Information Technology: VA and DOD Face Challenges in Completing 
Key Efforts (22-JUN-06, GAO-06-905T).				 
                                                                 
The Department of Veterans Affairs (VA) is engaged in an ongoing 
effort to share electronic medical information with the 	 
Department of Defense (DOD), which is important in helping to	 
ensure high-quality health care for active duty military	 
personnel and veterans. Also important, in the face of current	 
military responses to national and foreign crises, is ensuring	 
effective and efficient delivery of veterans' benefits, which is 
the focus of VA's development of the Veterans Service Network	 
(VETSNET), a modernized system to support benefits payment	 
processes. GAO is testifying on (1) VA's efforts to exchange	 
medical information with DOD, including both near-term		 
initiatives involving existing systems and the longer term	 
program to exchange data between the departments' new health	 
information systems, and (2) VA's ongoing project to develop	 
VETSNET. To develop this testimony, GAO relied on its previous	 
work and followed up on agency actions to respond to GAO	 
recommendations.						 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-905T					        
    ACCNO:   A55842						        
  TITLE:     Information Technology: VA and DOD Face Challenges in    
Completing Key Efforts						 
     DATE:   06/22/2006 
  SUBJECT:   Electronic health records				 
	     Interagency relations				 
	     Medical information systems			 
	     Medical records					 
	     Military personnel 				 
	     Performance measures				 
	     Systems compatibility				 
	     Systems design					 
	     Veterans						 
	     Veterans benefits					 
	     Information sharing				 
	     DOD/IHS/VA Government Computer-Based		 
	     Patient Record Project				 
                                                                 
	     Federal Health Information Exchange		 
	     Program						 
                                                                 
	     VA HealtheVet VistA				 
	     Bidirectional Health Information			 
	     Exchange						 
                                                                 
	     Veterans Service Network				 
	     Armed Forces Health Longitudinal			 
	     Technology Application				 
                                                                 
	     Clinical Data Repository/Health Data		 
	     Repository 					 
                                                                 

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GAO-06-905T

     

     * Results in Brief
     * Background
          * VA and DOD Have Been Working on Electronic Medical Records S
          * Work on VETSNET Dates to 1986
     * VA and DOD Are Working to Share Medical Information
          * VA and DOD Are Taking Action to Achieve a Virtual Medical Re
     * VA Has Been Severely Challenged by VETSNET Project
     * Contacts and Acknowledgments
     * Attachment 1. Past GAO Products Highlighting VETSNET Concern

Mr. Chairman and Members of the Subcommittee:

I am pleased to participate in today's hearing on health information
technology. As you know, the Departments of Veterans Affairs (VA) and
Defense (DOD) are engaged in efforts to share electronic medical
information, which is important in helping to ensure that active duty
military personnel and veterans receive high-quality health care. Also
important, in the face of current military responses to national and
foreign crises, is ensuring effective and efficient delivery of veterans'
benefits, which is the focus of VA's development of the Veterans Service
Network (VETSNET), a modernized system to support benefits payment
processes.

For the past 8 years, VA and DOD have been working to develop the ability
to exchange patient health information electronically. As part of their
efforts, each department is developing its own modern health information
system-VA's HealtheVet VistA and DOD's Armed Forces Health Longitudinal
Technology Application (AHLTA),1 and they are collaborating on a program
to develop an interface to enable these future systems to share data and
ultimately to have interoperable2 electronic medical records with
computable data. That is, the data would be in a format that a computer
application can act on: for example, to provide alerts to clinicians (of
such things as drug allergies) or to plot graphs of changes in vital signs
such as blood pressure. According to the departments, the availability of
computable medical data contributes significantly to patient safety and
the usefulness of electronic medical records.

In addition, responding to a congressional mandate,3 VA and DOD initiated
information technology demonstration projects in 2004 that focus on
near-term goals: the exchange of electronic medical information between
the departments' existing health information systems. These projects are
to help in the evaluation of the feasibility, advantages, and
disadvantages of measures to improve sharing and coordination of health
care and health care resources. The two demonstration projects
(Bidirectional Health Information Exchange and Laboratory Data Sharing
Interface) are limited, interim initiatives that are separate from the
departments' ongoing long-term efforts in sharing data and developing
health information systems.

1 In November 2005, DOD gave this name to its future health information
system, previously known as Composite Health Care System (CHCS) II.

2 Interoperability is the ability of two or more systems or components to
exchange information and to use the information that has been exchanged.

3 The Bob Stump National Defense Authorization Act for Fiscal Year 2003,
Pub. L. No. 107-314, S:721 (a)(1), 116 Stat. 2589,2595 (2002). To further
encourage on-going collaboration, section 721 directed the Secretary of
Defense and the Secretary of Veterans Affairs to establish a joint program
to identify and provide incentives to implement, fund, and evaluate
creative health care coordination and sharing initiatives between DOD and
VA.

Another ongoing VA project is the development of VETSNET, which was
prompted by the need to modernize VA's Benefits Delivery Network, parts of
which are now 40-year-old technology. This project, which was originally
initiated in 1986, is essential to ensure the continued accurate
processing of benefits payments.

At your request, my testimony today will summarize our previous work and
describe agency actions to respond to our recommendations in two areas.

           0M First, I will discuss VA's continued efforts to exchange
           medical information with DOD, including (1) near-term initiatives
           to exchange data between the agencies' existing systems and (2)
           progress in achieving the longer term goal of exchanging data
           between the departments' new systems, to be built around
           electronic patient health records.
           0M Second, I will discuss VA's ongoing project to modernize its
           Benefits Delivery Network and develop VETSNET.

           To describe the current status of VA and DOD efforts to exchange
           medical information, we reviewed our previous work in this area,
           analyzed VA and DOD documentation to determine the implementation
           status of our open recommendations, and consulted with VA and DOD
           officials responsible for key decisions and actions on the health
           data-sharing initiatives. To describe VA's efforts on the VETSNET
           initiative, we reviewed our previous work in this area, analyzed
           documentation to determine the implementation status of our open
           recommendations-most specifically, the Carnegie Mellon Software
           Engineering Institute's Technical Assessment of the VETSNET
           project-and consulted with the Veterans Benefits Administration
           officials responsible for key decisions and actions on the
           project. The costs that has been incurred for the various projects
           were provided by cognizant VA and DOD officials. We did not audit
           the reported costs and thus cannot attest to their accuracy or
           completeness. All work on which this testimony is based was
           conducted in accordance with generally accepted government
           auditing standards.

