the act mandates that the Secretaries of Veterans Affairs
and Defense seek to ensure that, on or before October 1, 2004, the two
departments' pharmacy data systems are interoperable for VA and DOD
beneficiaries by achieving real-time interface, data exchange, and
checking of prescription drug data of outpatients and using national
standards for the exchange of outpatient medication information. The act
further states that if the specified interoperability is not achieved by
that date, then the Secretary of Veterans Affairs shall adopt DOD's
Pharmacy Data Transaction System for VA's use.

Health Executive Council.14 However, neither department has had the
authority to make final project decisions binding on the other, and there
has been a visible absence of day-to-day project oversight for the joint
initiative to develop an electronic interface between the departments'
planned information systems. Further, VA and DOD are operating without a
project management plan describing the overall development and
implementation of the interface, including the specific roles and
responsibilities of each department in developing, testing, and deploying
the interface and addressing security requirements. In discussing these
matters last week, VA officials stated that the departments had recently
designated a program manager for the planned prototype. Further, VA and
DOD officials added that they had begun discussions to establish an
overall project plan and finalize roles and responsibilities for managing
the joint initiative to develop an electronic interface. Until these
essential project management elements are fully established, VA and DOD
will lack assurance that they can successfully develop and implement an
electronic interface and the associated capability for exchanging health
information within the time frames that they have established.

Progress Toward Achieving a Two-Way Data Exchange Has Been Limited

In the absence of an architecture and project management structure for the
initiative, VA and DOD have continued to make only limited progress toward
developing the technological solution essential to interfacing their
patient health information. To their credit, the departments have
continued essential steps toward standardizing clinical data-important for
exchanging health information between disparate systems. The Institute of
Medicine's Committee on Data Standards for Patient Safety has reported the
lack of common data standards as a key factor preventing information
sharing within the health care industry. Over the past 4 months, VA and
DOD have agreed to adopt additional data standards15 for uniformly
presenting in any system data related to demographics,

14The Joint Executive Council is composed of the Deputy Secretary of
Veterans Affairs, the Undersecretary of Defense for Personnel and
Readiness, and the cochairs of joint councils on health, benefits, and
capital planning. The council meets on a quarterly basis to recommend
strategic direction of joint coordination and sharing efforts. The VA/DOD
Health Executive Council is composed of senior leaders from VA and DOD,
who work to institutionalize sharing and collaboration of health services
and resources. The council is cochaired by the VA Undersecretary for
Health and DOD Assistant Secretary of Defense for Health Affairs, and
meets on a bimonthly basis.

15When we testified last November, VA and DOD had agreed to four standards
to allow the transmission of messages and one standard allowing laboratory
results.

immunizations, medications, names of laboratory tests ordered, and
laboratory result contents.

Nonetheless, as reflected in figure 1, the technology needed to achieve a
two-way exchange of patient health information remains far from complete,
with only DOD's data repository having been fully developed.

Figure 1: VA/DOD High-level Strategy for the Two-Way Exchange of Health
Data

Under Development Developed

Source: VA and DOD.

Since November, both departments have delayed key milestones associated
with the development and deployment of their individual health information
systems. VA program officials told us that completion of a prototype for
the department's health data repository has been delayed approximately a
year, until the end of this June. The officials explained that earlier
testing of the prototype had slowed clinicians' use of the clinical
applications, necessitating a revised approach to populating the
repository. In addition, while DOD officials previously stated that the
department planned to complete the deployment of its first release of CHCS
II functionality (a capability for integrating DOD clinical outpatient
processes into a single patient record) in September 2005, the agency has
now extended its completion date to June 2006. According to DOD officials,
the schedule for completing this deployment was revised because of a later
than anticipated decision on when the department could proceed with its
worldwide deployment. Collectively, the lack of an architecture and
project management structure, coupled with delays in the departments'
completion of key projects, places VA and DOD at increased risk of being
unable to successfully accomplish the HealthePeople (Federal) initiative
and the overall goal of more effectively meeting service members' and
veterans' health care and disability needs.

  VA and DOD Could Benefit From Current And Past Recommendations On Sharing
  Electronic Medical Records

Mr. Chairman, as part of our review, you asked that we update the status
of VA's and DOD's actions to address prior recommendations related to
sharing electronic medical information. In this regard, both the
President's task force and we have made a number of recommendations to VA
and DOD for improving health care delivery to beneficiaries through better
coordination and management of their electronic health sharing
initiatives. In its final report of May 2003,16 the President's task force
recommended specific actions for providing timely, high-quality care
through effective electronic sharing of health information, such as the
development and deployment, by fiscal year 2005, of electronic medical
records that are interoperable, bidirectional, and standards-based. The
departments reported that they are in various stages of acting on these
recommendations, with anticipated completion dates ranging from June of
this year to September 2005. Our attachment to this statement summarizes
these specific recommendations, and the departments' reported actions to
address them. Giving full consideration to these recommendations could
provide VA and DOD with relevant information for determining how to
proceed with the HealthePeople (Federal) initiative.

