A letter report issued by the Government Accountability Office with an abstract that begins "Providers and stakeholders GAO interviewed in four states with ongoing electronic health information exchange efforts cited key challenges to exchange, in particular, issues related to insufficient standards, concerns about how privacy rules can vary among states, difficulties in matching patients to their records, and costs associated with exchange. Officials from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC)—agencies within the Department of Health and Human Services (HHS)—noted that they have several ongoing programs and initiatives to help address some aspects of these key challenges, but concerns in these areas continue to exist. For example, several providers GAO interviewed said that they have difficulty exchanging certain types of health information due to insufficient health data standards. Although HHS has begun to address insufficiencies in standards through its Medicare and Medicaid Electronic Health Record (EHR) programs, such as through the introduction of new 2014 standards for certified EHR technology, it is unclear whether its efforts will lead to widespread improvements in electronic health information exchange. In addition, providers GAO interviewed reported challenges covering costs associated with …

A letter report issued by the Government Accountability Office with an abstract that begins "Delays in developmental flight testing of the F-35's critical software may hinder delivery of the warfighting capabilities the military services expect. F-35 developmental flight testing comprises two key areas: mission systems and flight sciences. Mission systems testing verifies that the software-intensive systems that provide critical warfighting capabilities function properly and meet requirements, while flight sciences testing verifies the aircraft's basic flying capabilities. Challenges in development and testing of mission systems software continued through 2013, due largely to delays in software delivery, limited capability in the software when delivered, and the need to fix problems and retest multiple software versions. The Director of Operational Test and Evaluation (DOT&E) predicts delivery of warfighting capabilities could be delayed by as much as 13 months. Delays of this magnitude will likely limit the warfighting capabilities that are delivered to support the military services' initial operational capabilities—the first of which is scheduled for July 2015—and at this time it is not clear what those specific capabilities will be because testing is still ongoing. In addition, delays could increase the already significant concurrency between testing and aircraft procurement and result in additional …

A letter report issued by the Government Accountability Office with an abstract that begins "Federal, state, and local officials responsible for implementing grants funded by the American Recovery and Reinvestment Act of 2009 (Recovery Act) as well as the external oversight community reported lessons learned regarding both useful practices and challenges to ensuring accountability. Faced with aggressive timelines for distributing billions of dollars, they adopted a number of practices to foster accountability including (1) strong support by top leaders; (2) centrally-situated collaborative governance structures; (3) the use of networks and agreements to share information and work towards common goals; and (4) adjustments to, and innovations in, usual approaches to conducting oversight such as the increased use of up-front risk assessments, the gathering of "real time" information, earlier communication of audit findings, and the use of advanced data analytics. For example, in 2009, the Recovery Accountability and Transparency Board (Recovery Board) established the Recovery Operations Center which used advanced data analysis techniques to identify potential fraud and errors before and after payments were made. The Recovery Act's emphasis on accountability also presented challenges for several states and federal agencies. These included limited resources for oversight at the state and local levels, …

Correspondence issued by the Government Accountability Office with an abstract that begins "Hospitals and health care professionals, such as physicians, were awarded a total of approximately $6.3 billion in Medicare electronic health records (EHR) incentive payments for 2012, which is more than twice the $2.3 billion awarded to hospitals and professionals for 2011. Almost half of eligible hospitals and less than a third of eligible professionals received Medicare EHR incentive payments for 2012."

A letter report issued by the Government Accountability Office with an abstract that begins "From fiscal year 2002 to fiscal year 2012, indirect cost reimbursements from the National Institutes of Health (NIH) to universities increased slightly faster than those for direct costs, but increased notably faster during some periods. Specifically, from fiscal years 2002 to 2012, indirect costs increased 28.1 percent while direct costs increased 27.0 percent. However, for the fiscal years 2003 to 2012, indirect costs increased notably faster than direct costs, at 16.9 percent and 11.7 percent, respectively. In more recent years, annual changes were generally small but consistent. This increase occurred during a time when growth in NIH's budget for extramural research slowed to 5 percent from fiscal years 2008 to 2012, compared to about 21 percent from fiscal years 2002 to 2007. In fiscal year 2012, about 10 percent of the universities (50 out of about 500) receiving NIH extramural research funding received almost 70 percent of all indirect cost reimbursement provided to universities. Higher indirect cost rates tended to be associated with universities located in high-cost-of-living areas and privately owned universities."

