How DoD and VA solved a huge UX problem: Three dozen clicks to send an email

At DoD and VA’s first and only jointly-operated hospital, getting electronic health records to work well isn’t the only technical challenge. Until recently, basic things like email and file sharing were a huge headache too.

But DoD said it’s at least partly solved those problems at the James A. Lovell Federal Health Care Center, thanks to a recent pilot aimed at improving customer experience, and Defense officials see that project as a solid test case for how they might eventually bring better better user experiences to the rest of the department.

DoD and VA have gotten plenty of attention for the implementation challenges surrounding their EHRs, a saga that’s now stretched on for more than a decade. But at Lovell, IT users faced more fundamental problems. DoD and VA clinicians working side-by-side in the same facility had two different systems for almost everything.

“They couldn’t log into each other’s PCs — they had the DoD computer or the VA computer, people like National Guardsmen had multiple identities, so we forced them into a digital identity crisis whenever they came into work,” Jason Pickart, the director of integration planning in DoD’s user experience portfolio management office told attendees at AFCEA’s recent TechNet Cyber conference. “Which [cloud] tenant were they going to log into,  or were they going to log into both? Often they did. But ultimately, we wanted a consistent, stable and secure user experience.”

Like most users that are facing a cumbersome IT puzzle, people found workarounds. But they weren’t pretty. Prior to the UX improvement project, it took 35 separate clicks for a VA employee at the center to send an email to a DoD employee working in the same facility, and vice versa, Pickart said. If the email contained personal health information and needed to be encrypted, then even more clicks.

“Often they were things like work schedules, and sometimes they would literally print out a schedule, drive it over to the other side of the base, and would hand it over to somebody else so that they could bang it into their system,” he said. “Insane.”

Asking users what they want

DoD’s UX team knew it wasn’t going to completely eliminate the seams between two different federal agencies’ IT networks. So the Lean Six Sigma and UX experts working on the project decided they needed to start by asking users what they wanted — something they could measure. In this case, the answer was they wanted to be able to send an email with just two clicks, not 35.

“With this particular project, there wound up being a convergence of these communities. For Lean Six Sigma practitioners, we want to measure everything. When it comes to the UX community, often it’s about delighting the customer,” Pickart said. “Those of us who try to measure everything have no idea how to measure customer happiness, but we can, right? There are companies who do this. Yelp, for example — one to five stars for great service or great quality food. Those are measures of customer happiness. In this case, we approached customer satisfaction from a clickology perspective. How many clicks does it take for someone to do something?”

From there, the team broke processes like email into value stream maps, categorizing each of the steps as value-added, non-value-added, or non-value-added but still required by law. Armed with that information, they could figure out which steps could be eliminated — or at least made invisible to users.

Simplifying the complex in the background

And that’s the approach they settled on. The two departments’ email and business systems are still separate entities, but the work of tying them together now happens automatically in the background — not manually, on the part of users, every time someone wants to send an email.

“We ended up using a Microsoft capability called B2B, a capability which you can use in any of your tenants on Azure so that each tenant can recognize the others’ users as guests,” Pickart said. “So we created guest account access for each one of those tenants.”

Things got slightly more complicated from there, because of the different cloud security levels DoD and VA use for their email and collaboration systems. The Defense Health Agency keeps its Microsoft 365 tenant in a cloud environment classified at Impact Level 5 — the most protected level of non-secret data. VA’s systems, on the other hand, were the equivalent of Impact Level 2, which DoD considers completely unclassified.

But Pickart said the team overcame that mismatch by implementing a system of sensitivity labels that DoD employees could use to tag the specific data that truly needed IL-5 protection.

“That enabled the folks at DoD to identify data or document that was for DoD only — or specify that the data that was in the document was protected health information, but it was shareable with anybody in the clinical community,” he said. “That got our cybersecurity community over the hump when it came to VA users coming into the IL-5 tenant … And through these guest accounts, that meant each organization could use things like OneDrive, Microsoft Teams, they’d be able to chat with each other, send an instant message. They’re currently able to co-author and co-edit documents in Microsoft products — like if they’re creating a schedule in Excel, they’d be able to share that across their tenants very easily.”

The Lovell project predated the standup of DoD’s new customer experience unit, which the department created within the CIO’s office earlier this year.

Savan Kong, who leads that new organization, said the improvements at Lovell are evidence that it’s possible to make big CX changes in government, and he said his office is working on several others.

But he warned the department has a lot of work to do before it can make large-scale changes: The first steps are improving its IT governance, strategic planning, and performance analysis, all with CX in mind — work that’s currently underway in the CIO’s office.

“I feel like there’s many times where we jump the gun and we say, ‘This user experience is bad, how do we fix it?’ For an organization as big as the department, you can’t fix it by skipping all the steps that you need to take in order for you to effectively get to that point, especially if you want it to be sustainable, scalable, secure, and perform well,” Kong said. “So we like to think of [improved UX] as the result of all these things that we’re doing and the result of the things that we’re putting into place so that we can get to a great user experience.”

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