VA ‘confident we’re going to commercial’ for EHR, scheduling fixes

Millions of dollars and years of faulty pilots and heated congressional hearings have failed to produce more modern, interoperable IT systems at the Veterans Affairs Department, the Government Accountability Office says.

But VA insists that the past 18 months have been instrumental in turning that perception around.

“We lacked a coherent strategy,” Rob Thomas, VA’s acting assistant secretary and chief information officer, told the House Veterans Affairs Committee during a Feb. 7 hearing. “We lacked the right processes and procedures. For the past 18 months, we have been going through an incredible transformation. … That transformation is happening. Now we need to get on with it, which is what we aim to do.”

But David Powner, director of IT management issues at GAO, had a more blunt assessment of VA’s IT failures, which start at the top.

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“We get a new CIO too frequently,” he said. “When new folks come in, what do they do? A new strategy, new thoughts, not enough delivery. To be fair to VA, there’s been some delivery like I mentioned on [the Veterans Benefits Management System]. We don’t want to hear [about] a new CIO coming in to come up with another [strategy]. We have a strategy, right Rob? We have governance. We have processes. Now you need to use it and deliver.”

The House VA Committee opened its session with a hearing on VA IT for years, and 2017 was no different.

It’s the first hearing for the committee with new leadership, but as Chairman Phil Roe (R-Tenn.) and Ranking Member Tim Walz (D-Minn.) both mentioned, it’s not the first time they’ve discussed these issues.

“Mr. Thomas, I appreciate you being here. I couldn’t resist the maybe overused cliche that Groundhog Day was last week,” Walz said. “You’re the fourth person since I’ve been here to sit there telling us when we’re going to update the records.”

VA’s focus is on five major IT systems, Thomas said. Nearly all of them have experienced delays, cost overruns and changes in planning, and those moving parts have been difficult to track.

“It always feels like the goal posts are moving, and I can’t keep track of the movement on those goal posts,” Rep. Julia Brownley (D-Calif.) said. “It’s testified in one committee that says this, and then we go to the next meeting and then it says, ‘Oh, we had some delays.'”

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Powner offered to help work with VA to give the committee quarterly updates on the progress of these five systems.

VistA Evolution: VA has made three attempts within the past decade to modernize this system. The Electronic Health Management Platform is part of this system and is designed to settle VA’s interoperability challenges with the Defense Department “once and for all.”

Now on its fourth try, Thomas said “he’s confident [VA] will go commercial.”

“This uncertainty is not acceptable, and a decision needs to be made,” Powner said. “VA needs to let go of VistA and go with a commercial solution. We see no justification for VA and DoD pursuing separate systems.”

But after years of debate and frustration, members of the committee said they’re still unclear about VA’s direction.

“The Commission on Care and the [veterans service organizations] have called for the purchase of a commercial electronic health record,” Walz said. “I want to explore that some, of where we’re going. We thought the VA was moving in that direction last summer. It doesn’t appear like that now. That troubles me in terms of a long-range vision.”

VistA Scheduling Enhancements (VSE): VSE is the department’s in-house scheduling tool, which is designed to help VA employees schedule millions of health care appointments through a more modern interface.

VA terminated the original iteration of this project in 2009 after spending $127 million over nine years.

The department will decide by Feb. 10 whether it will move forward with VSE or a commercial solution instead.

“Again, buying instead of building is the way to go,” Powner said.

Medical Appointment Scheduling System: MASS is VA’s commercial alternative to the VSE. The department is testing an industry solution, at the prompting of Dr. David Shulkin, the nominee to be the next VA secretary for the Trump administration, after a few slip-ups with VSE.

VA will have results from the MASS pilot within about 18 months, said Dr. Jennifer Lee, deputy undersecretary for health for policy and services at the VA. Until then, the department needs an interim solution, and for that, VA said it will have a decision on whether it will move forward with its in-house VistA Scheduling Enhancement tool by Feb. 10.

“I just hope this technology’s not obsolete by the time you get it in place,” said Rep. Ann Kuster (D-N.H.), who like Walz remembered when the committee kicked off the 112th Congress with a hearing on VA IT.

Veterans Benefits Management System: VA partially deployed VBMS in 2013, and the system is getting continuous updates. Records in the system are almost entirely automated now, but VBMS still cannot process appeals or all types of veterans claims. The project was supposed to be finished in 2015, and it still needs a firm completion date, Powner said.

The department said it will be able to pay off claims through VBMS by the end of the year.

Financial management: After two failed attempts to modernize its financial management system, VA plans to adopt the Agriculture Department’s financial management shared services offering. There’s no timeline yet for when that process will begin.

The department and USDA started at the beginning of the fiscal year a fit-gap analysis to consider VA’s future involvement. Once that analysis is finished, VA will have a more clear timeline, Thomas said.

VA IT spend

VA will spend about $4.5 billion on information technology this year, the fourth largest IT budget in the federal government.

Roughly $500 million — or about 10 percent — of its IT resources will go toward developing or acquiring new systems. Each year, VA spends less of its budget developing new capabilities and more on maintaining current systems and employee salaries, Powner said.

“They’re not alone, this is a problem across the federal government,” he said. “But a 10-90 split, or close to that, [is] not where we need to be.”

VA has two IT systems that are more than 50-years old.

“One is a personnel and accounting system, another is associated with claims processing. These are expensive and difficult to maintain and pose security risks,” Powner said.

Compared to the rest of government’s progress in closing data centers, VA is also falling short, Powner added. The department closed 30 of its 391 centers for a total of roughly $19 million.

GAO added two new areas to its 2015 High-Risk list: managing VA health care and the department’s IT acquisitions and operations.

Those areas will remain on GAO’s list this year, Powner said. GAO Comptroller General Gene Dodaro is expected to testify next week on the agency’s 2017 High-Risk List.