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Electronic Health Records - VA Needs to Identify and Report Existing System Costs
Difficulties after 30 years of decentralized development The US Department of Veterans Affairs provides health care services to approximately 9 million veterans and their families. However, the IT system they use is more than 30 years old, is costly to maintain, and does not fully support exchanging health data. The US GAO, analyzed the system's modenization plans and found serious problems with definition and cost estimation.
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Difficulties after 30 years of decentralized development The US Department of Veterans Affairs provides health care services to approximately 9 million veterans and their families. However, the IT system they use is more than 30 years old, is costly to maintain, and does not fully support exchanging health data. The US GAO, analyzed the system's modenization plans and found serious problems with definition and cost estimation.
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US Government Accountability Office
, issued in 2019
Risk cases: 3
The development and use of identification services in public administration
with legislation in procuring services. The audit also examined development, control and monitoring structures regarding identification services. The audit focused on electronic identification services that are used ... in public administration's electronic transactions. ... The audit examined the implementation and coordination of projects aimed at developing identification services in public administration, cooperation among authorities in this area and compliance ... ... Unhealthy competition linked with lack of coordinatnion and with procurement irregularities ... See what may go wrong with the IT public procurement. Check out what is the basis to avoid irregularities or omissions in complying with public procurement legislation. National Audit Office ... of Finland identified also risks resulting from lack of horizontal coordination.
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with legislation in procuring services. The audit also examined development, control and monitoring structures regarding identification services. The audit focused on electronic identification services that are used ... in public administration's electronic transactions. ... The audit examined the implementation and coordination of projects aimed at developing identification services in public administration, cooperation among authorities in this area and compliance ... ... Unhealthy competition linked with lack of coordinatnion and with procurement irregularities ... See what may go wrong with the IT public procurement. Check out what is the basis to avoid irregularities or omissions in complying with public procurement legislation. National Audit Office ... of Finland identified also risks resulting from lack of horizontal coordination.
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National Audit Office of Finland
, issued in 2008
Risk cases: 3
Informatisation of hospitals
The goals of the audit were: 1. Assesment to what degree service providers are prepared to implement the electronic health information system. 2. Assessment of government activities related ... to the construction of the health information system within the framework of the "Healthcare Informatisation Program" ... ... Sometimes it is really not about the money.. ... Informatisation of healthcare is one of the most money-consuming IT activities of the State. Polish NIK shows how a poor concept can delay modernization of hospitals. The new IT system was expected ... to take some burden off doctors, streamline medical care, prevent fraud and improve efficiency. But will it be created at all?
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The goals of the audit were: 1. Assesment to what degree service providers are prepared to implement the electronic health information system. 2. Assessment of government activities related ... to the construction of the health information system within the framework of the "Healthcare Informatisation Program" ... ... Sometimes it is really not about the money.. ... Informatisation of healthcare is one of the most money-consuming IT activities of the State. Polish NIK shows how a poor concept can delay modernization of hospitals. The new IT system was expected ... to take some burden off doctors, streamline medical care, prevent fraud and improve efficiency. But will it be created at all?
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Sumpreme Audit Office
, issued in 2013
Risk cases: 3
Correct information at the right time in healthcare and nursing – collaboration without effect?
patient information at the right time by means of direct electronic access. ... The Swedish National Audit Office has conducted an audit to determine whether Government initiatives have contributed to the objective that authorised healthcare staff shall have access to the right ... ... Information share is crucial for competitive health care ... Health and social care staff has very limited access to patient information from other care-giving institutions, which may lead to health damage and wrong-treatment. The cooperation between ... the Government and the municipalities must improve if the investments in better access to common patient information shall get impact in practice.
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patient information at the right time by means of direct electronic access. ... The Swedish National Audit Office has conducted an audit to determine whether Government initiatives have contributed to the objective that authorised healthcare staff shall have access to the right ... ... Information share is crucial for competitive health care ... Health and social care staff has very limited access to patient information from other care-giving institutions, which may lead to health damage and wrong-treatment. The cooperation between ... the Government and the municipalities must improve if the investments in better access to common patient information shall get impact in practice.
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Riksrevisionen (Swedish National Audit Office)
, issued in 2011
Risk cases: 3
Peering Point Betriebs GmbH
in the course of the introduction of the electronic administration system) and other services in health care. Since its foundation the company has suffered losses. Net losses were covered by the two owners ... In 2004 the Peering Point Betriebs GmbH was established to provide an effective and secure IT network for the operation of the e-card (a smart card which replaced health insurance vouchers ... – the Main Association of Austrian Social Insurance Institutions and the Austrian Medical Chamber – to 50 % each, and since 2011 in a proportion of 60 to 40. The Main Association failed to give an objective ... ... Safe but expensive ... Network safety of a healthcare e-card system has been provided at a high cost. As the Austrian Court of Audit discovered - there was no concept to reduce the expenditure.
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in the course of the introduction of the electronic administration system) and other services in health care. Since its foundation the company has suffered losses. Net losses were covered by the two owners ... In 2004 the Peering Point Betriebs GmbH was established to provide an effective and secure IT network for the operation of the e-card (a smart card which replaced health insurance vouchers ... – the Main Association of Austrian Social Insurance Institutions and the Austrian Medical Chamber – to 50 % each, and since 2011 in a proportion of 60 to 40. The Main Association failed to give an objective ... ... Safe but expensive ... Network safety of a healthcare e-card system has been provided at a high cost. As the Austrian Court of Audit discovered - there was no concept to reduce the expenditure.
