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Tables ‘Tablet: Federal Health Care Center FHCC Progress Implementing Selected Provisions forthe 12 Executive Agreement Integration Areas, as of May 20 ‘Table 2: Federal Heath Care Cente

United States Government Accountability Office

GAO

Why GAO Did This Study

‘The National Defense Authoreation

Pet NDAR) for Fiscal Year 2070

futhorzed the Deparnents of

Veterans Aare (VA) and Defense

(B00)t6 esDhleh s year

damonshann polsc ta riegrsie VA

Gnd DOD medial arena atrstot

[eka Fegeral Heats Care Center

(HCC) n North Cheago ins

Expectations forthe FHC ae outined

nan Erecutve Agreement signed by

Yaad DOO In Abs 2070,

‘The NOAA fr Fiscal Year 2010

‘ected GAO fo annuay evaluate

ao aspects ofthe CC

Integration The reboR ersnine,

(3) what protess VA ana DOD have

‘nase inglementng the Executive

[areement to esti and operate

thẻ PHCC and 2) wnat lan any VA

rovsion of cae and operations GA,

Fevvowed FHC documents sna

Ya 000, and HCC eft ana

reviewed related GAO vot

What GAO Recommends

{GAo econmans that 000 seek 8

legiiave change to designate he

FHCC as amity ieatment acy

(MP) DOD fect prong

Ineccal or dental are fo elge

IndtuSls and tatVA andDOD,

‘rect HCC leacersip other

fevauate te tegration performance

Feporing toot G00 ae ot ae wah the recommendation rear the

MTF deegnation but GAO contnoes

toboleve such desgration 6

Important Vand DOD agreed ith

{GAO's recommendation rearing the

‘Scorecard reporing too

What GAO Found FHC offials have made progress implementing provisions ofthe Execute

‘Agreements 12 integration areas, For some atea, al prouslons have been

‘sessed, including establishing the faciy’s governance structure and patent rity sysiem Progress cones to be made in other areas, such as wake

‘management and personnel and qualty assurance However, as proWously

‘opoted by GAO, tere have boon delay implementing tho lntormation {echnoloy provisions, which present challenges for operating the FHCC as a {uly ttepfted fect In adaton, while some workarounds aren place, the lack fan MTF designation that ther DOD medical feces ave presents

Challenges for effcent FHC operations and resus in uncertainty regarding access to preored dug pices and provider authority to sign modal readiness forms for ace duty Navy servicemembers

[Although VA and DOD are assessing he provision of care and operations atthe FHC, thor plan to report on performancs lacks ansparency and may not provide a meaningil and accurate measure of success, Specialy, VA ad BOD through FHCC stat, reusing 15 infenration benchmarks set forth in the Execs Agreement to assess the niegraton From these benchmarks, FHC Staffidentfed 38 coresponding performance measures to assess the

integrations success While FHCC staf plan to report on those porfermance

‘measures through a reporting tool they developed-a scorecard thal calculates

‘Monty summaty score he toa lacks Wansparency and may Aa provide &

‘eanngflindieatr of performance The scorecard does not account for data coBecion vaialon, thee is no designated target scoe(s) to indicate successtul Integration performanea, and the scorecard nly contained a ealeulaton rrr, allot which raise concerns about its ably lo provide ransparent, meaning And accurate lnormation,

Tables

‘Tablet: Federal Health Care Center (FHCC) Progress

Implementing Selected Provisions forthe 12 Executive Agreement Integration Areas, as of May 20

‘Table 2: Federal Heath Care Center (HCC) Integration

Benchmark Characteristes by Focus Area and Time

Table: Federal Health Care Center (FHCC) integration

Benchmarks by Number of Reported Measures 28

Paget (2t0.11870 VAand 000 Federal Heath Care Center,

Figures

Figure I: Timeline of Integrating Health Services at North Chicago

‘VA Medical Cencer (NCVAMC) and Naval Health Cine

Figure 2: Photographs of Nevly Constructed or Renovated Areas of

the Federal Health Care Center (FHCC) 8 Figure 3: Organizational Chart for Federal Health Care Center