                                Results in Brief

VA and DOD are implementing limited, near-term demonstration projects, and
they are making progress toward their long-term effort to share electronic
patient health data. The two demonstration projects, which have been
implemented at selected sites, have provided significant benefits,
according to the two departments, because they enable lower costs and
improved service to patients by saving time and avoiding errors:

           0M Bidirectional Health Information Exchange, implemented at 16
           sites, allows the two-way exchange of health information on shared
           patients4 in text format (including outpatient pharmacy data, drug
           and food allergy information, patient demographics, radiology
           results, and laboratory results5).
           0M The Laboratory Data Sharing Interface application, implemented
           at 6 sites, is used to facilitate the electronic transfer/sharing
           of orders for laboratory work and the results of the work.

           In their longer term efforts to achieve a virtual medical record,
           VA and DOD have more to do to achieve the two-way electronic data
           exchange capability originally envisioned. They have made progress
           implemented three of our four earlier recommendations (forexample,
           they have developed an architecture for the electroninterface
           between DOD's Clinical Data Repository and VA's HealtData
           Repository).6 However, they have not yet developed a clearly
           defined project management plan that gives a detailed description
           othe technical and managerial processes necessary to satisfy
           project requirements, as we recommended. Moreover, the departments
           haveexperienced delays in their efforts to begin exchanging
           computable patient health data. The departments now expect that by
           the end of this month their joint facility in El Paso will begin
           to share computable outpatient pharmacy and medication allergy
           dawhich will be able to support drug interaction checking and
           druallergy alerts.

           years have determined, the development and implementation of
           thproject have been hampered by inadequate project management and
           immature software development capabilities. VETSNET was originally
           intended to replace the aging Benefits Delivery Netwwhich makes
           about 3.5 million payments to veterans each month, including
           compensation and pension benefits, education benefits, and
           vocational rehabilitation and employment benefits. In 1996
           theVeterans Benefits Administration (VBA) changed its focus to
           modernizing only the compensation and pension payment sysour past
           reviews of the modernization project, we made a number of
           recommendations aimed at improving VBA's software development
           capabilities and program management, including that the agency
           establish an integrated project plan to guide its transition from
           theold to the new system. Although VBA took steps to respond to
           our recommendations, it did not establish an integrated project
           plan. In2005, after postponing the target date for completion
           numerous times, VBA contracted for an independent assessment of
           its VETSNET program. This assessment concluded that the
           risksprogram arose not from technical issues, but from management
           and organizational issues like those that we had previously
           described. VBA reports that it is now developing a new integrated
           project planfor the compensation and pension payment system that
           is to includerealistic milestones. According to VBA, only after
           this plan is completed will it begin developing plans for
           modernizing the systems for education benefits and for vocational
           rehabilitatioemployment benefits. Similarly, VBA has not yet
           developed plans formaking the transition to VETSNET and ending
           dependence on the Benefits Delivery Network. Without plans to move
           from the currentto the replacement system, VBA will lack assurance
           that it can continue to pay beneficiaries accurately and on time
           through thtransition period.

4 Shared patients receive care from both VA and DOD clinicians. For
example, veterans may receive outpatient care from VA clinicians and be
hospitalized at a military treatment facility.

5 These data are text files providing surgical, pathology, cytology,
microbiology, chemistry, and hematology test results and descriptions of
radiology results.

6 The other two implemented recommendations were that they select a lead
entity with final decision-making authority for the initiative and that
they establish a project management structure to provide day-to-day
guidance of and accountability for their investments in and implementation
of the interface capability.

veterans in recognition of their service to the nation by ensuring they
receive medical care, benefits, social support, and lasting memorials. The
information technology programs that I will be discussing today are
primary concerns of two of VA's major components:7 the Veterans Health
Administration, which manone of the largest health care systems in the
United States, with 157hospitals nationwide, and the Veterans Benefits
Administration, which provides benefits and services to veterans and their
dependents that include compensation and pension, educatguaranty, and
insurance.

VA and DOD Have Been Working on Electronic Medical Records Since 1998

In 1998, following a presidential call for VA and DOD to start
developing a "comprehensive, life-long medical record for eacservice
member," the two departments began a joint course of action aimed at
achieving the capability to share patient health information for active
duty military personnel and veterans.8 Their first initiative, undertaken
in that year, was known as the Government Computer-Based Patient Record
(GCPR) project; the goal of this project was an electronic interface that
would allow physicians and other authorized users at VA and DOD health
facilities to access data from any of the other agency's health
information systems. The interface was expected to compile requested
patient information in a virtual record that could be displayed on a
user's computer screen.

7 VA's third major component is the National Cemetery Administration,
which is responsible for providing burial benefits to veterans and
eligible dependents.

In our reviews of the GCPR project, we determined that the lack of a lead
entity, clear mission, and detailed planning to achieve that mission made
it difficult to monitor progress, identify project risks, and develop
appropriate contingency plans. In April 2001 and in June 2002,9 we made
recommendations to help strengthen the management and oversight of the
project. In 2001, we recommended that the participating agencies (1)
designate a lead entity with final decision-making authority and establish
a clear line of authority for the GCPR project and (2) create
comprehensive and coordinated plans that included an agreed-upon mission
and clear goals, objectives, and performance measures, to ensure that the
agencies could share comprehensive, meaningful, accurate, and secure
patient health care data. In 2002, we recommended that the participating
agencies 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.

VA and DOD took specific measures in response to our recommendations for
enhancing overall management and accountability of the project. By July
2002, VA and DOD had revised their strategy and had made progress toward
being able to electronically share patient health data. The two
departments had refocused the project and named it 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. This agreement also
established FHIE as a joint activity that would allow the transfer from
DOD to VA of health care information in two phases:

8 Initially, the Indian Health Service (IHS) also was a party to this
effort, having been included because of its population-based research
expertise and its long-standing relationship with VA. However, IHS was not
included in a later revised strategy for electronically sharing patient
health information.

9 GAO, 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.: Apr. 30, 2001).

           0M The first phase, completed in mid-July 2002, enabled the
           one-way transfer of data from DOD's existing health information
           system (the Composite Health Care System or CHCS) to a separate
           database that VA clinicians could access.
           0M A second phase, finalized in March 2004, 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.

           According to the December 2004 VA/DOD Joint Executive Council10
           Annual Report, FHIE was fully operational, and providers at all VA
           medical centers and clinics nationwide had access to data on
           separated service members. According to the report, the FHIE data
           repository at that time contained historical clinical health data
           on 2.3 million unique patients from 1989 on, and the repository
           made a significant contribution to the delivery and continuity of
           care and adjudication of disability claims of separated service
           members as they transitioned to veteran status. The departments
           reported total GCPR/FHIE costs of about $85 million through fiscal
           year 2003.

