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.

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.

The Rest of The Story: The "Founding Founders"

    Today, the White House created a bit of a kerfuffle with a blog post entitled "The Papers of the Founding Founders Are Now Online".  No, that's not a typo of mine.  Here's the screenshot:

    After Charles C.W. Cooke of National Review raised the alarm, Twitchy got into the act. Sooner, Twitter was abuzz with the news.  Many assumed it was actually a case of political correctness gone meta.  Whatever the reason, it was not long before the adjustment was made, and the "Founding Fathers" resumed their rightful place in U.S. history.
    But there's more.  Unlike many of the current scandals (IRS, NSA, DOJ, AP, ETC.) where journalists, pundits, and bloggers have so far searched in vain for the smoking gun, the incontrovertible evidence of presidential fingerprints, this time is different.  The path of this scandal leads directly to the Oval Office, indeed to the lips of President Obama himself.  (OK, technically the path leads to Ford's Theatre, but "Oval Office" sounded more dramatic.  On June 7, 2010, the president spoke at an education and arts event at the famed theatre in Washington, and near the close of his remarks, according to the official White House transcript, he said the following [emphasis added for dramatic effect]:

And as we celebrate Independence Day, there are few better examples of how the spirit of our Founding Founders did more than just create a nation -- it inspired people in every corner of the globe yearning to be free.

     In a somewhat disappointing footnote to this story, the video of the actual event reveals that President Obama actually said "Founding Fathers," White House transcript notwithstanding.  Oh, well, Woodward and Bernstein's place in journalistic history is secure... for now.

Another IRS Scandal: Two ‘Sentenced for Unemployment Insurance Fraud’

    Congressional hearings over the last two weeks have been filled with stories of misconduct due to incompetence and inexperience among certain IRS employees.  Both Republicans and Democrats have leveled the accusations, and Internal Revenue officials testifying before Congress have admitted as much.  At the same time, all parties have stressed that the vast majority of IRS employees are hard-working, competent, and honest civil servants.

    This story isn't about them either.

    The Indiana Department of Workforce Development just announced the sentencing of two former IRS employees for unemployment insurance fraud.  Seven other former IRS employees have already been convicted and sentenced as a result of the investigation:

INDIANAPOLIS  – Over the past week two former United States Internal Revenue Service (IRS) employees have been sentenced for unemployment insurance fraud. Carmen Brown, also known as Carmen Smith, 41, of Indianapolis, and Terri Wardell, 48, of Fishers, both pled guilty to unemployment insurance fraud. The two filed for and received unemployment insurance benefits while working full-time for the IRS. Smith illegally received nearly $14,000 in benefits. Wardell fraudulently collected over $18,000... 

“It does not matter who you are or who you work for, we work diligently to make sure those who take funds they are not eligible for, are held accountable”, said Scott B. Sanders, Commissioner of the Indiana Department of Workforce Development. “These funds are for Hoosiers truly in need and we take our job safeguarding these funds very seriously.” 

    The IRS detected the original signs of fraud and reported the information to the DWD who then pursued the investigation resulting in these convictions.


Note: This article first appeared at The Weekly Standard.