DOD and VA Outpatient Pharmacy Data: Computable Data Are Exchanged for Some Shared Patients, but Additional Steps Could Facilitate Exchanging These Data for All Shared Patients
Highlights
Since 1998, the Department of Defense (DOD) and the Department of Veterans Affairs (VA) have been working to electronically exchange patient health data, including outpatient pharmacy data, cross their electronic health information systems. Exchanging outpatient pharmacy data is important for DOD and VA because certain DOD and VA patients, known as shared patients, receive health care from both agencies. Clinicians' access to complete health information from both agencies' health information systems could assist clinicians in making more informed medical decisions and help prevent adverse medication reactions--which include detrimental or unintended reactions when multiple medications are taken together and allergic reactions to a medication. In March 2004, DOD and VA began collaborating on a long-term initiative to make their outpatient pharmacy data computable. Computable data refer to data that are in a format that a computer application can act on: for example, to provide automatic checks for adverse medication reactions or to plot graphs of changes in vital signs such as blood pressure. In reporting on this initiative in the past, GAO noted that the agencies have experienced delays in their efforts to begin exchanging computable outpatient pharmacy data. Concerned about DOD's and VA's progress in this effort, Congress asked GAO to examine the initiative that the agencies have under way to make their outpatient pharmacy data computable. In this report, GAO provides information on (1) DOD's and VA's expectations of what the exchange of computable outpatient pharmacy data will provide in safeguards against adverse medication reactions for shared patients, and (2) the status of DOD's and VA's initiative for attaining computable outpatient pharmacy data.
Recommendations
Recommendations for Executive Action
Agency Affected | Recommendation | Status |
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Department of Defense | To help ensure that all shared patients benefit from the exchange of computable outpatient pharmacy data, the Secretary of Defense and the Secretary of Veterans Affairs should expedite efforts to develop a solution for activating shared patients when patients' identifying information does not match exactly. |
Closed – Implemented
A DOD system upgrade completed is expected to reduce the error rate for activating shared patients to less than 5 percent. According to DOD, an automated capability for activating shared patients was implemented in 9/08 and is being operationalized across DOD and VA. The automated capability collects historical beneficiary information collected/stored by the Bidirectional Health Information Exchange and transfers that data to the Clinical Data Repository/Health Data Repository. According to a DOD Automated Activation Rate Report for October 2008 through July 2009, a 1 percent average activation error rate had been achieved.
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Department of Veterans Affairs | To help ensure that all shared patients benefit from the exchange of computable outpatient pharmacy data, the Secretary of Defense and the Secretary of Veterans Affairs should expedite efforts to develop a solution for activating shared patients when patients' identifying information does not match exactly. |
Closed – Implemented
VA concurs with the recommendation. VA and DOD completed the work to update the Defense Enrollment Eligibility Reporting System (DEERS) system to support the increased identification of active dual consumers. Since the inception of this capability, the Military Health System has worked to reduce the error rate for activating shared patients to less than 5 percent. According to a DOD Automated Activation Rate Report for October 2008 through July 2009, a 1 percent average activation error rate had been achieved.
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Department of Defense | To help ensure that all shared patients benefit from the exchange of computable outpatient pharmacy data, the Secretary of Defense should expedite efforts to assign a unique DOD identification number to VA patients who were discharged from active duty before 1997. |
Closed – Implemented
VA patients who were discharged from active duty before 1997 may not have a unique identification number DOD assigns to its beneficiaries, and without this number, these patients cannot be activated. DOD's Defense Enrollment Eligibility Reporting System (DEERS) assigns patients in its system with the unique identification number needed to activate these patients for Clinical Data Repository/Health Data Repository (CHDR). Consistent with GAO's recommendation, DOD entered data for those Veterans Affairs beneficiaries not previously in the DEERS.
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Department of Veterans Affairs | To help ensure that all shared patients benefit from the exchange of computable outpatient pharmacy data, the Secretary of Veterans Affairs should expedite efforts to expand to all VA sites the capability to automatically check DOD data that are exchanged through CHDR. |
Closed – Implemented
Consistent with GAO's recommendation, to ensure all shared patients benefit from the exchange of computable pharmacy data. VA has nationally released Remote Data Interoperability (RDI) to all sites, which gives VA the capability to check data exchanged through CHDR. However, before computable data can be exchanged, patients who use both DOD's and VA's health care systems must be identified as shared patients and then activated. VA has not expanded the active dual consumer marking capability beyond seven sites. VA is currently conducting an internal technical review to determine the schedule to expand the active dual consumer marking capability. Although all sites are not currently activating shared patients, officials indicated that all DOD and VA sites can exchange computable pharmacy data for patients previously activated at other sites.
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Department of Defense | To help ensure that all shared patients benefit from the exchange of computable outpatient pharmacy data, the Secretary of Defense and the Secretary of Veterans Affairs should expedite the development of written guidelines for all sites to use for defining and identifying shared patients. |
Closed – Implemented
Consistent with GAO's recommendation, the DOD and VA have developed written guidelines for all sites for defining and identifying shared patients.
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Department of Veterans Affairs | To help ensure that all shared patients benefit from the exchange of computable outpatient pharmacy data, the Secretary of Defense and the Secretary of Veterans Affairs should expedite the development of written guidelines for all sites to use for defining and identifying shared patients. |
Closed – Implemented
Consistent with GAO's recommendation, the Department of Defense and VA have developed written guidelines for all sites for defining and identifying shared patients.
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