If the gist of Wednesday's Government Accountability Office report sounds familiar, that's because it is.
For the past seven years, the GAO as a watchdog has been barking incessantly at the Veterans Affairs Department and the Military Health System over the inability of the two government-run healthcare organizations to exchange patient records between their clinical computer systems, which evolved from the same system, but were allowed to fork beyond interoperability.
But, according to the latest GAO report, there still is something about the recommendation to plan that neither the VA nor the Defense Department seems to understand.
That report, released July 25, is titled VA and DoD Are Making Progress in Sharing Medical Information, but Remain Far from Having Comprehensive Electronic Medical Records. It contains testimony before the Veterans' Disability Benefits Commission of Valerie Melvin, director of human capital and management information systems issues at the GAO, and is a summary of similar testimony she gave in May before the House Subcommittee on Oversight and Investigations of the Veterans' Affairs Committee.
It begins, "For almost a decade, VA and DoD have been pursuing ways to share health information and create comprehensive electronic medical records," and is only the latest in a raft of GAO reports on the efforts of VA and military providers to freely exchange patient information.
Over the past six years, but prior to the latest report based on Melvin's testimony, the GAO or its officials have prepared full reports or made appearances to give testimony before Congress at least 10 times about the VA-Defense Department interoperability project, which was launched by an executive order by President Clinton in 1997.
In the series, the GAO has consistently charged the two federal agencies with "management weakness" in overseeing the interoperability project; not putting one person or one group in charge of the project; and "the lack of a detailed project management plan to guide their efforts."
In the latest report, the GAO notes the VA and Defense Department combined have spent $148.8 million thus far on their joint interoperability projects. That is in addition to the nearly $1.3 billion the two have spent on HealtheVet VistA at the VA, the successor to its legacy VistA system, and AHLTA at the Defense Department, the replacement for its Composite Health Care System, or CHCS I. The rationale for both of the upgrades is, at least in part, to achieve interoperability between the military and veterans healthcare systems.
The latest GAO report was not all gloom and frustration. The agency noted that as part of the HealtheVet VistA and AHLTA upgrades, the two government organizations have reached what the GAO is calling a "milestone" toward the goal of being able to share data. Both have created new clinical data repositoriescalled the Clinical Data Repository (CDR) at the Defense Department and the Health Data Repository (HDR) at the VAand begun populating them with a limited data set, the GAO said. Clinicians from each system can access some of the patient data through a common interface, called the CHDR, or "cheddar," a mash-up of CDR and HDR that is up and running at seven VA and Defense Department care sites. It affords clinicians access to outpatient pharmacy and drug allergy data to be exchanged, the GAO notes.
In addition, the VA and Defense Department have long since completed work on a project begun in 2002, the Federal Health Information Exchange, to allow the one-way transfer of data for mustering out service personnel from the Defense Department to the VA, including laboratory and radiology results, outpatient pharmacy data, allergy information, patient demographics, consultation information and standard outpatient records. In 2005, the Defense Department and VA added pre-deployment and post-deployment health assessments to the data that could be moved one way via the FHIE. Data are moved monthly in batches over the FHIE, or weekly for veterans in VA facilities, the GAO said.
Another project, the Bidirectional Health Information Exchange affords clinicians a "real-time, two-way view of outpatient health data from existing systems at all VA sites and 25 DoD sites, and certain inpatient discharge summary data at all VA sites and five DoD sites" using the legacy VistA and CHCS I systems.
In addition, the two groups have developed several workarounds to move information on severely wounded patients from the military to the VAs four polytrauma centers. "These ad hoc processes include manual workarounds, such as scanning paper records and individually transmitting radiological images," according to the report. Yet these labor-intensive operations are possible, the GAO said, "only because the number of polytrauma patients is small," about 350 in all to date.
According to the GAO, while the VA previously said it would complete work on its VistA replacement, HealtheVet VistA, by 2012 and the Defense Department on its CHCS I replacement, AHLTA, by 2011, "there is currently no scheduled completion date for either system."
Complicating matters for the Defense Department is that while CHCS I is the primary system for the Military Health System, there are four other legacy healthcare information systems in use in addition to the new AHLTA system and its CDR.
"DoD's various systems are not integrated and its 138 sites do not necessarily communicate with each other," much less the VA, the GAO said. "In addition, not all of DoD's medical information is electronic; some records are paper-based."
In January, the VA and the Defense Department announced that they have agreed to create a single, unified computer system for both government healthcare programs, a goal that might have been achieved decades earlier if a similar agreement had been reached in 1988, when the Defense Department issued a major contract to create its main computer system, CHCS I.
As it was, taxpayers in the late 1980s and 1990s shelled out more than $1 billion paid to outside contractors headed by Science Applications International Corp. to convert the VA's public domain Decentralized Hospital Computer Program (which became VistA) to create CHCS I, a proprietary system for military use, and in so doing, creating the interoperability the two departments have struggled to overcome for nearly a decade.
Noting the announced new joint effort to develop a single computer system for the two health systems and the host of short-term interoperability projects under way, the GAO concluded, "It is essential for the departments to develop a comprehensive project plan to guide these efforts to completion, as we have previously recommended."
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