We evaluated the effectiveness of the Office of Information and Technology’s (OIT) management of the Pharmacy Reengineering (PRE) project, which was restarted in October 2009 under the Project Management Accountability System (PMAS). Although some progress has been made, OIT has not been effective in keeping the PRE project on target in terms of schedule, cost, and the functionality delivered.. Specifically, deployed PRE functionality has improved patient safety; however, project managers have struggled to deploy PRE increments in a timely manner. Project managers were also unable to provide reliable costs at the increment level. OIT restarted PRE at a time when PMAS had not evolved to provide the oversight needed to ensure project success. As such, PRE management was challenged in keeping PRE on track and the project is at an increased risk of not being completed on time and within budget. Moreover, the future of Pharmacy Reengineering is uncertain due to potential plans to transfer funding and remaining development to the Integrated Electronic Health Record (iEHR) project in FY 2014. Stronger accountability over cost, schedule, and scope for the remaining development is needed prior to such a transfer so that iEHR is not compromised by the same challenges. We recommended the Executive in Charge and Chief Information Officer (CIO) ensure all of the time used to complete each remaining PRE increment is reported and monitored, including the time on the initial operating capability phase; ensure adequate oversight and controls, including the planning guidance, staffing, and cost and schedule tracking needed to deliver functionality on time and within budget; and establish a plan for future funding of PRE until iEHR is decided. The CIO agreed with our recommendations and provided an acceptable corrective action plan.