A letter report issued by the Government Accountability Office with an abstract that begins "Students in Bureau of Indian Education (BIE) schools perform consistently below Indian students in public schools on national and state assessments. For example, based on estimates from a 2011 study using national assessment data, in 4th grade, BIE students on average scored 22 points lower for reading and 14 points lower for math than Indian students attending public schools. The gap in scores is even wider when the average for BIE students is compared to the national average for non-Indian students. Additionally, the high school graduation rate for BIE students in 2011 was 61 percent, placing BIE in the bottom half among graduation rates for Indian students attending public schools in states where BIE schools are located."

A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2009 through May 2013, the Department of Defense (DOD) allocated approximately $73.9 million from its Counternarcotics Central Transfer Account to the Regional Helicopter Training Center (RHTC) in Colombia. As of May 2013, about $47.0 million of this funding had been disbursed. Most of this funding was allocated to RHTC helicopter maintenance, including approximately $31.1 million (42 percent) to a maintenance contract and about $12.0 million (16 percent) for parts and tools. As of June 2013, the Department of State (State) had also allocated approximately $382,000 from its Foreign Military Financing (FMF) account toward training of helicopter mechanics for RHTC."

Correspondence issued by the Government Accountability Office with an abstract that begins "Officials with the Department of Commerce's Economic Development Administration (EDA) said that the agency has taken preliminary steps to execute the Federal Loan Guarantees for Innovative Technologies in Manufacturing program but, as of June 2013, had not issued any loan guarantees under this program. According to officials, EDA has taken some steps to execute the program, such as establishing a staffing budget and creating a timeline for executing the program. According to the timeline, initial awards could be finalized in mid- to late 2015. The program received $10 million in appropriations--$5 million in fiscal year 2012 and $5 million in fiscal year 2013--which by law are to remain available until expended. No funds have been obligated by the program as of June 2013."

Testimony issued by the Government Accountability Office with an abstract that begins "As GAO has reported over the last decade, the Department of Energy’s (DOE) management of major projects and programs, security and safety at DOE sites, and reliable enterprise-wide management information, including budget and cost data, are among the most persistent management challenges the department faces."

A letter report issued by the Government Accountability Office with an abstract that begins "GAO’s analysis found varying degrees of improvement associated with the National Transportation Safety Board’s (NTSB) actions in areas selected for review."

A letter report issued by the Government Accountability Office with an abstract that begins "Within the Department of Homeland Security (DHS), U.S. Customs and Border Protection's (CBP) data on commercial vehicle wait times--the time it takes to travel from the end of the queue to the CBP primary inspection point at land border crossings--are unreliable for public reporting and CBP management decisions across border crossings. These data--which are collected manually by CBP officers--are unreliable because CBP officers inconsistently implement an approved data collection methodology, and the methodologies used vary by crossing. For example, five of the six crossings GAO visited require observation of the end of the queue to estimate wait times, but officials at these crossings reported the lines extended beyond their view at times. As a result, these data are generally not used by the private sector and are of limited usefulness for CBP management decisions on staffing and infrastructure investments. Determining and taking steps to help CBP officials overcome challenges to consistent implementation of existing methodologies could improve the reliability and usefulness of CBP's current wait time data. CBP officials have identified automated wait time data collection technology as the best way to improve data reliability. The …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs' (VA) performance pay policy has gaps in information needed to appropriately administer this type of pay. The performance pay policy gives VA's 152 medical centers and 21 networks discretion in setting the goals providers must achieve to receive this pay, but does not specify an overarching purpose the goals are to support. VA officials responsible for writing the policy told us that the purpose of performance pay is to improve health care outcomes and quality, but this is not specified in the policy. Moreover, the Veterans Health Administration (VHA) has not reviewed the goals set by medical centers and networks and therefore does not have reasonable assurance that the goals make a clear link between performance pay and providers' performance. Among the four medical centers GAO visited, performance pay goals covered a range of areas, including clinical, research, teaching, patient satisfaction, and administration. At these medical centers, all providers GAO reviewed who were eligible for performance pay received it, including all five providers who had an action taken against them related to clinical performance in the same year the pay was …

A letter report issued by the Government Accountability Office with an abstract that begins "The Office of Management and Budget (OMB) provides detailed guidance in Circular No. A-11 for the agency goal development and the performance data verification and validation processes. OMB Circular No. A-11 directs agencies to have a data validation plan for performance reporting and cost-effective validation and verification techniques in place to ensure the completeness and reliability of all performance measurement data used in annual performance plans. In 2012, OMB revised Circular No. A-11 to incorporate the requirements of the Government Performance and Results Act Modernization Act of 2010 (GPRAMA), which requires agencies to establish 2-year agency priority goals for areas where they seek to achieve near-term performance results but provides agencies with discretion to select their goals and the performance data used to show progress towards achieving these goals. Agencies must ensure that the data they use to report progress toward performance goals is accurate and reliable."