FHCC Federal Health Care Cantar IEEE Institue of Electrical and Electronics Engineers

m information technology MTE riltary treatment facity NCVAMC North Chicago Veterans Affairs Medical Center NDAA Nations! Defense Authorization Act

NHCGL Naval Health Clinic Great Lakes

VÀ Department of Veterans fais Vista Veterans Health Information Systems and Technology ‘Architecture

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agreements 0 improve access to, and qualty and costffectiveness of health care provides by the two departments Since 1982, VA and DOD have entered infos number of rasource-sharing agreements to provide heath care services emergency, specially, inpaien, and outpatient care—to VA end DOD beneficaries,° reimbursing each other for ine cost

‘of such services, Since the 1980s, VA ana DOD have expanded their sharing efforts to include "joint ventures”—sharing agreements that

‘encompass multiple health care services and result n mutual benef, shared isk, an joint operations in specif clinical areas,

‘As of 2010, there were nine VA and DOD joint ventures throughout the

‘country, one of whieh was between the North Chicago VA Madical Center (NCVAMC) and DOD's Naval Heath Clinic Great Lakes (NKCGL),

{cies located near one another in and around Nartn Chicago, ilinois.> Since the 1980s, VA ané DOD have entered into multiple agreements to Share healthcare resources between these two faciles—including Imegrating their mental health, surgical and emergency departments

‘Most recently, the National Defense Authenzaion Act (NDA) for Fiscal

‘Year 2010 formalize the partnership by sutnorzing ine establishment of

2 S:year demonstration project, aed at fully megrating the VA and DOD

‘cities into a single integrated health system, the DODIVA Medical

38086 § 6114 The Copanment of Veterans Ala as provusy known ashe {say etcce and hae axpendons and surat Active ay pasar ace asi srponart mars om ttn ty for eloas 20 days

Facity Demonstation Project, Federal Health Gare Genter (FHOG).* As the frst FHGC, this demonstration projec is expected to provide lessons learned for decision makers for any future FHCs that may be

established based on this mocel The pannership was drven, in part, by ecommendations fom the Defense Base Closure and Realignment

‘Commission * as well as an effor by VA to tently opportunities for realigning and upgrading its healthcare facities across the country ©

‘Among other goats the integration of NEVAMC and NHCGL was Intended to increase the efficiency of both facies by merging staff and

‘The level of integration involved inthis demonstration project is Lunprecedanted in the history of VA and DOD health care resource sharing Specialy, the FHCC—ed ay officials from both VA and DOD, speciicaly the Navy-—is unique because is designes to be the fist fully integrated joint fatty, for use by both VA and DOD benefiianes, with a single line of governance and a single funding source With an integrated Workforce of VA and Navy personnel, the FHCC expects to provide health

‘care services to approximately 116,000 patents per year This nudes the medieal and dental serviees the FHCC provides annualy to

approximately 40.000 Navy recruits to ensure their medical readiness for duly By providing these health care services to Navy’ recruits, the FCC 's chargad with maintaining the “pipeline to the feet” of new Navy personnel

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“The Secretaries of VA and DOD signed an Executive Agreementin Apa

2010 that otined the FHCC's structure and included provsions regarding health care services and operations at the fact Beginning (Cetaber 1, 2010, services previously provided by NCVAMC ané ts community based outpationt clinics, and NHCGL and ts associated Sines, were inlagrated into a frstatate-kind FHCC ' DOD proviged '3130 milion fer canstrucion of an ambulatory care center and associated structures, such as a parking garage and, in accordance with the NOAA {or Fiscal Year 2010, as the option of wansferring the newiy constructed properties to VA 5 years aller ihe Execulve Agreement was executed of

‘once specified benchmarks are compieled, whichever occurs frst If Instead, the Secretary of VA or DOD decides not io continue the emanstration project, DOD retains ownership of the properties

‘The NDAA for Fiscal Year 2010 requires that we review and assess -anhualy: the progress made in implementing the agreement signed by

\VA and DOD to establish the FHCC, and the affects ofthe agreement o7 the provision of care and operation of the facity.* In this frst annua report wa address the follwing questions:

41 What progress have VA and OOD made in implementing the Executive Agreement to establish and operate the North Chicago FHCC?