           In addition, officials stated that in December 2004, the
           departments began to plan for using the FHIE framework to transfer
           pre- and postdeployment health assessment data from DOD to VA.
           According to these officials, transferring of this information
           began in July 2005, However, not all DOD medical information is
           captured in CHCS. For example, according to DOD officials, as of

           System (a commercial product customized for DOD). In addition,
           many Air Force facilities use a system called the Integrated
           ClinDatabase for their medical information. The revised DOD/VA
           strategy also envisioned achieving a longer term, two-way exchange
           of health inform

           HealthePeople (Federal), this initiative is premised on the
           departments' development of a common health information
           architecture comprising standardized data, communications,
           security, and high-performance health information systemsjoint
           effort is expected to result in the secured sharing of heabetween
           the new systems that each department is currently developing and
           beginning to implement-DOD's AHLTA and VA'sHealtheVet VistA.  DOD
           began developing AHLTA in 1997.11 DOD has completed  a
           keycomponent for the

           system capabilities by 2011.12 (When we reported in June 2004,
           this deployment was expected in September 2008.) DOD expects to
           spend about $783 million for the system through fiscal year
           2006.13 VA began work on HealtheVet VistA and its associated
           Health Data Repository in 2001 and expected to complete all six
           initiatives comprising this system in 2012. VA reported spending
           about $514
           million on initiatives that comprise HealtheVet VistA through
           fiscal year 2005.14 Under the HealthePeople (Federal) initiative,
           VA and DOD envision that, on enter

           Repository. The record would be updated as the service member
           receives medical care. When the individual separated from
           activeduty and, if eligible, sought medical care at a VA facility,
           VA wthen create a medical record for the individual, which would
           be stored in its Health Data Repository. On viewing the medical
           recorthe VA clinician would be alerted and provided with access to
           the individual's clinical information residing in DOD's
           repository. In same manner, when a veteran sought medical care at
           a military treatment facility, the attending DOD clinician would
           be alerted anprovided with access to the health information in
           VA's repository. According to the departments, this planned
           approach would makvirtual medical records displaying all available
           patient health information from the two repositories accessible to
           both departments' clinicians. To achieve this goal requires the
           departments to be able tocomputable health inform

           component of HealtheVet VistA) and DOD's Clinical Data Repository
           (a component of AHLTA). In March 2004, the departments began
           aeffort to develop an interface linking these two repositories,
           knownas CHDR (a name derived from the abbreviations for DOD's
           Clinical Data Repository-CDR-and VA's Health Data Repository-HDR).
           According to the departments,15 they planned to be able to
           exchange selected health information through CHDR by October 2005.
           However, by September 2005, this deadline had slipped to February
           2006 (and now to the end of June). Developing the two
           repositories, populating them with data, alinking them through the
           CHDR interface would be important steps toward the two
           departments' long-te

           on completing the development and deployment of the
           associatedhealth information systems-HealtheVet VistA and AHLTA.
           In a review of the CHDR program in June 2004,16 we reported that
           the efforts of DOD and VA in this area demonstrated a number of
           management weaknesses. Among these were the lack of a w

           health information exchange; an established project management
           lead entity and structure to guide the investment in the interface
           aits implementation; and a project management plan defining
           thetechnical and managerial processes necessary to satisfy project
           requirements. With these critical components missing, VA and
           DODincreased the risk that they would not achieve their goals.
           Accordingly, we recommended that the departments develop an
           architecture for the electronic interface between their health
           systems that includes system requirements, design specifications,
           and software descriptions;

           initiative; establish a project management structure to provide
           day-toguidance of and accountability for their inv
           implementation of the interface capability; and create and
           management plan for the electronic interface that defines the
           technical and managerial processes necessary to satisfy
           projrequirements and includes (1) the authority and
           each organizational unit; (2) a work breakdown structure for all
           othe tasks to be performed in developing, testing, and implementhe
           software, along with schedules associated with the tasks; and(3) a
           security policy. In September 2005, we testified that VA and DOD
           had made progress in the electronic sharing of patient health data
           in their near-term demonstration projects. We noted that with
           regard to their long-term goals,

           to face significant challenges-in particular, developing a
           promanagement plan of sufficient specificity to be an effective
           guidethe program.17 Besides pursuing their long-term goals for
           future systems through the HealthePeople (Federal) strategy, the
           departments are working on two demonstration projects that focus
           on exchanging information bet

           shared patients, and (2) Laboratory Data Sharing Interface, an
           application used to transfer laboratory work orders and results.
           These demonstration projects were planned in response tprovisions
           of the Bob Stump National Defense Authorization Ac2003, which
           mandated that VA and DOD conduct demonstration projects that
           included medical information and information technology systems to
           be used as a test for evaluating the feasibiadvantages, and
           disadvantages of measures and programs dto improve the sharing and
           coordination of health care and health care resources between the
           departments. Figure 1 is a time line showing initiation points for
           the VA and DOD efforts discussed here, including strategies, major
           programs, and therecent demonstration projects.

10 The Joint Executive Council is composed of the Deputy Secretary of
Veterans Affairs, the Undersecretary of Defense for Personnel and
Readiness, and the co-chairs 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.

11 At that time it was known as CHCS II. In November 2005, DOD renamed
CHCS II the Armed Forces Health Longitudinal Technology Application
(AHLTA).

12 DOD's AHLTA  capabilities are being deployed incrementally. The first
increment provides a graphical user interface for clinical outpatient
processes, thus providing an electronic medical record capability.
According to DOD, the first increment has been deployed to 115 of the 138
DOD health facilities.

13 These expenditures represent total implementation and start-up costs
and include, among other things, procurement, acquisition operations, and
maintenance used for the development, integration, and deployment of the
system.

14 The six initiatives that make up HealtheVet VistA are the Health Data
Repository, billing replacement, laboratory, pharmacy, imaging, and
appointment scheduling replacement. This amount includes investments in
these six initiatives by VA as reported in its submission to the Office of
Management and Budget for fiscal year 2005.

15 December 2004 VA and DOD Joint Strategic Plan.

16 GAO, Computer-Based Patient Records: VA and DOD Efforts to Exchange
Health Data Could Benefit from Improved Planning and Project Management,
GAO-04-687 (Washington, D.C.: June 7, 2004).

17 GAO, Computer-Based Patient Records: VA and DOD Made Progress, but Much
Work Remains to Fully Share Medical Information, GAO-05-1051T (Washington,
D.C.: Sept. 28, 2005).

