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 "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, …

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 …