2 What plan, if any, €o VA and DOD have to asses the provision of care and aperations atthe North Chicaga FHOC?

“To determine what progress VA and DOD have made in implementing the Executive Agreement to establish and operate the North Chicago PHCC, Wwe examined the 12 integration areas and provisions outined in the Executive Agreement, and assessed the FHCC's progress in meeting them Spectically, we reviewed VA and DOD decumertation of implementation plans and progress incuding timelines for integrating the {acily, policies for operation of the FHHCC, and plans for mtegrating the financial systems." We reviewed our earlier work examining the

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Information technology aspects of the FHCC integration.” We also Interviewed ofeials at VA, DOD, and the FHCC about the planning

‘racess for, and implementation af, the integration atthe Nerth Chicago

‘5 In addition, to observe the status of integration efforts, we conducted

‘te visits tothe North Chieago stein September 2010, prior tothe official

‘establishment ofthe FHC, and in January 2011, after FHCC officials

‘estimated that several key aspects ofthe integration would be complete

by that ime,

‘To determine what plan if any, VA and DOD have to assess the provision

‘of care and operations at ihe FHCC, we examined FHCC staff efforts to

‘measure care and operations in the context of 15 integration benchmarks specific performance measures for determining PHCC success—selected by VA and DOD and identified as ene ofthe

‘12 Executive Agreement integration areas We did not assess wether

‘he integration benchmarks are the most appropriate measures of a

‘successful integration nor did we evaluate the reiabiliy or validity of the FHCC's performance rests, The integration benchmarks are an

‘established cloment ofthe Executive Agreement fo which VA and DOD have formally agreed and FHCC officals have not yet reported a full cycle

‘of performance data, We reviewed relevant documents thal describe the FHCs plans for measuring standards of care provided to patents and for assessing the success of operations forthe ste In addilon, we Inerviewed officals at VA and DOD, including those at tha FHCC, regarding the provision of care and operations, standards they use to

‘measure and assess them, and plans to evaluate and report results in these areas,

We conducted this performance audit from August 2010 to July 2011 in accordance with generally accepted government auditing standards

“Those standards require that we plan and perform the aucit to obtain

‘sufficient, appropriate evidence to provide @ reasonable basis fr our {ingings and conclusions based on our audit objectives We believe that the evidence obtained provides a reasonable basis for our findings and

‘conclusions based on our au objectives,

Background ‘VA and DOD's history of sharng resources 1 provide Integrated health care services to heir beneficlanes in and around North Chicago has

‘occurred in twee phases The thie phase culminated in the

‘stablstiment of the FHCC, which was farmalzed by an Executive

‘Agreemant signed by the Secretaries of VA and DOD in Ail 2090, The FCC is unique emong other VA and DOD sharing relationships in its level of ealavoration, govemance stature, and financial model

History of VA and DOD

Integration of Health

Services in North Chicago

‘The history of VA and DOD integrating heath services in Noh Chicago can be described in three distinct phases (See fg 1) These phases, {aver the time period rem 2003 te 201 and include the official, festablishment ofthe FHCC in October 20:0,

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‘+ Phase Il began in 2005 withthe $13-millon renovation and modernization of the NCVARIC, inéuding ts operating rooms and an

‘expansion of the emergency department In 2008, NHCGL’s inpatient

‘medical, surgical pediatre, and intensive care unis, operating rooms, land emergency department were vansfered to NCVAMC With the transfer of inpatient services, ine naval hospital bacama a naval heath clinic, since the facity na longer provided inpatient services.” + Phase Il began in 2007 when constuction began on new parking areas followed in 2008 by the groundbreaking for he construction of

‘anew ambulatory care center, The FHC Adusory Board was {established in 2008 to help provide guidance fr ie integration and

‘ture operation ofthe facility whien was authorized inthe NDAA for Fiscal Year 2010, In October 2010, the former NGVAMC and NHCGL facies mergac to become the FHCC, flowing complation of 2 '5130-millon DODunded construction project The FHCC consists of alle services, buildings, and locations formerly eperated by either NCVAMC or NHCGL including the new 207,000-square-foot ambulatory care center and is parking lot an garage, a 45,000

