The Department of Veterans Affairs' management of key IT projects is under close scrutiny from federal lawmakers who are frustrated with what they see as rushed efforts to roll out potentially flawed software tools as well as a lack of governance for the VA's interoperability projects.
The VA's slow progress to set up a joint program office with the Department of Defense to work out differences between their separate electronic health record (EHR) implementations has prompted legislators to work on a draft bill to move these efforts along. During a House Subcommittee on Technology Modernization hearing Tuesday, subcommittee chairman Jim Banks, R-Indiana, said he was drafting a bill aimed at improving accountability for interoperability efforts between the DOD and the VA.
The interagency program office (IPO) “is not living up to Congress’ vision for a single point of accountability,” Banks said.
The IPO, which was created by law, was set up to act as a single point of accountability for VA-DOD interoperability efforts, yet a Government Accountability Office (GAO) official testified Tuesday the agencies have shown little progress in creating a working governance structure for these interoperability efforts.
In fact, Carol Harris, director for information technology acquisition management at the GAO, said the VA's EHR project already is facing serious challenges and the ability of VA and DOD to hash out differences between their EHRs would be crucial to the success of the projects.
“Ensuring that VA fully defines the role of IPO with DOD is the most important action to take to ensure the electronic health record modernization program is a success. If they do not fully define that process with DOD, they are going to fail,” Harris said. “When the wheels start falling off the bus, you need to identify who is responsible and have corrective action.”
The subcommittee provides oversight of the VA’s planned acquisition of a $10 billion Cerner EHR system to replace its legacy Vista platform. DOD is also rolling out a Cerner EHR, and the two agencies plan to leverage a shared Cerner Millennium platform.
Committee members also voiced concerns about ongoing IT management and leadership issues at the VA. Case in point, lawmakers were frustrated that VA Chief Information Officer James Gfrerer, assistant secretary for the Office of Information and Technology, did not attend the hearing, nor did any other VA official.
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The GAO has examined the VA’s system modernization efforts and found that the department has significant challenges in managing its IT projects and programs.
“VA’s track record of delivering failed or troubled IT systems is a large reason why we designated VA healthcare as a high-risk area for the federal government in 2015,” Harris said.
VA has pursued three efforts over two decades to modernize its EHR, and these efforts led to high costs, interoperability challenges and did not result in a modernized system, Harris said. The current EHR implementation is the VA’s fourth effort and the program already faces serious challenges, Harris said.
The agency’s IT leadership challenges, with high turnover in its CIO role, is a major problem, Harris said. “The VA has had 10 CIOs since 2004 and six since 2012, making the average CIO tenure less than two years,” she said. A CIO needs to be in office three to five years to be effective and five to seven years for any major change initiative to take hold in a large public sector organization, Harris noted.
During a full House Veterans' Affairs committee hearing Tuesday afternoon, lawmakers also scrutinized the VA's IT initiatives to support the Mission Act following a highly critical report from the U.S. Digital Service (USDS) about a flawed software tool the VA is building.
House Veterans' Affairs committee chairman Phil Roe, R-Tennessee, said headlines about the USDS report, which was first covered by ProPublica, were alarming, and he was concerned about the readiness of the VA’s new eligibility software tool scheduled to be rolled out June 6.
The Mission Act was passed last year and allows veterans to seek care outside of the VA health system if their physicians agree it's best or if it would be hard for them to reach a VA facility. The VA is developing an automated decision support tool to help clinicians determine veterans’ eligibility to receive care outside the VA system.
An independent review (PDF) by the USDS found significant flaws with the tool and recommended the VA stop its development. In the report, USDS said the tool is the “principal technology in progress for the Mission Act rollout effort” and that it has identified “significant risks surrounding software development timing, integration dependencies, and usability.”
USDS said the software, if released into production, will negatively disrupt the physician workflow and reduce daily appointment capacity within the Veterans Health Administration (VHA). The report predicted glitches would lengthen each appointment by five to 10 minutes, the USDS team estimated, which equates to being able to treat 75,000 fewer veterans every day systemwide.
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Richard Stone, M.D., executive in charge at the VHA at the VA, said the VA will be ready to offer veterans community care by June 6. “Once it goes live, the tool will improve efficiency for veterans’ providers making referrals to help simplify decisions about community care eligibility. But the tool is not essential for implementing any new provisions of the Mission Act," Stone said. In the event that any technical challenge occurs, the VA can make eligibility decisions using existing and enhanced methods and tools, he said.
“I’m confident we will have the functionality by June 6 for the decision support tool,” Gfrerer, the VA’s CIO, said.
Rep. Julia Brownley, D-California, noted the VA does not have a great reputation when it comes to IT. "Do you believe you’re traveling down the right road and can meet the deadlines?"
"This is complex work," Stone said. "There are a lot of new requirements. Are we concerned? Yes. Do I think the decision support tool will make life easier? Yes. That said, the Choice Act expires on the 6th and we must go forward with Mission Act on June 6. I'm pleased that we got a third party to take a look at us. It was a chance to take a good, hard look at ourselves. I’m optimistic we’re going to get this done."