A letter report issued by the Government Accountability Office with an abstract that begins "Self-referred anatomic pathology services increased at a faster rate than non-self-referred services from 2004 to 2010. During this period, the number of self-referred anatomic pathology services more than doubled, growing from 1.06 million services to about 2.26 million services, while non-self-referred services grew about 38 percent, from about 5.64 million services to about 7.77 million services. Similarly, the growth rate of expenditures for self-referred anatomic pathology services was higher than for non-self-referred services. Three provider specialties--dermatology, gastroenterology, and urology--accounted for 90 percent of referrals for self-referred anatomic pathology services in 2010."

A letter report issued by the Government Accountability Office with an abstract that begins "The Internal Revenue Service's (IRS) National Research Program (NRP) has helped test or develop practices that have been used in operational examinations of individual tax returns, according to IRS officials. These practices include, for example, helping test IRS's remote learning system and helping IRS adopt new examination support software."

A letter report issued by the Government Accountability Office with an abstract that begins ""

Testimony issued by the Government Accountability Office with an abstract that begins "Most of the Department of Defense's (DOD) major satellite programs are in mature phases of development, that is, the initial satellites have been designed, fabricated, and launched into orbit while additional satellites of the same design are being produced. For the portfolio of major satellite programs, new cost and schedule growth is not as widespread as it was in prior years, but DOD is still experiencing problems. For example, total program costs have increased approximately $180 million from a baseline of $4.1 billion for one of two satellite programs that are in the earlier phases of acquisition. Though satellite programs are not experiencing problems as widespread as in years past, ground control systems and user terminals in most of DOD's major space system acquisitions are not optimally aligned, leading to underutilized satellites and limited capability provided to the warfighter. For example, the development and fielding of user terminals for a Navy communications satellite program lag behind the launch of new satellites by more than a year. Additionally, the development of ground software needed to extract capabilities of new missile warning satellites is not expected to be complete until …

Testimony issued by the Government Accountability Office with an abstract that begins "Actual costs to relocate federal users from the 1710-1755 megahertz (MHz) band have exceeded the original $1 billion estimate by about $474 million as of March 2013, although auction revenues appear to exceed relocation costs by over $5 billion. Actual relocation costs exceed estimated costs for various reasons, including unforeseen challenges and some agencies not following the National Telecommunications and Information Administration's (NTIA) guidance for preparing the cost estimate. In contrast, the Department of Defense (DOD) expects to complete relocation for about $275 million or approximately $80 million less than its $355 million estimate. According to DOD officials, the relocation of systems from this band has been less expensive than originally estimated because many systems were simply re-tuned to operate in the adjacent 1755-1850 MHz band. The auction of the 1710-1755 MHz band raised almost $6.9 billion in gross winning bids. NTIA expects agencies to complete the relocation effort between 2013 and 2017; therefore, final net auction revenue (auction revenue less relocation costs) may change."

A letter report issued by the Government Accountability Office with an abstract that begins "Agencies draw upon a variety of information sources in developing and updating their physical security programs. The most widely used source, according to survey responses from 32 agencies, is the institutional knowledge or subject matter expertise in physical security that agencies' security staff have developed through their professional experience. The second most used source are standards issued by the Interagency Security Committee (ISC). The standards, which are developed based on leading security practices across the government, set forth a decision-making process to help ensure that agencies have effective physical security programs in place. However, according to survey responses, the extent of agencies' use of ISC standards varied--with some agencies using them in a limited way. Agency officials from the case-study agencies said that certain conditions at their agencies--such as the types of facilities in the agencies' portfolios and their existing physical security requirements--contribute to limited use of the standards. ISC officials said that the standards are designed to be used by all agencies regardless of the types of facilities or their existing security programs; the standards can be customized to the needs of individual facilities and …