‘square-foot renovation of the NCVAMC, anc various outpatient and fecrultcnis formerly operates by either NCVAMC or NHCGL (See

‘ig 2 for photographs of newiy constructed or renovated areas ofthe FHCC ) The ambulatory care center, whieh 'sphysicaly connected to

‘he NCVAMC, houses outpatient services including pediatres,

‘women’s heath, and mental health In addon, thas on-site laboratory radiology, ane pharmacy services, enabling patents to access these ancillary services in the same locaton as their

‘outpatient series," Phase Il continued into 2011 wth the move into the new ambulatory cae canter and the delvery of patient services there

Executive Agreement in Apr 2070, the Secretaries of VA and DOD signed the Executive

‘Agreement that established the FHCC The Executive Agreement defines

‘he relationship between VA and DOD for establishing and operating the FHCC, in accordance with the NOAA for Fiscal Year 2010, and contains provisions in 12 integration areas regarding specific aspects of FHCC

‘operations These 12 areas are: (1) govemance structure; (2) access to healthcare at the FHC; (3) research; (4) contracting; (5) information

tecanology 1), (8) fiscal autnonty: 7} wordforce management

‘and personne’ (8) qualty assurance; (9) contingency planning:

(10) integration benchmarks: (11) propery (ie constuction and physical plant management, and (12) reporting requirements

thin the 12 areas are provisions desenbing how the FHCC should be

‘operated or what VA and DOD wil das part of their efforts to joitly

‘operats the facity Some provisions relate to establishing and operating

‘he FHCC and have designated deadines, such as implementing IT sralegies Other provisions do not have specified deadlines or wil not be

‘met unt a certain pointin the integration, or ae contingent on other Canditions being met For example, @ provision in the raperting requirements inlegration aea calls fora nal rapor at he ene ef the 5-year đemonstabon In 2016, Sinee the repod 1s due al the ena ofthe S.year demonstration period, this particular prowsion cannot yel be

“implemented

‘The Executive Agreement also includes 18 inlegration benchmarks that

\VA and DOD plan to use to determine the integration’s success,

‘Assessment of the integration benchmarks throughout the 5-year

‘femanstration project wil help inform whether the FHOC partnership

‘should continue beyond the demonsiaton period authorized by the NDAA for Fiseal Year 2010

Unique Features of the

FHCC ‘operations represents the highest level of callaporation among the nine “The FHGC is unique among VA and DOD joint ventures in three Key ways Fits, the FHCC's integration ofthe provision ef care and

‘existing VA and DOD joint ventures VA and DOD have periodically assessed their join venture arrangements to determine the level of

‘allaboration between pariners, which they measure an a continuum om

‘separate" to ‘consolidated * Thay use this continuum to assess program

‘loments ofa joint venture's partnership such as governance, education

‘and Vaining, and esearch, VA and DOD olfcials reported to us that

‘overall, the FHCC nas more program elements, such as its clinical services and stafing, which fall the ‘consaliated" ond of tho Collaboration continuum tran any of the other joint venture sites, Second, the FHCC operaies under a single line of govemance to manage medical

‘and dental care, ane has an integrated worktorce of approximately 5,000

‘lian and active duly miltary employees from Both VA and DOD" —a

‘Fee gute ean FCC esate sncudina VA aatne apa eoneaciom pra avy coors convened is VA clans, eave ay somiomenbor aa Nan coma

Tealure thats unique tothe FHCC Although the FHCC's leadership and Workforce ar integrated, they also remain crecty acccuntable to both

\VA and BOD through the Joint Executive Couneil and the Health Executive Council, VA and DOD officials told us that none of the other joint venture sites has an integrated governance structure and instead ‘mainian separate VA and DOD lines of authority The third way in whieh the FHC is unique among VA and DOD joint ventures sits financial

‘model, The FHCC has a single funding source to which VA and DOD wil Contabure, unlike the other joint venture ates which have separate VA

‘and DOD funding sources The NOAA for Fiscal Year 2010 established the Joint DOD-VA Medical Facity Demonstration Fund (int Fund) as the funcing mechanism forthe FHCC, with VA and DOD bath making transfers to the Joint Fund for the reseztve appropriations."

