Defense, VA struggle to share medical information

Agencies have made some progress on two demonstration projects, but lack a clearly defined management plan, GAO official says.

Efforts to standardize the sharing of health information across the Defense and Veterans Affairs departments lack a clear integration plan, a government watchdog said Thursday.

Despite some progress made on two demonstration projects to exchange laboratory results and patient health information, Linda Koontz, director of information management issues at the Government Accountability Office, said in written testimony that the agencies have failed to develop a clearly defined management plan.

"I don't want to criticize the services that our veterans receive. ... I think we can do a better job serving those veterans and the rest of America's taxpayers by better managing our resources and investments," Oklahoma Republican Tom Coburn, chairman of the Senate Homeland Security Subcommittee on Federal Financial Management, said in prepared remarks.

Defense and the VA have been working for the past eight years to develop the capability to exchange e-health information.

The two-way exchange project, which enables the real-time sharing of allergy, laboratory, outpatient and radiology information, is being tested by Defense and all VA treatment facilities, Carl Hendricks, chief information officer for the military health system at Defense, said the second project, which facilitates the sharing of lab order entries and results, is being tested at several Defense and VA sites.

Still, the departments have incurred delays to share patient data and have not yet fully populated repositories to store the data for future e-health systems, GAO reported. Even though a December 2004 Defense/VA report said the Federal Health Information Exchange program is fully functional, not all of that data was captured in Defense's system as of September 2005.

Two deadlines have been missed to develop an interface to connect each department's databases. Hendricks said the ability to exchange pharmacy medication and allergy data between repositories should be complete by the end of fiscal 2006.

"Developing an electronic interface that will enable VA and DOD to exchange computable patient medical records is a highly complex undertaking," which could improve the quality of healthcare for its beneficiaries, Koontz testified. "Establishing accountability measures and addressing security" would help avoid further delays.

Hendricks said the department has imposed security policies to protect information systems and medical data. In addition, the department has training procedures in place for government and contract workers, as well as an accreditation process for its systems.

Michael Kussman, the VA's deputy undersecretary for health, testified that the departments in 2005 signed an agreement that defines the "authorities and parameters" of sharing data. The sharing of data also complies with federal health privacy rules, he said.

Moreover, he said progress at the VA to modernize its delivery of benefits via VETSNET has been "discouraging." After a $300 million investment and "numerous false starts," the VA re-launched its efforts in 1996. But only now is the department "developing an integrated master plan for its compensation and pension system," Kussman said.

"It's not fair to ask future generations ... to pick up the tab tomorrow for systems and plans that don't work well or on time today," Coburn said.