A letter report issued by the Government Accountability Office with an abstract that begins "Atmospheric deposition of nitrogen oxides (NOx), sulfur dioxide (SO2), and mercury contributes to the impairment of the nation's waters, but the full extent is not known. For example, states provide EPA with data on the extent to which their waterbodies do not meet water quality standards, and some states have reported that some of their waterbodies are polluted because of atmospheric deposition. However, the states have not assessed all of their waterbodies and are not required to report on the sources of pollution. Similarly, federal studies show that atmospheric deposition of NOx, SO2, and mercury is polluting waterbodies but have data for only some waters. The main sources of NOx and SO2 are cars and other forms of transportation and coal-burning power plants. Power plants are also the largest U.S. source of mercury emissions, but international sources also contribute to the mercury deposited in U.S. waters."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Labor's Occupational Safety and Health Administration (OSHA) provides more frequent monitoring and more consistent guidance for its federal enforcement activities than for state enforcement activities. More specifically, OSHA regional officials review performance reports on federal activities at least every other week but review reports on state-run program activities quarterly. In addition, OSHA's guidance for audits of its regional and area offices is more consistent than the guidance for its audits of state-run programs. Guidance for audits of its offices requires that regional offices conduct a comprehensive audit with on-site review of inspection case files at least once every 4 years and other audits focused on more specific activities in all other years. In contrast, guidance for regional office audits of state-run programs changes from year to year and does not include a regular schedule for comprehensive audits with on-site case file reviews. While the frequency of OSHA's monitoring of state-run programs is necessarily different because of the independent enforcement authority of participating states, OSHA's lack of consistent guidance for audits of these state-run programs may allow enforcement deficiencies to go undetected, increasing the …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) protects the U.S. homeland through two distinct but interrelated missions: (1) homeland defense, which defends against threats such as terrorism, weapons of mass destruction, and cyber incidents; and (2) civil support, which involves supporting other federal agencies in responding to major domestic disasters, emergencies, and special events. DOD has issued and updated several key pieces of doctrine, policy, and strategy for homeland defense and civil support, but it has not updated its primary Strategy for Homeland Defense and Civil Support since it was initially issued in 2005 and does not have a process--similar to that for its joint publications and directives-- to do so. The Joint Staff determined in August 2010 that joint publications on homeland defense needed a complete revision. The joint publication on civil support is also being revised. U.S. Northern Command, the combatant command responsible for homeland defense, is revising these publications to reflect changes in national and department priorities and to incorporate lessons learned from exercises and events such as Hurricane Katrina. Still, such key national and department-level strategies and significant events are not reflected in DOD's …

A letter report issued by the Government Accountability Office with an abstract that begins "Key standards for manufactured homes provide a lower margin of safety against a carbon monoxide exposure incident than those for site-built homes, which are constructed at their permanent locations. For instance, the Department of Housing and Urban Development (HUD) Code requires a minimum 3-foot separation between air intakes and exhaust vents, while industry standards for site-built homes have required a greater distance for many years. The industry standards call for a greater separation between air intakes and exhaust vents to help reduce the risk that contaminants such as carbon monoxide will re-enter the home. Indoor air quality experts whom GAO interviewed stated that the exhaust of an improperly operating furnace combined with unique wind conditions could, in rare cases, present a risk of carbon monoxide exposure. GAO analysis shows that increasing the separation between an air intake and exhaust vents, using industry standards, can significantly dilute concentrations of contaminants."

A letter report issued by the Government Accountability Office with an abstract that begins "In-country, the U.S. Agency for International Development (USAID) and its implementing partners face a range of factors that, to varying degrees, affect their ability to target food assistance effectively to vulnerable groups. These factors include (1) the quality of data used to identify and reach recipients, (2) host government policies, and (3) sharing of rations among recipients and community members. Targeting effectiveness is reduced when data quality is poor, host government policies cause distortions in program design and implementation, and sharing prevents food rations from being consumed by the intended recipients in the intended amounts. USAID and its implementing partners try to mitigate such challenges by, for example, employing technology to improve data quality, coordinating closely with government officials to foster better relationships, and educating recipients about proper food usage to reduce sharing. In some cases, host governments have facilitated targeting efforts by, for example, establishing national targeting guidelines that set a common standard, or national statistical offices that assist in collecting data. Nevertheless, ensuring that food assistance reaches intended recipients remains difficult."