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GAO REPORT CONTINUES TO REBUKE VA AND DoD FOR
MEDICAL RECORDS FIASCO -- For the past seven
years, the
GAO as a watchdog has been barking incessantly
at the VA and
DoD health system over the inability of the two
government-run
healthcare organizations to exchange patient
records.
GAO report here...
http://www.gao.gov/new.items/d071108t.pdf
For more about GAO reports on the VA, use the
VA Watchdog search engine...click here...
http://www.yourvabenefits.org/
sessearch.php?q=gao&op=and
Story here...
http://www.modernhealthcare.
com/apps/pbcs.dll/article?AID=/20070720
/FREE/70720001/0/FRONTPAGE
Story below:
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GAO report calls out VA, Defense Dept.
By: Joseph Conn / HITS staff writer
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.
Reports from the GAO:
1.
http://www.gao.gov/new.items/d07852t.pdf
2.
http://www.gao.gov/new.items/d07554r.pdf
3.
http://www.gao.gov/new.items/d06905t.pdf
4.
http://www.gao.gov/new.items/d051051t.pdf
5.
http://www.gao.gov/new.items/d04687.pdf
6.
http://www.gao.gov/new.items/d04811t.pdf
7.
http://www.gao.gov/new.items/d04402t.pdf
8.
http://www.gao.gov/new.items/d04271t.pdf
9.
http://www.gao.gov/new.items/d02703.pdf
10.
http://www.gao.gov/new.items/d01459.pdf
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 repositories—called the Clinical Data
Repository (CDR) at the Defense Department and the Health Data
Repository (HDR) at the VA—and 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 VA’s
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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Larry Scott --