FHC officials nelucing both VA and DOD øffcile) have made progress Implementing tie provisions of the 12 Executive Agreement iegration -r#as,Fourof he 12 integration areas have been fly implemented,

7 are in progress and proceeding accoccing ta plan, and 1 area I has

‘been delayed and continues fo present challenges In addition, the FHCC's lack of 2 miltary treatment facily (MTF) designation has presented challenges for FHCC operatons and healthcare providers,

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FHCC officials have addressed all provisions for ofthe 12 Execulue

‘Agreement inlegration area

‘are progressing in thar implementation of

7 other areas, and have experienced delays in the implementation of

4 area, IT (See table 1)

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Implemented Provisions for

Four Integration Areas

(Officials have completed implementation of the governance stucture,

‘access to health care at the FHCC research, and contracting integration Governance structure, The Executive Agreement defined the structure fof the FHCC's governance structure and leadership, with 2 VA official serving as the director and a naval captain serving as the deputy decor (See fig 3) As of October 1, 2010, the former dractor of NCVANC became the director of the FHC, and a commana change Brought in a new naval captain to become deputy citectr, taking over command from the former NHCGL commanding oficer

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In adsiion the advisory bodies described inthe Executive Agreement a

In place The FHCC has an Advisory Boaré—co-chaied by and

‘comprised of Senior ofivals from VA and DOD—that monitors the FHCC's performance and advises an strategie drecion, mission, vison,

‘and policy, The Advisory Board also provides input into the performance

‘evaluaions of FHCC leadership and serves as a communication ink

‘between VA and DOD executive leadership and the FHCS through the

‘int Executive Coun and the Heafh Execdtive Courel Also, @

‘Stakeholders Advisory Caunci—comprsed of members from various regional and local organizations representing FHCC interests "provides feedback on now wel the FHCC is meating customers’ needs and

'ehether the FHCC s meeting VA and DOD missions VA and DOD officals also designed the major operational components ofthe FHCC to have shared VA ane OOD leadership The six citical and admin trative Civisions” that report fo the director and deputy director are lea by an

‘associate director and an assistant rector, one from VA and the other Tom the Navy,

‘Access to health care at the FHCC To address access te heath care at tne FHC for veterans and DOD enefcianes, the NOAA for Fiscal Year

2010 and the Executive Agreement established a patient prionty system thal s unique fo the FHICC for use in tne event of resource constraints FCC's patient pronty system is based on the priory list for TRICARE DOD's program to provide health cave fois beneficiaries, and

incorporaioe VA benefciares ® More spacrfcally, the system protiizes

‘active duly servicemembers above veterans and other DOD beneficiaries

235 follows

1 members of he Armed Forces on active duty,

‘Fine Sahay Ado Counc membership include operon For ol 7Š

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‘Benefiganes using TRICARE Extra are voneiared tobe TRICARE Standard partcipants

Shared oe sash nto pony

2.ˆ velerens and nen veteran VÀ benefeaies ”" and TRICARE Prime enrolled actve duty dependents:

3 TRICARE Prime enroled retirees, their dependents and survivors;

4 TRIGARE Standard active duty dependents and

5, TRICARE Standard retirees, their dependents, and survivors, Including TRICARE fer Lite beneficianes

(Officials told us that they do not anticipate needing to activate the patient prot systam because they ere curcenty meeting the needs of FHCC beneficianies—health care providers athe FHC currently serve all patients based on mecical need Offa's aso tld us that their monitoring

‘of Navy recruit medical readiness ensures they are able to maintain the

"pipaline tothe ost of enlisted sailors, Research, The Executive Agreoment slated thatthe FHCC would comply

‘with VA policy for research efforts, but provided that when 20D researchers or patients are involved ina stuey, the Navy's rules on protection of human subjects would apply in adciton to VA's In adetion {o implementing his provision, FHCC officials told us they decided to Integrate the research program atthe FHCC Since a majority of tho research conductad is VA research, it was easily incporatad ino the broader FHC integration effors The FHCC has an Institutional Review Boara"—a body responsibi for reviewing and approving research protocols involving human subjects—located ata hospital aflated with the FHC thal pravides research management ane operational oversight

to the FCC, the Edward Hines, Jr VA Hospital Hines, lines Als, in

‘sccordance with the Executive Agceament, FHCC offcias ole us that 3

‘DOD institutional Review Board in Sen Diego, California, may also be Involved for research involving DOD researchers or active duty servicemembers atthe FHCC