Figure 1: History of Selected VA/DOD Electronic Medical Records and Data
Sharing Efforts

Work on VETSNET Dates to 1986

The VETSNET effort grew out of an initiative begun by the Veterans
Benefits Administration (VBA) in 1986 to replace its outdated Benefits
Delivery Network. The Benefits Delivery Network, parts of which were
developed in the 1960s, contains over 3 million veterans benefits records,
including compensation and pension, education, and vocational
rehabilitation and employment. Originally, the plan was to modernize all
of these systems and in so doing provide a rich source for answering
questions about veterans' benefits and enable faster processing of
benefits. As envisioned in the 1980s, the modernization would produce a
faster, more flexible, higher capacity system that would be both an
information system and a payment system. In 1996, after experiencing
numerous false starts and spending approximately $300 million on the
overall modernization of BDN, VBA revised its strategy and narrowed its
focus to modernizing the compensation and pension payment system.

At that time, we undertook an assessment of the department's software
development capability18 and determined that it was immature. In our
assessment, we specifically examined the VETSNET effort and concluded that
VBA could not reliably develop and maintain high-quality software on any
major project within existing cost and schedule constraints. VBA showed
significant weaknesses in requirements management, software project
planning, and software subcontract management, with no identifiable
strengths. We also testified that (1) VBA did not follow sound systems
development practices on VETSNET, such as validation and verification of
systems requirements; (2) it employed for the project a new systems
development methodology and software development language not previously
used; and (3) it did not develop the cost-benefit information necessary to
track progress or assess return on investment (for example, total software
to be developed and cost estimates).19 As a result, we concluded that
VBA's modernization efforts had inherent risks.

Between 1996 and 2002 we reported several more times on VETSNET,
highlighting concerns in several areas. (See attachment 1 for a
description of the conclusions and findings of our products on this
topic.) In these products, we made several recommendations aimed at
improving VA's software development capabilities, including that the
department take steps to achieve greater maturity in its software
development processes20 and that it delay any major investment in software
development (beyond that needed to sustain critical day-to-day operations)
until it had done so. In addition, we made recommendations aimed
specifically at VETSNET development, including that VBA assess and
validate users' requirements for the new system; complete testing of the
system's functional business capability, as well as end-to-end testing to
ensure that payments are made accurately; and establish an integrated
project plan to guide its transition from the old to the new system.

18 GAO, Software Capability Evaluation: VA's Software Development Process
Is Immature, GAO/AIMD-96-90 (Washington, D.C.: June 19, 1996).

19 GAO, Veterans Benefits Modernization: Management and Technical
Weaknesses Must Be Overcome If Modernization Is to Succeed,
GAO/T-AIMD-96-103 (Washington, D.C.: June 19, 1996).

20 Specifically, at the repeatable level of process maturity, basic
project management processes are established to track cost, schedule, and
functionality, and the necessary process discipline is in place to repeat
earlier successes on projects with similar applications.

Although VBA took various actions in response to these recommendations, we
continued to identify the department's weak software development
capability as a significant factor contributing to VBA's persistent
problems in developing and implementing the system-the same condition that
we identified in 1996. We also reported that VBA continued to work on
VETSNET without an integrated project plan. As a result, the development
of VETSNET continued to suffer from problems in several areas, including
project management, requirements development, and testing.

              VA and DOD Are Working to Share Medical Information

VA and DOD have made progress in sharing patient health data by
implementing  applications developed under two demonstration projects that
focus on the exchange of electronic medical information. The first-the
Bidirectional Health Information Exchange-has been implemented at 16
VA/DOD locations, and the second-Laboratory Data Sharing Interface-has
been implemented at  6  VA/DOD locations.

Bidirectional Health Information Exchange. According to a VA/DOD annual
report and program officials, Bidirectional Health Information Exchange
(BHIE) is an interim step in the departments' overall strategy to create a
two-way exchange of electronic medical records. BHIE builds on the
architecture and framework of FHIE, the application used to transfer
health data on separated service members from DOD to VA. As discussed
earlier, FHIE provides an interface between VA's and DOD's existing health
information systems that allows one-way transfers only, which do not occur
in real time: VA clinicians do not have access to transferred information
until about 6 weeks after separation. In contrast, BHIE focuses on the
two-way, near-real-time21 exchange of information (text only) on shared
patients (such as those at sites jointly occupied by VA and DOD
facilities). This application exchanges data between VA's VistA system and
DOD's CHCS system (and AHLTA where implemented). As of September 2005, the
departments reported having spent $2.6 million on BHIE.22

The primary benefit of BHIE is near-real-time access to patient medical
information for both VA and DOD, which is not available through FHIE.
During a site visit to a VA and DOD location in Puget Sound in 2005,  we
viewed a demonstration of this capability and were told by a VA clinician
that the near-real-time access to medical information was very beneficial
in treating shared patients.

As of June 2006, BHIE was deployed at VA and DOD facilities at 16 sites,
where the exchange of demographic, outpatient pharmacy, radiology,
laboratory, and allergy data (text only) has been achieved. In addition,
according to officials, over 120 outpatient military clinics associated
with these sites also have access to this information through BHIE.
According to VA and DOD, BHIE will be implemented at two more sites in
July 2006.23 Table 1 presents a schedule for implementation of BHIE; the
sites listed are all DOD sites with nearby VA facilities.

Table 1: Implementation of BHIE at Selected DOD Facilities

Facility                                             Implementation date   
Madigan Army Medical Center, Fort Lewis, Puget       October 2004          
Sound, Wash.                                         
William Beaumont Army Medical Center, El Paso, Tex.  October 2004          
Eisenhower Army Medical Center, Fort Gordon, Ga.     September 2005        
Naval Hospital Great Lakes, Great Lakes, Ill.        September 2005        
Naval Medical Center, San Diego,  Calif.             September 2005        
National Naval Medical Center, Bethesda, Md.         November 2005         
Walter Reed Army Medical Center, Washington, D.C.    November 2005         
Malcolm Grow Medical Center, Andrews Air Force Base, November 2005         
Md.                                                  
Mike O'Callaghan Federal Hospital, Nellis Air Force  November 2005         
Base, Nev.                                           
Landstuhl Regional Medical Center, Landstuhl,        March 2006            
Germany                                              
Tripler Army Medical Center, Honolulu, Hawaii        April 2006            
Womack Army Medical Center, Fort Bragg, N.C.         April 2006            
David Grant Medical Center, Travis Air Force Base,   April 2006            
Calif.                                               
Brooke Army Medical Center, San Antonio, Tex.        May 2006              
Wilford Hall Medical Center, San Antonio, Tex.       May 2006              
Bassett Army Community Hospital, Fort Wainwright,    May 2006              
Alaska                                               
Naval Hospital, Jacksonville, Fla.                   Planned for July 2006 
Naval Hospital, Charleston, S.C.                     Planned for July 2006 

21 Officials reported that on average, response time is less than 30
seconds.

22 VA reported spending $2.4 million on BHIE through fiscal year 2006. DOD
reported spending $63.2 million through fiscal year 2006 for BHIE, FHIE,
LDSI, and CHDR; it did not provide a breakdown for individual programs.

