- The 1998 Government Computer-Based Patient Record project to give each department an interface into the other's EHR suffered, as "basic principles of sound IT project planning, development and oversight" weren't followed and "accountability ... was blurred across several management entities." The project was finished in 2005.
- A joint clinical health data repository, slated for completion in October 2005, was nearly one year late. This initiative, GAO said, lacked a project management plan and an architecture for describing the common interface.
- Although a directive to develop six specific "fully interoperable [EHR] systems or capabilities" by Sept. 30, 2009, was met, the GAO saw none of the "objective, quantifiable, and measurable performance goals and measures that are characteristic of effective planning." These were developed seven months after the functionality was in place.
- The Virtual Lifetime Electronic Record, a way to streamline how patient records move with a soldier who leaves active duty, began with successful pilot programs. However, without "identifying the target set of capabilities that they intended to demonstrate in the pilot projects and then implement on a nationwide basis," the VLER couldn't meet its goal of implementation at all domestic VA and DoD sites by 2013.
- Lack of planning for an integrated, jointly funded federal health care center left the VA and DoD unable to "estimate the project cost or establish a baseline schedule." The total cost ballooned to $122 million -- not including the workarounds resulting from delays in setting up single sign-on, single patient registration, and physician order portability.
- Finally, the fate of the interoperable EHR remains in doubt, the GAO said, and "the extent to which the departments' revised approach to iEHR is guided by a joint health architecture remains to be seen." This in spite of a February 2011 GAO report that recommended putting EHR modernization efforts and IT investments in the context of common health care business needs.
These myriad initiatives, Melvin concluded, suffered from a "persistent absence of clearly defined, measurable goals and metrics" and "deficiencies in key IT management areas of strategic planning, enterprise architecture and investment management."
Federal government seeks interoperability input
Interoperability, then, remains the biggest hurdle to efficient and effective use of health care IT. That's why Dr. Doug Fridsma, the director of the Office of Standards and Interoperability and the acting chief scientist at the ONC, says health IT interoperability is like designing a city.
Linking the disparate clinical, billing, administrative, and email systems in use at the nation's medical centers, hospitals, and independent practices isn't about individual building blueprints, Fridsma says. Because those organizations are, in effect, individual neighborhoods, it's about "zoning laws, roads and infrastructure, rules and governance, and safety and protection," all of which must be implemented according to flexible standards that change incrementally (not radically) and emphasize usability and workflow.