VA Official Bragged About Agency's Scheduling System in 2013 Speech

   A report released this week by the inspector general for the Department of Veterans Affairs (VA) found that "inappropriate scheduling practices are systemic throughout VHA." But as recently as September 2013, Stephen Warren, the Executive in Charge for Information and Technology for the VA, said that he could not "pass up an opportunity to brag about how" VistA, the scheduling software in use for more than two decades by the VA, "plays a role in providing the quality care Veterans receive at VA."
    Warren made the remarks in his keynote address at the 2nd annual summit of the Open Source Electronic Health Record Alliance (OSEHRA):

I know I have already talked a lot about VistA, but I cannot in good [conscience] pass up an opportunity to brag about how it plays a role in providing the quality care Veterans receive at VA.  VistA at VA supports the care for over six million veterans, with 75 million outpatient visits and 680,000 inpatient admissions at more than 1,500 sites of care, including: 152 hospitals, 965 outpatient clinics, 133 community living centers, and 293 Vet Centers. 

These facilities are run by over 244,000 employees including more than 20,000 physicians and 53,000 nurses and have affiliations with more than 1,200 educational institutions where more than 100,000 health care students receive clinical training from VA each year.

    Warren spoke about VistA Evolution, the VA's current effort to use "open source" software innovations to improve the scheduling and other aspects of the care provided to veterans by the VA. (The VA recently awarded $3 million in prizes in a contest for medical appointment scheduling applications.) An April 2014 presentation by the VA spells out the VistA Evolution concept in great detail, including this timetable for its development and implementation:

    The presentation borrowed from the popular comic strip Dilbert to make the point about the challenges faced in upgrading the information systems:

    Warren addressed the VA's ambitious plans for VistA evolution at the OSEHRA summit:

VistA Evolution will improve patient-centered care and provide Veterans access to a comprehensive medical profile that supports the transition of care between VA and DOD treatment facilities.  

One of VA’s top priorities is increasing access to care for our nation’s Veterans.  VistA is a prime example of how Open Source is helping to develop and deliver an evolved version to meet that priority.  The fundamental purpose of VA’s Open Source initiative was to accelerate the evolution of VistA.  While VistA provides an integrated view of a patient and VA clinicians love it, we were not keeping up with the demands of our customers, the clinician.. 

The ultimate goal of this Open Source effort is to standardize 133 production VistA instances in support of the VA’s medical centers and clinics and is expected to be complete at all VA sites by the end of 2015.

    The VA's previous effort to upgrade its systems ran for nine years, from 2000 to 2009, and cost $127 million, but in the end did not deliver and was scrapped.
    While the inspector general's report this week does not appear to be critical of VistA itself, it noted that "[d]uring our review at Phoenix HCS we determined that certain audit controls within Veterans Health Information Systems and Technology Architecture (VistA) were not enabled. This limited VHA and the OIG’s ability to determine whether any malicious manipulation of the VistA data occurred." The VA since turned VistA's audit controls.


Note: A version of this post first appeared at The Weekly Standard.

VA Spent $396K on Appointment Scheduling Software in 2013

    The Department of Veteran's Affairs (VA) posted three notices on fbo.gov in 2013 regarding its intent to purchase appointment scheduling software to correct problems with preparation and delivery of appointment notices to veterans for the VA's compensation and pension clinics. The set-aside contract for software was awarded on September 26, 2013 for $395,949 to Tridec Technologies, LLC, a Service Disabled Veteran Owned Small Business (SDVOSB) located in Dayton, Ohio. However, the contract award was not listed online at fbo.gov, the online government contracting website. According to an email response from the VA press office, the missing contract award notice was due to an oversight.
    The VA's compensation and pension clinics evaluate veterans for eligibility for disability claims, both physical- and mental-health related. The contract solicitation noted that the clinics "have a mandate to schedule and complete any examinations requested within 30 days." The VA faced several problems with the scheduling process as the documents accompanying the solicitation indicate:

• [T]he appointment letter mailing process is averaging 7-10 days for the Veteran to receive the information.

• There is a higher incidence of Veterans not showing for their appointments due to delays in notification. 

• [S]chedulers are currently unable to edit appointment letters in real time which results in pen & ink changes presenting an unprofessional appearance and increasing the opportunity for errors. 

• [M]ultiple appointments ... generate multiple letters which cannot be automatically consolidated.  
• Multiple appointments for different clinics that are under the same service line, print in alphabetical rather than chronological order.  This results in missed appointments as well since our Veterans look at the first appointment listed and assume it represents their arrival time.

    The VA also hoped that the quick turnaround time afforded by email would allow cancelled appointments to be refilled more quickly to cut down on unused time slots and more efficiently utilize the clinics. Regarding implementation, the VA said that "initially this program will be launched at multiple VA’s Compensation and Pension Clinics with the goal to transition to all VA Clinics nationally."
    As noted above, the VA press office informed THE WEEKLY STANDARD in response to an email inquiry that the "lack of post-award synopsis was an oversight". A response has not yet been received to a follow up email asking about the status of the software's implementation and if the VA has plans to expand use of the software beyond the compensation and pension clinics.
    The contract with Tridec Technologies covers twelve months, through September 2014. Tridec lists two contracts with the VA on its website, but neither of the two involve the scheduling software. Tridec has not responded to an inquiry regarding the software contract.


Note: A version of this post first appeared at The Weekly Standard.