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‘employees who were at NHCGL prior tothe integration ware converted to

\VA civilian employees te help suppor the integrated contracting and purchasing functions

COficials efforts have progressed as planned to implement prowsions for the fiscal authority, workforce management and personnel, quality

‘assurance, contingency planning, inlegration benchmarks, property, and roporting recuirements areas

Fiscal authority, The FHCC fiscal authorty integration acea included the development ofan integrated budgeting and financial reconciliation process For fiscal years 201 through 2013, the FHCC plans to use historical financial data to budget and determine the amount each department wil vansfer tothe Join Fund and expeess to manually

‘conduct the year-end reconcllaion process, Offical tld us thal by fiscal year 2014, the FHCC intends fo have an automated year-end fnancial Feconcilaton process, However, as of Ai 1, 2011, the integration area

‘on fiscal authorty hae’ not been fully implemented because appropsations had not been made availabe forthe Joint Fund The NDAA for Fiscal Year 2010 estabished the Joint Fund as the FHCC's funding source, but FHCC officials cauls not use it ni funds had been authorizes anc

‘appropriated for VA and DOD ta transfer into the Joint Fund, which

‘occurred in Apri 2011 Until tha ime, the FHCG was funded by an alternative funding mechanism astabished by the Exacutive Agreement {or use in the event that Congress did not authorize and appropriate funds tobe ansfered to the Joint Fund As of April 2011, FHS officials planned to coase use af the afernative funding mechanism and begin use

‘ofthe Joint Fund at the start ofthe next quarter on July 1 2011

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“The delay n avalabil of nds may result in a dalay in addressing an NDAA for Fiscal Year 2010 requirement int is also one of he integration Denchmarks—the annual independent audi ofthe deint Fund, wich is

‘conducted al he end ofthe fiscal year The audit wil evaluate the

‘adequacy of VA's and DOD's proportional contributions to the Joint Fund *Ih addition, the implementation of the automated fancial reconciliation process is contingent on @ related IT capabilty, wich does rot yet have an estimated completion dete, Together, tnese delays may impact the FHGC's abiliy to adress one af the measures af its

Imegration’s success, Workforce management and personnel In the workforce management and personne! inlegraton are, the NDAA for Fiscal Year 2010

fuhorzed a transter from DOD tg VA ofthe postions and persanne!

‘ecessary to operate the FHCC = The Executive Agreement ientfied

1533 DOD cviian postions that wore aligibe for transfer te VA, and FCC cfeils told us that VA made offers of employment te the indivicuals in|

‘nose positions, In total, 489 DOD civilan personnel were transferred to

\VAas of October 10, 2010—the deadline established in he Executive

‘Agreement The 533 converte civilan pasitions, along with 724 active duty postions, 1877 VA cvilan positions, 249 VA and DOD contract postions, and 18 new housekesping positions, comprise the

‘approximately 3.000 positions that intaly staffed the FHC FHC

‘officials are in the process of signing afilaion agreements with heath

‘are facies and trainin insttuions and plan to address another provision regarding the development of crleria and assessment mathods

fo measure staff experiences withthe integration at a later date, Officials have also inlegrated thet sIAf raining through an integrated education department

‘Quality assurance The Executve Agreement stated thatthe FHCC

‘would have one integrated quality assurance plan and would maintain

‘accrediation by the external accreaing bodies required by ether VA ar DOD It also outlined the FHCC’s cradentaing and privileging process for healthcare professionals FHCC officals have an integrated quality assurance pian forthe facty in place, as well as policies addressing

‘credentialing and privieging of providers and the ole of independent auty pas Ce 1-64, § 170A), 129 Sat 2165 2579 000,

Mab No 11-84, § 176M, 12 Sat 2180 25702000,

‘orpsmen atthe FHEC.™ White some bodies, such as the VA Office ef the Inspector Genera, nave conducted reviews of the FHCC since it was established,” other accrestalon and certification eviews, such as tat of

