Veterans Affairs Spent $5K for 'Floor Cleaning' For Obama's Visit

    A year after news broke of the waiting list scandal at the Veterans Administration medical facility in Phoenix, AZ, President Obama finally visited the facility in March. And while they didn't quite roll out the red carpet for the president, they did clean the floors - and spent $5,000 to do it.
    A record of the contract is posted at the USASpending.gov website, and included in the details is the description "FLOOR CLEANING SERVICE FOR POTUS VISIT."

 
    The contract posting also indicates that "urgency" required a non-competitive contract award, and "only one source" was investigated to complete the work. News of the planned visit came out just days in advance of the president's trip.
    While at the Phoenix medical center, the president held a roundtable discussion where he heard from veterans, and also announced the formation of the MyVA Advisory Committee:

The MyVA Advisory Committee will advise the VA on additional ways the VA can work to improve customer service delivery and veterans’ outcomes. President Obama also charged the new committee with assessing what progress has already been made at the VA to improve veterans’ access to quality medical care.

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

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 Awarded $3M in Prizes in Appointment Scheduling App Contest in 2013

     In October 2013, as the nation was focused on the deeply flawed rollout of the Healthcare.gov Obamacare marketplace, the Department of Veterans Affairs (VA) awarded $3 million in prizes to three participants in the agency's Medical Appointment Scheduling Contest. The contest was announced in 2012 to help the VA make the move to a more modern and flexible scheduling system:

VA’s current Medical Scheduling Package (MSP) is a component of VistA; it’s legacy electronic health record (EHR) system. The MSP not only makes appointments for clinicians, but also captures data that allows VA to measure, manage, and improve efficiency and access to care. However, VA’s current MSP is more than 25 years old. It neither meets current requirements, nor does it provide the flexibility needed to adapt for future needs[.]

    A press release from the contest winner MedRed noted that the:

VA started to develop a Medical Scheduling Package replacement in 2000. This effort was not successful.  When VA ended the project in 2009, none of the planned capabilities were delivered. It had cost more than $127 million.

    The prize-winning app, Health e-Time, was developed in about two and a half months according to MedRed's CEO William Smith, and was actually a collaboration between MedRed, telecom company BT and the VISTA Expertise Network, who will all split a $1.8 million first prize.
    According to GovernmentHealthIT, the Health e-Time application "offers veterans the ability to schedule visits online across VA locations and gives VA providers the ability to share appointments with veterans’ personal digital calendars and with other non-VA providers.
    Just this past week, CalConnect, a calendering and scheduling consortium, held a "Workshop on VA Scheduling System" at its conference in Dulles, VA, and William Smith of MedRed addressed attendees about the contest and his company's winning entry Health e-Time. Smith has previously described Health e-Time as "an open-source solution that could seamlessly integrate with VistA, the VA’s Electronic Health Record system."
    Second and third place prizes were awarded for the contest as well, earning $705,000 and $512,000 respectively. There were a total of forty-one entries submitted.


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

Presidential Memo Expands the Definition of "Federal Law Enforcement Agencies"

    As part of the president's 23 "executive actions" on gun violence, a presidential memo was issued regarding firearms tracing in connection with criminal investigations.  The memo instructs that:

Federal law enforcement agencies shall ensure that all firearms recovered after the date of this memorandum in the course of criminal investigations and taken into Federal custody are traced through ATF at the earliest time practicable. Federal law enforcement agencies, as well as other executive departments and agencies, are encouraged, to the extent practicable, to take steps to ensure that firearms recovered prior to the date of this memorandum in the course of criminal investigations and taken into Federal custody are traced through ATF.

    However, another provision defines which agencies are included in "Federal law enforcement agencies":

(e) For purposes of this memorandum, "Federal law enforcement agencies" means the Departments of State, the Treasury, Defense, Justice, the Interior, Agriculture, Energy, Veterans Affairs, and Homeland Security, and such other agencies and offices that regularly recover firearms in the course of their criminal investigations as the President may designate.

     This is a pretty sweeping definition compared to the Justice Department's definition:

A federal law enforcement agency is an organizational unit, or subunit, of the federal government with the principle functions of prevention, detection, and investigation of crime and the apprehension of alleged offenders.  Examples of federal law enforcement agencies include the U.S. Customs and Border Protection, Federal Bureau of Investigation (FBI), the Secret Service, and the Bureau of Alcohol, Tobacco and Firearms (ATF). 

     Since the memo also addressed "other executive departments and agencies," it is unclear what this partial deputizing of other agencies as "law enforcement" means.  Perhaps further examination of other executive actions on gun violence will make this more clear.