23 According to the program manager, implementation of BHIE requires
training of staff from both departments. In addition, implementation at
DOD facilities requires installation of a server; implementation at VA
facilities requires installation of a software patch (downloaded from a VA
computer center), but no additional equipment.

Sources: VA and DOD.

Note: VA facilities are sited near all the DOD facilities shown.

Additionally, because DOD stores electronic medical information in systems
other than CHCS (such as the Clinical Information System and the
Integrated Clinical Database), work is currently under way to allow BHIE
to have the ability to exchange information with those systems. Currently,
one site is testing the use of BHIE as an interface allowing both
departments' staff to view discharge summaries stored in the Clinical
Information System.24 DOD and VA plan to perform a side-by-side comparison
to ensure that this capability maintains data quality. When they are
satisfied, the capability will be provided to those DOD locations that
currently use the Clinical Information System and have BHIE implemented.
Doing so will permit all VA sites access to the information in the
Clinical Information System on shared patients at DOD sites running BHIE.

In addition, at the VA/DOD site in El Paso, a prototype is being designed
for exchanging radiological images using the BHIE/FHIE infrastructure. If
the prototype is successful, this capability will be extended to the rest
of the sites.

24 VA and DOD are planning to initiate the pilot at a second site in
August 2006.

Laboratory Data Sharing Interface. The Laboratory Data Sharing Interface
(LDSI) initiative enables the two departments to share laboratory
resources. Through LDSI, a VA provider can use VA's health information
system to write an order for laboratory tests, and that order is
electronically transferred to DOD, which performs the test. The results of
the laboratory tests are electronically transferred back to VA and
included in the patient's medical record. Similarly, a DOD provider can
choose to use a VA lab for testing and receive the results electronically.
Once LDSI is fully implemented at a facility, the only nonautomated action
in performing laboratory tests is the transport of the specimens.

Among the benefits of LDSI are increased speed in receiving laboratory
results and decreased errors from manual entry of orders. However,
according to the LDSI project manager in San Antonio, a primary benefit of
the project will be the time saved by eliminating the need to rekey orders
at processing labs to input the information into the laboratories'
systems. Additionally, the San Antonio VA facility will no longer have to
contract out some of its laboratory work to private companies, but instead
use the DOD laboratory. As of September 2005, the departments reported
having spent about $3.3 million on LDSI.25

An early version of what is now LDSI was originally tested and implemented
at a joint VA and DOD medical facility in Hawaii in May 2003. The
demonstration project built on this application and enhanced it; the
resulting application was tested in San Antonio and El Paso. It has now
been deployed to six sites. According to the departments, a plan to export
LDSI to two additional locations has been approved. Table 2 shows the
locations at which it has been or is to be implemented.

25 VA reported spending $1 million on LDSI through fiscal year 2006. DOD
reported spending $63.2 million through fiscal year 2006 for BHIE, FHIE,
LDSI, and CHDR; it did not provide a breakdown for individual programs.

Table 2: Implementation of LDSI at VA/DOD Facilities

Facility                                        Implementation date        
Tripler Army Medical Center and VA Spark M.     May 2003                   
Matsunaga Medical Center, Hawaii                
Kirtland Air Force Base and Albuquerque VA      May 2003                   
Medical Center, N.Mex.a                         
Naval Medical Center and San Diego VA Health    July 2004                  
Care System, Calif.                             
Great Lakes Naval Hospital and VA Medical       October 2004               
Center, Ill.                                    
William Beaumont Army Medical Center, El Paso,  October 2004               
Tex.                                            
Brooke Army Medical Center, San Antonio, Tex.   August 2005                
Bassett Army Community Hospital, Alaska         Planned for June 2006      
Nellis Air Force Base, Nev.                     Planned for September 2006 

Sources: VA and DOD.

a According to officials, although LDSI was implemented at this site, it
is no longer being actively used.

VA and DOD Are Taking Action to Achieve a Virtual Medical Record, but Much Work
Remains

Besides the near-term initiatives just discussed, VA and DOD continue
their efforts on the longer term goal: to achieve a virtual medical record
based on the two-way exchange of computable data between the health
information systems that each is currently developing. The cornerstone for
this exchange is CHDR, the planned electronic interface between the data
repositories for the new systems.

The departments have taken important actions on the CHDR initiative. As we
testified in September 2005,26 they successfully completed Phase I of CHDR
in September 2004 by demonstrating the two-way exchange of pharmacy
information with a prototype in a controlled laboratory environment.27
According to department officials, the pharmacy prototype provided
invaluable insight into each other's data repository systems,
architecture, and the work that is necessary to support the exchange of
computable information. These officials stated that lessons learned from
the development of the prototype were documented and being applied to
Phase II of CHDR, the production phase, which is to implement the two-way
exchange of patient health records between the departments' data
repositories. Further, the same DOD and VA teams that developed the
prototype were developing the production version.

26 GAO, Computer-Based Patient Records: VA and DOD Made Progress, but Much
Work Remains to Fully Share Medical Information, GAO-05-1051T (Washington,
D.C.: Sept. 28, 2005).

27 The completion of the pharmacy prototype project satisfied a mandate of
the 2003 Bob Stump National Defense Authorization Act, Pub. L. 107-314,
sec. 724 (2002).

In addition, the departments developed an architecture for the CHDR
electronic interface, as we recommended in June 2004. The architecture for
CHDR includes major elements required in a complete architecture. For
example, it defines system requirements and allows these to be traced to
the functional requirements, it includes the design and control
specifications for the interface design, and it includes design
descriptions for the software.

Also in response to our recommendations, the departments established
project accountability and implemented a joint project management
structure. Specifically, the Health Executive Council was established as
the lead entity for the project. The joint project management structure
consists of a Program Manager from VA and a Deputy Program Manager from
DOD to provide day-to-day guidance for this initiative. Additionally, the
Health Executive Council established the DOD/VA Information
Management/Information Technology Working Group and the DOD/VA Health
Architecture Interagency Group, to provide programmatic oversight and to
facilitate interagency collaboration on sharing initiatives between DOD
and VA.

To build on these actions and successfully carry out the CHDR initiative,
however, the departments still have a number of challenges to overcome.
The success of CHDR will depend on the departments' instituting a highly
disciplined approach to the project's management. Industry best practices
and information technology project management principles stress the
importance of accountability and sound planning for any project,
particularly an interagency effort of the magnitude and complexity of this
one.

