Conflicting IT systems and business practices are among the challenges hindering healthcare collaboration efforts between the Department of Defense and the Department of Veterans Affairs, the GAO found. problems run even deeper at the 10 joint ventures the two departments manage around the country.
"Misaligned construction planning processes" stand in the way of joint facility planning, Government Accountability Auditors said in the report. In other cases, veterans sometimes have trouble getting on base to use military medical facilities.
The GAO recommended that the two departments:
- set performance measures related to access, quality and costs at collaboration sites
- tackle barriers to collaboration
- determine how to systematically identify opportunities to initiate or expand collaboration
The IT barriers largely prevent the VA and DoD from electronically sharing patient information, according to the report. The departments' joint venture in Honolulu developed an IT tool, called Janus, that allows providers to see their patients' VA and DoD health records on a single screen, but they have read-only access. At the joint venture in Biloxi, Miss., clinicians in some areas have side-by-side computers, one to access each set of records. It is "time consuming and costly, and does not allow staff to share information as efficiently as they would like," the GAO noted.
The two departments are developing an integrated electronic health record (iEHR), planning testing of the $4 billion program at two joint sites in 2014 and implementation in 2017. But GAO auditors deemed the implementation timeframe uncertain. The office managing the development was not yet fully staffed early this summer, "nor did they have final plans for how iEHR would be developed and implemented given that many decisions had yet to be made."
In August, meanwhile, VA CIO Roger Baker said the two departments' EHRs cannot be fully integrated through a single interface. Janus can be used for integrating information on outpatient treatment, but other interfaces will be required for accessing other clinical databases.
"Overall, given the uncertainty about when and how iEHR will be implemented, it is not clear when collaboration sites could expect to see benefits from this new effort," the auditors said. "Although local officials have expressed interest in obtaining IT tools from the departments in the short term to help address their IT barriers, (iEHR program office) officials said their focus is on developing iEHR rather than implementing separate IT tools at individual facilities."
Such uncertainly makes it difficult for officials at collaboration sites to plan, GAO said.
To learn more:
- here's the GAO report (.pdf)