‘The Joint Commission, * are pening and the frst reviews forthe FHCC will occur onthe schedules that were in place forthe NHCGL and NCVAMG pior tothe imiegraton

‘One compenent of ually assurance isthe maintenance of clinical skis forthe FHCC's Navy heaith care providers, Oficial told us that one of

‘he benefits ofthe integration is that dental scnool graduates obtaining

‘avanced education inthe Navy can see veteran patients wile

‘completing their residencies and have apportunities la be exposed to diferent dental conetons than those normally seen in the generally younger and healthier recruit population Some of these dentists wil be placed on ships, wnere they are often the only on-site dentist FHOC ficias described a simiar benef fr health care professional providing inpatient care

Contingency planning The Executive Agreement included contingency planning provisions regarcing he establishment of certain FHCC

‘emergancy management postions, and stated which antiterrorism and

‘other secunty guidelines would inform the establishment of the FHCC's

‘ecurty plans In adn, the FHCC must mainain training standards for staf that meet the joint VA/DOD programs in this integration area The FHC has the necessary emergency management personnel, taining standards, and programs in place; however, officals are in he process of finalizing an agreement to outing the relationship between VA police and DOD security personnel

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seater exam, VA Oe ote raptor Genta Heather inspection Aged ‘ony af Care nsuse Cosa Jaron Love racerahowtn Cae Corton Not Spa le Repse No tr 2016k to (Hồehhoon, ĐC, VA OMe of he rapecar (Gena tar 2-251) ond Mamartice Pee) Ressich, Nh neapa Mara anth esenit saheniiaton Iostnan Programs VISN 12, Saion Cosa S55 Eetne- Up Cuaty Reson Report (Ptrceon N- Mathenaica Paley Research Dee 2.20°0)

he Jant Commisten ean independent cgaiaaon at acted and cetfes Neath

Implementation of Key IT

Integration Area Provisions Has

Been Delayed

Integration benchmarks, The Execulive Agraement established

15 integration benchmarks to dafine ihe dagree of te intagration’s success VA and DOD effeials atthe regional and headquarters levels and FHGC officials worked together to develop these benchmarks thal

‘aver such topics as patont and staff satisfaction, cinical and

‘administrative functions, and extemal evaluation The integration benchmarks are being used by the FHCC t0 assess provision of care and

‘operations and are discussed in more deal later in this repon

Property The Executive Agreement and the NDAA for Fiscal Year 2010 describe the terms ofthe transfer of property ownership thal may occur at the end ofthe 5-year demonstration period from DOD to VA A

ddetarmination te transfer oumership may accur upon the earlier of (1) completion ofthe integration benchmarks or (2) 5 years from the date ine Executive Agreement was executed Its determined thal the FHC should nat continue to be an integraec facility, DOD will lain ownership fof the amaulatory care contar and assccialed Structures that were buit

‘with DOD furs

Reporting requirements, Thera are several ceporing equiremants described in the Executive Agreement that were establishes by the NOAA for Fiscal Year 2010, nchiding submiting the Executive Agreement to the appropriate commitlees of Congress 1 week before its execution, and a final ropor from the Secretaries of VA and DOD that wil bo submitted

5 % years after the Executive Agreement was executed.” The report to scribe and assass the parformance of the FCC, and to provide a

‘recommendation as to whather the partnership should continue beyond

‘the đemonzaton periog, Congress vil make the final determination 35 {o whether to continue the parinership,

‘The Executive Agreement identified IT capabilies that VA and DOD were

to have in place by te opening day of tie FHCC, October 1, 2010, 10 faciltate interoperabilty between VA and DOD electric health record systems, as well as other capabiles for financial management ard

‘outpatient appointments tat are ta be develeped in the future The theee Capabilies that were fo be in place upon the FHCC's opening ware (1) mesical single siga-on—uhich allows staff to use one screen to

Gee Pu No #1124, § 170), 79 Sat 2100, 25602000) and Tecmalogy enact (Vata) aa GOD Secor elt ear de le cded

‘teamed Fare Hess tangtasral Testnaagy Aeseonson AMT)