Accordingly, in 2004 we recommended that the departments develop a clearly
defined project management plan that describes the technical and
managerial processes necessary to satisfy project requirements and
includes (1) the authority and responsibility of each organizational unit;
(2) a work breakdown structure for all of the tasks to be performed in
developing, testing, and implementing the software, along with schedules
associated with the tasks; and (3) a security policy. As of September
2005, the departments had an interagency project management plan that
provided the program management principles and procedures to be followed
by the project. However, this plan did not specify the authority and
responsibility of organizational units for particular tasks; the work
breakdown structure was at a high level and lacked detail on specific
tasks and time frames; and security policy was still being drafted. No
more recent plan has yet been provided. Without a plan of sufficient
detail, VA and DOD increase the risk that the CHDR project will not
deliver the planned capabilities in the time and at the cost expected.

In addition, officials did not meet a previously established milestone: by
October 2005, the departments had planned to be able to exchange
outpatient pharmacy data, laboratory results, allergy information, and
patient demographic information on a limited basis. However, according to
officials, the work required to implement standards for pharmacy and
medication allergy data was more complex than originally anticipated and
would result in a delay. The new target date for the limited exchange of
medication allergy, outpatient pharmacy, and patient demographic data has
been postponed from February to June 2006.

Currently, the departments report that they are close to finishing the
development of a pilot to perform this data exchange at their joint
facility in El Paso. They expect to be able to begin the pilot by the end
of this month, which will allow them to share outpatient pharmacy and
medication allergy information that can support drug-drug interaction
checking and drug-allergy alerts. If the pilot is successful, it will
enable for the first time the exchange of computable information between
the departments' two data repositories.

Finally, the health information currently in the data repositories has
various limitations.

           0M Although DOD's Clinical Data Repository includes data in the
           categories that were to be exchanged at the missed milestone
           described above (outpatient pharmacy data, laboratory results,
           allergy information, and patient demographic information), these
           data are not yet complete. First, the information in the Clinical
           Data Repository is limited to those locations that have
           implemented the first increment of AHLTA, DOD's new health
           information system. As of June 15, 2006, according to DOD
           officials, 115 of 138 medical treatment facilities worldwide have
           implemented this increment, and officials expect that the
           remaining facilities will receive the increment by the end of this
           year. Second, at present, health information in systems other than
           CHCS (such as the Clinical Information System and the Integrated
           Clinical Database) is not yet being captured in the Clinical Data
           Repository. However, work is currently under way to allow BHIE to
           have the ability to exchange information with those systems.
           0M The information in VA's Health Data Repository is also limited:
           although all VA medical records are currently electronic, VA has
           to convert these into the interoperable format appropriate for the
           Health Data Repository. So far, the data in the Health Data
           Repository consist of patient demographics, vital signs records,
           allergy data, and outpatient pharmacy data for the 6 million
           veterans who have electronic medical records in VA's current
           system, VistA (this system contains all the department's medical
           records in electronic form). VA officials told us that they are
           currently converting lab results data.

               VA Has Been Severely Challenged by VETSNET Project

Since its inception, the VETSNET program has been plagued by problems. In
2002, we offered a number of recommendations regarding the ongoing
compensation and pension (C&P) replacement program. We testified that VBA
should assess and validate users' requirements for the new system and
complete testing of the system's functional business capability, including
end-to-end testing.28 We also recommended that VA appoint a project
manager, thoroughly analyze its current initiative, and develop a number
of plans, including a revised C&P replacement strategy and an integrated
project plan. We also noted that VBA had much work to do before it could
fully implement the VETSNET C&P system by its target date (at that time)
of 2005, and thus it would have to ensure that the aging Benefits Delivery
Network (BDN) would be available to continue accurately processing
benefits payments until a new system could be deployed. Accordingly, we
recommended that VBA develop action plans to move from the current to the
replacement system and to ensure the availability of BDN to provide the
more than 3.5 million payments made to veterans each month.29

VA concurred with our recommendations and took several actions to address
them. For example, it appointed a full-time project manager. Also, the
project team reported that to ensure that business needs were met,
certification had been completed of users' requirements for the system's
applications.

In addition, VA reported that a revised strategy for the replacement
system was completed. This revised strategy included the business case,
described the methodology used to identify system development
alternatives, displayed the cost/benefit analysis results of the viable
alternatives that could be used to develop the system, and provided a
description of the recommended development plan. Based on this strategy,
the Secretary of Veterans Affairs, Assistant Secretary for Information and
Technology, the Under Secretary for Benefits, and the Deputy Chief
Information Officer for Benefits approved continuation of the VETSNET
development in September 2002.

Further, to ensure that the benefits delivery network would be able to
continue accurately processing benefits payment until the new system was
deployed, VBA purchased additional BDN hardware, hired 11 new staff
members to support BDN operations, successfully tested a contingency plan
in the event of disruption of the system, and provided retention bonuses
to staff familiar with BDN operations.

28 GAO, VA Information Technology: Progress Made, but Continued Management
Attention Is Key to Achieving Results, GAO-02-369T (Washington, D.C.: Mar.
13, 2002).

29 GAO, Veterans Affairs: Sustained Management Attention Is Key to
Achieving Information Technology Results, GAO-02-703 (Washington, D.C.:
June 12, 2002).

However, VBA did not develop an integrated project plan for VETSNET, which
is a basic requirement of sound project management. In addition, it did
not develop an action plan for transitioning from the current to the
replacement system. Thus, although the actions taken addressed some of our
specific concerns, they were not sufficient to establish the program on a
sound footing.

In 2005, the VA CIO became concerned by continuing problems with VETSNET:
the project continued to postpone target dates, and costs continued to
increase (VA indicated that by 2005 these costs exceeded $69 million).
Accordingly, he arranged to contract for an independent assessment of the
department's options for the VETSNET project, including an evaluation of
whether the program should be terminated. This assessment, conducted by
the Carnegie Mellon Software Engineering Institute (SEI), concluded that
the program faced many risks arising from management, organizational, and
program issues, but no technical barriers that could not be overcome.30
According to SEI, terminating the program would not solve the underlying
management and organizational problems, which would continue to hamper any
new or revised effort.

SEI recommended that the department not terminate the program but take an
aggressive approach to dealing with the issues SEI described while
continuing to work on the program at a reduced pace. According to SEI,
this approach would allow VA to make necessary improvements to its system
and software engineering and program management capabilities while making
gradual progress on the system. SEI also discussed specific concerns about
the system's management and the organization's capabilities, presenting
areas that required focus regardless of the particular course that VA
chose for the system. For example:

30 Kathryn Ambrose, William Novak, Steve Palmquist, Ray Williams, and
Carol Woody, Report of the Independent Technical Assessment on the
Department of Veterans Affairs VETSNET Program (Carnegie Mellon Software
Engineering Institute, September 2005).