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Austrian Court of Audit
, issued in 2012
Risk cases: 1
Activities of the state in implementing the e-health system - Do the state, doctors and patients benefit from ehealth?
of health care – have been achieved. The four main e-health projects were reviewed in the audit: Electronic Health Record, Digital Prescription, Digital Registration and Digital Image. The problems ... Estonia’s population is aging and the share of elderly people is increasing, as fewer children are being born and people are living longer. This creates a constantly growing need for health ... and social services and patients are also becoming more and more demanding about the volume and quality of the services provided. The more extensive and systematic implementation of e-health solutions helps ... ... Why state, doctors and patients do not benefit from e-Health as much as they could? ... The report reviews whether the objectives set to the e-Health – ambitious multiyear program of Estonian Government - have been achieved. They are: higher quality of the health service and more ... efficient organisation of health care. As SAI Estonia found out, wide range problems started from two basic points: lack of strategic manager and unrealisitc schedule.
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of health care – have been achieved. The four main e-health projects were reviewed in the audit: Electronic Health Record, Digital Prescription, Digital Registration and Digital Image. The problems ... Estonia’s population is aging and the share of elderly people is increasing, as fewer children are being born and people are living longer. This creates a constantly growing need for health ... and social services and patients are also becoming more and more demanding about the volume and quality of the services provided. The more extensive and systematic implementation of e-health solutions helps ... ... Why state, doctors and patients do not benefit from e-Health as much as they could? ... The report reviews whether the objectives set to the e-Health – ambitious multiyear program of Estonian Government - have been achieved. They are: higher quality of the health service and more ... efficient organisation of health care. As SAI Estonia found out, wide range problems started from two basic points: lack of strategic manager and unrealisitc schedule.
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National Audit Office of Estonia
, issued in 2014
Risk cases: 3
Conflicts of interest
First, recognise the conflicts of interest are a real risk the British NAO gathered a significant amount of intelligence on conflicts, particularly in the health and education sectors. These are areas of government where services are increasingly commissioned and delivered by parties at arm’s-length to departments. Conflicts of interest can occur naturally as a product of the way a system is designed and most often arise from operational situations.
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First, recognise the conflicts of interest are a real risk the British NAO gathered a significant amount of intelligence on conflicts, particularly in the health and education sectors. These are areas of government where services are increasingly commissioned and delivered by parties at arm’s-length to departments. Conflicts of interest can occur naturally as a product of the way a system is designed and most often arise from operational situations.
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National Audit Office
, issued in 2015
Risk cases: 8
Improved Planning and Performance Measures Are Needed to Help Ensure Successful Technology Modernization
Massive modernization effort needs coordination Social security issues can touch lives of many. Information technology in this area are increasingly costly and difficult to maintain. GAO is recommending to develop comprehensive metrics to effectively gauge modernization progress; complete comprehensive strategic planning, including its enterprise architecture; and define the new roles and responsibilities to help ensure effective oversight.
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Massive modernization effort needs coordination Social security issues can touch lives of many. Information technology in this area are increasingly costly and difficult to maintain. GAO is recommending to develop comprehensive metrics to effectively gauge modernization progress; complete comprehensive strategic planning, including its enterprise architecture; and define the new roles and responsibilities to help ensure effective oversight.
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General Accountability Office
, issued in 2012
Risk cases: 3
The implementation of national IT projects in social and health care
IT management expenditure in public administration totalled about 2.1 billion euros in 2009. IT management expenditure by local authorities and federations of municipalities in the field of health ... care totalled about 270 million euros ino 2009. Health care's share of IT management expenditure in public administration thus amounted to about 13 per cent in 2009. ... ... IT-centred manner of project implementation can harm IT investments' results ... SAI Finland perfomed a vast review of IT projects in health and social protection. Many interesting findings cover structural problems, as 'Many separate systems with no future' and characteristics ... of poor governance, as 'No cost monitoring - unclear objectives - arguable usefulness'.
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IT management expenditure in public administration totalled about 2.1 billion euros in 2009. IT management expenditure by local authorities and federations of municipalities in the field of health ... care totalled about 270 million euros ino 2009. Health care's share of IT management expenditure in public administration thus amounted to about 13 per cent in 2009. ... ... IT-centred manner of project implementation can harm IT investments' results ... SAI Finland perfomed a vast review of IT projects in health and social protection. Many interesting findings cover structural problems, as 'Many separate systems with no future' and characteristics ... of poor governance, as 'No cost monitoring - unclear objectives - arguable usefulness'.
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National Audit Office of Finland
, issued in 2011
Risk cases: 3
Federal Human Resources Data
Internal control weaknesses may put mission at risk GAO audited the Enterprise Human Resources Integration payroll data warehose. The American auditors pointed at problems that may impede 'leverage of these data to meet its mission and allow others to make full use' of them. The critical internal contols areas to be improved in this cas are: completeness, accuracy, and validity of information, authorization, documentation, monitoring, results' evaluation.
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Internal control weaknesses may put mission at risk GAO audited the Enterprise Human Resources Integration payroll data warehose. The American auditors pointed at problems that may impede 'leverage of these data to meet its mission and allow others to make full use' of them. The critical internal contols areas to be improved in this cas are: completeness, accuracy, and validity of information, authorization, documentation, monitoring, results' evaluation.
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General Accountability Office
, issued in 2016
Risk cases: 2