DoD and VA Outpatient Pharmacy Data
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COMPUTABLE DATA ARE EXCHANGED FOR SOME SHARED PATIENTS, BUT ADDITIONAL STEPS COULD FACILITATE EXCHANGING THIS DATA FOR ALL SHARED PATIENTS.
Since 1998, DoD and the Department of Veterans Affairs have been working to electronically exchange patient health data, including outpatient pharmacy data, across 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, the Government Accountability Office (GAO) had 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, Representative Ike Skelton, chairman of the House Armed Services Committee and Duncan Hunter, the committee’s ranking member, requested the GAO to examine the initiative that the agencies have under way to make their outpatient pharmacy data computable. Key findings included:
• 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.
• The status of DoD’s and VA’s initiative for attaining computable outpatient pharmacy data.
To address the objectives, the GAO analyzed documents and interviewed officials from DoD and VA about the agencies’ efforts to exchange computable outpatient pharmacy data for shared patients. It also viewed a demonstration of DoD’s and VA’s exchange of computable outpatient pharmacy data in El Paso, Texas, where DoD and VA first exchanged these data for shared patients.
RESULTS
DoD and VA expect the exchange of computable outpatient pharmacy data to provide each agency with seamless access to shared patients’ medication histories and more complete electronic checks for adverse medication reactions. Officials expect information on outpatient medications dispensed by either agency’s health care system to be stored in each agency’s repository in the standardized vocabulary each agency uses, following translation from a standardized set of terms, which will allow either agency’s electronic health information system to include the other agency’s data in its automatic checks.
According to DoD and VA officials, having pharmacy data from both DoD and VA, rather than data from a single agency, could reduce adverse medication reactions by providing more complete checks for shared patients.
DoD and VA are exchanging computable outpatient pharmacy data for some shared patients, but have not completed steps important for exchanging these data for all shared patients. DoD and VA developed an electronic interface—Clinical Data Repository/Health Data Repository (CHDR)—that links DoD’s and VA’s health data repositories and allows for the exchange of computable data between them. 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, which refers to shared patients being matched on certain identifiers—first name, last name, date of birth, Social Security number—in both agencies’ health information systems and established as “active” shared patients.
DoD and VA have begun exchanging computable outpatient pharmacy data through CHDR for patients activated at seven locations as of March 2007. In addition, DoD officials indicated that all 117 DoD sites in the continental United States, Alaska, and Hawaii will be able to activate shared patients by the end of June 2007; VA indicated that all 128 VA sites will be able to activate shared patients by mid- September 2007. DoD and VA have been addressing three issues that hinder their ability to exchange computable outpatient pharmacy data for all shared patients.
• DoD and VA officials have identified two problems that prevent them from activating some shared patients. In some cases, patient information does not match exactly on all identifiers. In addition, VA patients who were discharged from active duty before 1997 may not have a unique identification number that DoD assigns to its beneficiaries, and without this number, these patients cannot be activated. According to DoD and VA, the agencies are working to resolve these problems. DoD stated that in February 2007 it completed a software upgrade to help resolve problems with matching patients’ identifying information. Similarly, VA officials told the GAO that VA is developing a software upgrade, but could not provide a date for when its upgrade would be operational. In addition, DoD reported that it is working with a VA-provided list of patients who are receiving care from VA and were discharged from active duty before 1997. DoD reported that it will create unique identification numbers for these patients and anticipates this effort will be completed by the end of September 2007.
• VA must expand to all its 128 sites the capability to automatically check DoD data that are exchanged through CHDR. VA officials said this capability was in place at 10 sites as of March 2007 and expect it to be in place at all VA sites by the end of July 2007.
• While DoD and VA officials told us that guidelines for identifying shared patients would help sites determine which patients should be activated, the agencies have not established written guidelines, including criteria to define shared patients and procedures to identify shared patients, for all sites to use. DoD expects the guidelines to be completed by the end of June 2007.
Until DoD and VA take additional steps to ensure all shared patients benefit from the exchange of computable pharmacy data, many shared patients will not receive the benefit of more complete automatic electronic checks for adverse medication reactions. To meet the timelines for resolving the three issues identified, it will be important for the agencies to make these efforts a priority, given previous delays in developing the capability to exchange computable data.
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 certain ongoing efforts. Specifically, The GAO recommend that (1) the Secretary of Defense and the Secretary of Veterans Affairs expedite efforts to develop a solution for activating shared patients when patients’ identifying information does not match exactly, (2) the Secretary of Defense expedite efforts to assign a unique DoD identification number to VA patients who were discharged from active duty before 1997, (3) the Secretary of Veterans Affairs expedite efforts to expand to all VA sites the capability to automatically check DoD data that are exchanged through CHDR, and (4) the Secretary of Defense and the Secretary of Veterans Affairs expedite the development of written guidelines for all sites to use for defining and identifying shared patients.
AGENCY COMMENTS
In commenting on a draft of the GAO report, DoD and VA concurred with their findings and recommendations. (DoD’s and VA’s comments are reprinted in enclosures II and III, respectively.) DoD stated that it will expedite efforts for the identified recommendations to be completed by the specified time frames. VA stated that the two agencies are taking the necessary steps to overcome issues that have hindered their ability to exchange computable outpatient pharmacy data for all shared patients. DoD and VA provided updated information on their efforts and DoD provided technical comments. ♦