           0M Setting realistic deadlines. SEI commented that there was no
           credible evidence that VETSNET would be complete by the target
           date, which at the time of the SEI review was  December 2006.
           Because this deadline was unrealistic, VBA needed to plan and
           budget for supporting BDN so that its ability to pay veterans
           benefits would not be disrupted.
           0M Establishing an effective requirements process.
           0M Implementing effective program measurements in order to assess
           progress.
           0M Establishing sound program management. According to SEI,
           different organizational components had independent schedules and
           priorities, which caused confusion and deprived the department of
           a program perspective.

           These observations are consistent with our long-standing concerns
           regarding fundamental deficiencies in VBA's management of the
           project.

           In the wake of the SEI assessment and recommendations, VA is in
           the process of creating, with contract help, an integrated master
           plan that is to cover the C&P replacement project. Because this
           plan is in process, no cost or schedule milestones have yet been
           finalized. According to VA, the integrated master plan is to be
           completed by the end of August 2006.

           VA officials told us that they intend to complete this plan before
           beginning to plan for modernizing the systems for paying education
           benefits or for paying vocational rehabilitation and employment
           benefits. Plans for making the transition to VETSNET and ending
           VBA's dependence on BDN are also on hold.

           Thus, VA still lacks an integrated project plan or a plan to move
           from the current to the replacement system. Until it has an
           integrated project plan and schedule incorporating all the
           critical areas of the system development effort, VBA will lack the
           means of determining what needs to be done and when, and of
           measuring replacement system, VBA will lack assurance that it can
           cpay beneficiaries accurately and on time through the transition
           period.

           and DOD to exchange computable patient medical records is a highly
           complex undertaking that could lead to substantial benefimproving
           the quality of health care and disability claims processing for
           the nation's service members and veterans. VA and DOD have made
           progress in the electronic sharing of patient health data in their
           limited, near-term demonstration projects, and have taken
           aimportant step toward their long-term goals by improving the
           management of the CHDR program. However, the
           departmentsconsiderable work and significant challenges before
           they can achieve these long-term goals. While the departments have
           maprogress in developing a project management plan, it is not yet
           complete. Having a project management plan of sufficient specito
           guide the program-including establishing accountability and
           addressing security-would help the departments avoid further
           delays in their schedule and ensure that they produce a
           capabilitthat meets their expectations.

           through its development of VETSNET, but the pace of progress hbeen
           discouraging. Much work remains in accomplishing the original
           comprehensive goal of modernizing the aging system VBA currently
           depends on to pay veterans benefits. Until VBA develops an
           integrated project plan that addresses the long-stanmanagement
           weaknesses that we and others have identified, it will be
           uncertain when and at what cost VETSNET will be delivered.

           respond to any questions that you or other members of the
           Subcommittee may have at this time.

                          Contacts and Acknowledgments

For information about this testimony, please contact Linda D. Koontz,
Director, Information Management Issues, at (202) 512-6240 or at
[email protected]. Other individuals making key contributions to this
testimony include Barbara S. Collier, Martin Katz, Barbara S. Oliver, Eric
L. Trout, Robert Williams Jr., and Charles Youman.

         Attachment 1. Past GAO Products Highlighting VETSNET Concerns

We previously performed several reviews addressing VETSNET and made
numerous recommendations aimed at strengthening the program and VA's
software development and management capabilities. The table summarizes the
results of these reviews.

GAO Products Highlighting Concerns with VETSNET Project to Replace
Compensation and Pension (C&P) Payment System

Issuance date                                                              
Report/testimony           Results of review
June 19, 1996              VETSNET had inherent risks in that (1) it did   
GAO/T-AIMD-96-103          not follow sound systems development practices, 
                              such as validation and verification of systems  
                              requirements; (2) it employed a new systems     
                              development methodology and software            
                              development language not previously used; and   
                              (3) VBA did not develop the cost-benefit        
                              information necessary to track progress or      
                              assess return on investment (for example, total 
                              software to be developed and cost estimates).   
June 19, 1996              VBA's software development capability was       
GAO/AIMD-96-90             immature and it could not reliably develop and  
                              maintain high-quality software on any major     
                              project within existing cost and schedule       
                              constraints, placing its software development   
                              projects at significant risk. VBA showed        
                              significant weaknesses in requirements          
                              management, software project planning, and      
                              software subcontract management, with no        
                              identifiable strengths.                         
May 30, 1997               VETSNET experienced schedule delays and missed  
GAO/AIMD-97-79             deadlines because (1) it employed a new         
                              software development language not previously    
                              used by the development team, one that was      
                              inconsistent with the agency's other systems    
                              development efforts; (2) the department's       
                              software development capability was immature    
                              and it had lost critical systems control and    
                              quality assurance personnel, and (3) VBA lacked 
                              a complete systems architecture; for example,   
                              neither a security architecture nor performance 
                              characteristics had been defined for the        
                              project.                                        
September 15, 1997         VBA's software development capability remained  
GAO/AIMD-97-154            ad hoc and chaotic, subjecting the agency to    
                              continuing risk of cost overruns, poor quality  
                              software, and schedule delays in software       
                              development.                                    
May 11, 2000               $11 million had reportedly been spent on        
GAO/T-AIMD-00-74           VETSNET C&P neither the May 1998 completion    
                              date nor the revised completion date of         
                              December 1998 were met. Contributing factors    
                              included lack of an integrated architecture     
                              defining the business processes, information    
                              flows and relationships, business requirements, 
                              and data descriptions, and VBA's immature       
                              software development capability.                
September 21, 2000         VBA's software development capability remained  
GAO/T-AIMD-00-321          ad hoc and chaotic. The VETSNET implementation  
                              approach lacked key elements, including a       
                              strategy for data conversion and an integrated  
                              project plan and schedule incorporating all     
                              critical systems development areas. Further,    
                              data exchange issues had not been fully         
                              addressed.                                      
April 4, 2001 GAO-01-550T  The project's viability was still a concern. It 
                              continued to lack an integrated project plan    
                              and schedule addressing all critical systems    
                              development areas, to be used as a means of     
                              determining what needs to be done and when. A   
                              pilot test of 10 original claims that did not   
                              require significant development work may not    
                              have been sufficient to demonstrate that the    
                              product was capable of working as intended in   
                              an organizationwide operational setting.        
March 13, 2002 GAO-02-369T VBA still had fundamental tasks to accomplish   
                              before it could successfully complete           
                              development and implementation. It still had to 
                              assess and validate users' requirements for the 
                              new system to ensure that business needs were   
                              met. It needed to complete testing of the       
                              system's functional business capability, as     
                              well as end-to-end testing to ensure that       
                              payments would be made accurately. Finally, it  
                              needed to establish an integrated project plan  
                              to guide its transition from the old to the new 
                              system.                                         
June 12, 2002 GAO-02-703   VA still needed to address long-standing        
                              concerns regarding development and              
                              implementation. VA needed to appoint a project  
                              manager, undertake a complete analysis of the   
                              initiative, and develop plans, including a      
                              revised C&P replacement system strategy and an  
                              integrated project plan. It also needed to      
                              develop and implement action plans to move VBA  
                              from the current to the replacement system and  
                              to ensure that the Benefits Delivery Network    
                              would be able to continue accurately processing 
                              benefits payments until the new system was      
                              deployed.                                       
September 26, 2002         Much work remained before VBA could fully       
GAO-02-1054T               implement the VETSNET C&P system, and complete  
                              implementation was not expected until 2005.     
                              This meant that VBA had to continue relying on  
                              its aging Benefits Delivery Network to provide  
                              the more than 3.5 million payments that VA had  
                              to make to veterans each month.                 
                                                                              