Also, as mentioned earlier, our prior reviews of the departments' project
to develop a government computer-based patient record determined that the
lack of a lead entity, clear mission, and detailed planning to achieve
that mission had made it difficult to monitor progress, identify project
risks, and develop appropriate contingency plans. As a result, in
reporting on this initiative in April 2001 and again in June 2002, we made
several recommendations to help strengthen the management and oversight of
this project. VA and DOD have taken specific measures in response to our
recommendations for enhancing overall management and accountability of the
project, with demonstrated improvements and outcomes. Extending these
practices to current activities supporting the development of
HealthePeople (Federal) could strengthen the departments' approach to
successfully accomplishing a two-way health information exchange.

In summary, Mr. Chairman, achieving an electronic interface to enable VA
and DOD to exchange patient medical records between their health
information systems is an important goal, with substantial implications
for improving the quality of health care and disability claims processing
for our nation's military members and veterans. However, in seeking a
virtual

16President's Task Force, Final Report, May 26, 2003.

medical record based on the two-way exchange of data between their
separate health information systems, VA and DOD have chosen an approach
that necessitates the highest levels of project discipline, including a
well-defined architecture for describing the interface for a common health
information exchange and an established project management structure to
guide the investment in and implementation of this electronic capability.
At this time, the departments lack these critical components, and thus
risk investing in a capability that could fall short of their intended
goals. The continued absence of a clear approach and sound planning for
the design of this new electronic capability elevates concerns and
skepticism about exactly what capabilities VA and DOD will achieve as part
of HealthePeople (Federal), and in what time frame.

Mr. Chairman, this concludes my statement. I would be pleased to respond
to any questions that you or other members of the Subcommittee may have at
this time.

Contacts and	For information about this testimony, please contact Linda D.
Koontz, Director, Information Management Issues, at (202) 512-6240 or at

Acknowledgments 	[email protected], or Valerie C. Melvin, Assistant
Director, at (202) 5126304 or at [email protected]. Other individuals making
key contributions to this testimony include Nabajyoti Barkakati, Michael
P. Fruitman, Carl L. Higginbotham, Barbara S. Oliver, J. Michael Resser,
Sylvia L. Shanks, and Eric L. Trout.

Appendix: VA's and DOD's Reported Actions to Address Recommendations in
the President's Task Force Report of May 26, 2003

                                Reported Actions

Recommendations Department of Veterans Affairs (VA)

1. VA and DOD should develop and The VA/DOD Joint Strategic Plan and the
Joint deploy by fiscal year 2005 electronic Electronic Health Records Plan
have set medical records that are interoperable, September 2005 as the
target date by which VA bi-directional, and standards-based. and DOD will
achieve interoperability of health

data. The VA/DOD Health Executive Council Information Management/
Information Technology Work Group is on track to complete this capability
by the end of fiscal year 2005. In March 2004, the departments awarded a
contract to develop a bidirectional pharmacy solution that will
demonstrate interoperability in a prototype environment. The departments
are on track to complete the prototype by October 2004.

2. The Administration should direct the This issue remains under review by
the Veterans Department of Health and Human Health Administration's HIPAA
Program Office. It Services to declare the two is VA's understanding that
VA and DOD have departments to be a single health care concluded that this
is not necessary in order to system for purposes of implementing share
information on patients that both the Health Insurance Portability and
departments are treating. Accountability Act (HIPAA) regulations.

3. The departments should implement The Joint Strategic Plan has set June
2004 as the
by fiscal year 2005 a mandatory single target date for the departments to
develop an
separation physical as a prerequisite of implementation plan for the one
physical exam
promptly completing the military protocol. VA and DOD are currently
piloting the
separation process. Upon separation, single separation physical exam that
meets DOD
DOD should transmit an electronic needs and VA's rating criteria at 16
Benefits
Department of Defense (DD) 214 Delivery at Discharge sites.
(discharge paperwork) to VA.

Department of Defense (DOD)

Operational interoperability is planned for fiscal year 2005.The pharmacy
prototype is the initial effort within the Clinical Health Data
Repositories (CHDR) framework. This framework is the effort to develop
software component services that will be used by the VA and DOD data
repositories. The prototype has a planned completion date of October 2004.

DOD believes that it and VA can achieve the appropriate sharing of
protected health information within the guidelines of the current
regulations. The HIPAA privacy rule has a specific exception authorizing
one-way sharing of health data at the time of a service member's
separation. This supports the "seamless transition to veteran status."

The departments are currently testing an advanced technological
demonstration project that transfers images of paper personnel documents
to VA from official military personnel file repositories in the Army,
Navy, and Marine Corps, with Air Force integration into the program in
process (including the DD214). When fully operational, this system will
send digital images of any personnel record to the VA within 48 hours of
the request.

Reported Actions Recommendations Department of Veterans Affairs (VA)

4. By fiscal year 2004, VA and DOD Both the Health Executive Council
(through the
should initiate a process for routine Deployment Health Work Group) and
the VA/DOD
sharing of each service member's Benefits Executive Council are currently
assignment history, location, developing and implementing processes to
occupational exposure, and injuries address these issues.
information.

Department of Defense (DOD)

DOD is already providing VA with daily information on personnel separating
from active duty, which includes assignment history, location, and
occupational duties through the DD214. DOD's TRICARE On Line provides
health care professionals with access to the individual service member's
pre-and post-deployment health assessments The Defense Occupational and
Environmental Health Readiness System with CHCS II, is capturing data on
occupational exposures and transferring it to the clinical data
repository. When these systems are fully operational, appropriate
information will be able to be shared via a two-way exchange with VA.

Source: VA and DOD.

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