An audit from the General Accounting Office concludes that the Departments of Defense and Veterans Affairs are not making a lot of progress on their latest plan to modernize electronic health records systems, including provisions for interoperability.

DOD and VA in February 2011 announced they would jointly develop an EHR, and then scrapped the plan two years later in favor of separate but tightly integrated EHRs, saying that option would be quicker and cheaper. But congressional authorizations for fiscal year 2013 EHR development carried conditions and the agencies haven’t met many of them.

The departments did meet a condition to complete a memorandum of agreement on cost-sharing business rules. And, the departments only partially met conditions to define the budget and cost baseline. “However, the baseline, as reported, was not based on accurate estimates that reflected changes in the program’s direction and related decisions made by the departments,” according to GAO.

Nor did they fully meet conditions for interoperability. “While the plan outlined milestone dates for achieving enhanced data interoperability and other near-term activities, it did not include a deployment timeline that could be linked to an integrated master schedule.”

DOD and VA also submitted information on annual and total spending for each department’s EHR project, but officials could not provide the basis for the spending estimates. Moreover, the departments partly met a condition to establish data standardization schedules, but did not include a schedule for actually achieving standardization. Finally, while the departments asserted that they comply with various acquisition rules, they did not explain the basis for the assertion, the GAO says.

In summary, GAO concludes that the plan has not provided meaningful representation of the EHR program as it evolved during the past year; it does not provide an accurate view of costs or offer significant insight into how interoperability will be achieved.  “As such, the plan does not provide adequate information for Congress, VA and DOD to use it as a basis for measuring program success, accounting for the use of current and future appropriations, and holding the departments accountable for achieving an interoperable electronic health record.”

GAO recommended that the departments’ future expenditure plans include verifiable budget, cost and spending information, provide a deployment timeline consistent with an integrated master schedule, include a data standardization schedule that facilitates interoperability, and provide a basis for assertions of compliance with acquisition rules. The departments agreed with the recommendations. The report is available here.


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