                              In late March, a VETSNET executive board and a  
                              project control board were established to       
                              provide decision support and oversee            
                              implementation, and VBA expected to hire a      
                              full-time project manager by the end of         
                              September. VBA also began revalidating          
                              functional business requirements for the new    
                              system, with completion planned by January      
                              2003, and it identified actions needed to       
                              transition VBA from the current to the          
                              replacement system. VBA also hired a contractor 
                              and tasked the contractor with conducting       
                              functional, integration, and linkage testing,   
                              as well as software quality assurance for each  
                              release of the system applications.             
                                                                              
                              Despite these actions, completing               
                              implementation of the new system could take     
                              several years. All but one of the software      
                              applications for the new system still needed to 
                              be fully deployed or developed. Specifically, a 
                              rating board automation tool (RBA 2000) was     
                              deployed, although VBA did not plan to require  
                              all its regional offices to use it until July   
                              2003. In addition, two others had not been      
                              completely deployed: one of these (Share, used  
                              to establish a new claim) was in use by only 6  
                              of the 57 regional offices. The other (Modern   
                              Award Processing-Development, used to develop   
                              information on claims) was in pilot testing at  
                              two regional offices-Salt Lake and Little       
                              Rock-but was not expected to be implemented at  
                              the other 55 regional offices until October     
                              2003. The remaining three software applications 
                              (Award Processing, Finance and Accounting       
                              System, and Correspondence) were still in       
                              development.                                    

Source: GAO.

(310772)

www.gao.gov/cgi-bin/getrpt? GAO-06-905T .

To view the full product, including the scope

and methodology, click on the link above.

For more information, contact Linda Koontz at (202) 512-6240 or
[email protected].

Highlights of GAO-06-905T , a testimony before the Subcommittee on Federal
Financial Management, Government Information, and International Security,
Committee on Homeland Security and Governmental Affairs, U.S. Senate

June 22, 2006

INFORMATION TECHNOLOGY

VA and DOD Face Challenges in Completing Key Efforts

The Department of Veterans Affairs (VA) is engaged in an ongoing effort to
share electronic medical information with the Department of Defense (DOD),
which is important in helping to ensure high-quality health care for
active duty military personnel and veterans. Also important, in the face
of current military responses to national and foreign crises, is ensuring
effective and efficient delivery of veterans' benefits, which is the focus
of VA's development of the Veterans Service Network (VETSNET), a
modernized system to support benefits payment processes.

GAO is testifying on (1) VA's efforts to exchange medical information with
DOD, including both near-term initiatives involving existing systems and
the longer term program to exchange data between the departments' new
health information systems, and (2) VA's ongoing project to develop
VETSNET.

To develop this testimony, GAO relied on its previous work and followed up
on agency actions to respond to GAO recommendations.

What GAO Recommends

GAO has previously made numerous recommendations on these topics,
including that VA and DOD develop an integrated project plan to guide
their efforts to share patient health data, and that VA develop an
integrated project plan for VETSNET.

VA and DOD are implementing near-term demonstration projects that exchange
limited electronic medical information between their existing systems, and
they are making progress in their longer term effort to share information
between the new health information systems that each is developing. Two
demonstration projects have been implemented at selected sites: (1) a
project to achieve the two-way exchange of health information on patients
who receive care from both departments and (2) an application to
electronically transfer laboratory work orders and results. According to
VA and DOD, these projects have enabled lower costs and improved service
to patients by saving time and avoiding errors. In their longer term
effort, VA and DOD have made progress, in response to earlier GAO
recommendations, by designating a lead entity with final decision-making
authority and establishing a project management structure. However, VA and
DOD have not yet developed a clearly defined project management plan that
gives a detailed description of the technical and managerial processes
necessary to satisfy project requirements, as GAO previously recommended.
Moreover, the departments have experienced delays in their efforts to
begin exchanging patient health data; they have not yet fully populated
the repositories that will store the data for their future health systems.
As a result, much work remains to be done before the departments achieve
their ultimate goal of sharing virtual medical records.

VA has also been working to modernize the delivery of benefits through its
development of VETSNET, but the pace of progress has been discouraging.
Originally initiated in 1986, this program was prompted by the need to
modernize VA's Benefits Delivery Network-parts of which are now
40-year-old technology-on which the department relies to make benefits
payments, including compensation and pension, education, and vocational
rehabilitation and employment. In 1996, after experiencing numerous false
starts and spending approximately $300 million, VBA revised its strategy
and narrowed its focus to modernizing the compensation and pension system.
In earlier reviews, GAO has made numerous recommendations to improve the
program's management, including the development of an integrated project
plan. In response to GAO's recommendations as well as those of an
independent evaluator, VA is now developing an integrated master plan for
the compensation and pension system, which it intends to complete in
August. Until VA addresses the managerial and program weaknesses that have
hampered the program, it is uncertain when VA will be able to end its
reliance on its aging benefits technology.

United States Government Accountability Office

GAO

Testimony

Before the Subcommittee on Federal Financial Management, Government
Information, and International Security, Committee on Homeland Security
and Governmental Affairs, U.S. Senate

For Release on Delivery

Expected at 2:30 p.m. EDT Thursday, June 22, 2006

INFORMATION TECHNOLOGY

VA and DOD Face Challenges in Completing Key Efforts

Statement of Linda D. Koontz, Director

Information Management Issues

GAO-06-905T

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