Publicly Released: July 11, 2023
Objective
The objective of this audit was to determine the extent to which the DoD can rely on the patient data in its Coronavirus Disease–2019 (COVID-19) Registry to make public health and clinical care decisions.
Background
On July 13, 2020, the Assistant Secretary of Defense (Health Affairs) (ASD[HA]) issued a memorandum directing the Defense Health Agency Director to establish the COVID-19 Registry to collect information on all COVID-19 events within the Military Health System. The Joint Trauma System (JTS), a subordinate organization of the Defense Health Agency, was responsible for maintaining the COVID-19 Registry. The DoD hired a contractor to enter patient health data into the registry with an accuracy rate of at least 90 percent.
Finding
The DoD cannot rely on the data in the COVID-19 Registry to make public health and clinical care decisions concerning the COVID-19 pandemic because the data were not complete, accurate, or representative of the universe of DoD patients who had a COVID-19 event. Among other issues, we identified errors in 24 of the 25 registry records we reviewed; therefore, we are at least 90 percent confident that the accuracy rate of the data in the registry is less than the contractually required minimum of 90 percent.
The data in the Registry were not complete, accurate, or representative of the universe of DoD patients who had a COVID-19 event because the ASD(HA) lacked a process for developing and populating patient registries. As a result, any data from the COVID-19 Registry that JTS officials provided to the DoD and other stakeholders during the COVID-19 pandemic were inaccurate and potentially misleading. Additionally, the DoD incurred questioned costs of $6.2 million for registry support services that did not meet the data accuracy requirements.
Recommendations
Among other recommendations, we recommend that the ASD(HA) establish and implement a policy for developing and populating patient registries, and to conduct a review of all patient registries in the Military Health System to verify the reliability of data in each registry and take corrective actions, as necessary. Additionally, we recommend that the JTS Chief conduct an analysis to determine whether the contractor complied with the terms of the contracts and recoup any of the $6.2 million in questioned costs, if necessary.
Management Comments and Our Response
The Under Secretary of Defense for Personnel and Readiness responded for the DoD officials to whom we directed recommendations in this report and disagreed with 8 of our 12 recommendations. In addition, DoD officials agreed with, but did not address, the specifics of one recommendation. Therefore, 9 recommendations are unresolved. We request additional comments within 30 days in response to the final report to address the unresolved recommendations.