VA planning two RFPs to help fix patient scheduling problems

The first solicitation will address near-term fixes for the current application. The second one will look to commercial technology for a wholesale replacement o...

The Veterans Affairs Department will try to address one major aspect of its patient scheduling scandal by looking to industry for help. VA is planning two major acquisitions in the coming months to take advantage of the commercial technology it discovered during a scheduled application contest last fall.

Steph Warren, VA’s chief information officer and executive in charge of Information and Technology, said Tuesday at the Senate Homeland Security and Governmental Affairs subcommittee on Efficiency and Effectiveness of Federal Programs and the Federal Workforce hearing that the solicitations are part of a multitude of actions VA is taking to fix the scheduling problems.

Warren said the first acquisition will go through the T4 contract to improve the user and system interfaces of the existing scheduling application.

“The second one is the broader one. It’s the replacement of the existing scheduling system with commercial product. We have an industry day next week. And then at the end of the month, we will sit down and have one-on-one interviews for feedback in terms of that engagement, and then that acquisition will go out,” Warren said in an interview after the hearing. “We are looking at what are the right packages to use to put that bid out on the street. We are moving very aggressively, not only to make the improvements so we can relief to the folks on the line, but also to bring that commercial product in and interface it with the existing business system.”

Contest winners

He said VA’s desire to use a commercial scheduling technology will drive the acquisition path.

The agency already knows there are commercial applications that will meet its needs. VA launched a contest on the platform in January 2013, offering $3.05 million to software developers who could create new systems that schedule appointments in VA’s nationwide health system.

In October, VA awarded prizes to three teams.

Health e Time, developed by three companies — MedRed LLC, BT and VISTA Enterprise Network — won the $1.8 million first place award for its “open source, medical scheduling software package designed to integrate with and augment the functionality of Open Source VistA.”

VA said key features include a user-friendly graphical interface, support for multi-site appointment management and the integrated scheduling of ancillary resources and equipment.

Second place, and the $705,000 prize, went to Oroville H, which developed the OH Scheduler, an enterprisewide scheduling system built using state-of-the-art Web technology for VISTA.

Third place, and the $520,000 prize, went to HP Open Community Tea, developed by a team of four developers, which “enhances legacy VistA Scheduling through integration with other VistA packages requiring support, therefore reducing implementation risk. It contains a scheduling service oriented architecture (SOA) to establish an authoritative SOA service for cross-facility scheduling complexity, optimization and enterprise considerations. We have integrated commercial off the shelf (COTS) and open source software (OSS) products to provide functionality such as a scheduling engine and enterprise service bus (ESB).”

Warren said the contest serves two purposes as VA prepares these two new solicitations.

He said first, VA wanted to see if there were products already available that would meet its needs.

“The answer was yes. So we don’t have to build it ourselves, which was a major breakthrough for the organization,” Warren said. “The second piece was, in the process of doing the competes, we established and validated the data interfaces. So we know if we go with a commercial product, how do you hook it in. I’ll share with you one of the primary reasons a commercial product acquisition fails is because the interfaces fail. You don’t know what the connections are, and the costs go crazy.”

Playing in the sandbox

The contest also helped VA create test and development sites for vendors, otherwise known as sandboxes, where vendors can prove the concept. He said sandboxes help drive down the risks to the agency.

“We know what the standards are. We have the test routines. We have the automated test sequences, and we also have the sandboxes where we can do that,” Warren said. “That drives us to that outcome to bring in a commercial product to interface with that world-class VISTA system that we have today.”

Warren said he didn’t think VA could take the products that came from the contest and turn it into an acquisition.

“The acquisition is: A, the marketplace improved; b, we’ve shown we can do it. We have the tools in place to drive that risk down,” he said. “And we want to make sure the best can play. Too often folks pre-select to something they want, and we want to make sure that is not the behavior. We want to get the best commercial product that will fit to the standards the team is looking for.”

Warren said during the hearing he hopes the RFPs will be out by the end of the year.

This would be at least VA’s second attempt to create or buy a scheduling program.

It canceled the scheduling replacement system in 2009 after spending $160 million over eight years and not getting close to the functionality it expected.

The decision to end the program was part of VA’s decision to stop 45 IT systems that were over schedule, over budget or not delivering on their promises.

Warren said VA is learning from its past mistakes by taking a more agile approach to software development.

Warren said as of Tuesday, 80 percent of VA’s IT projects meet schedule, budget and functionality requirements. He said that’s up for the fourth year in a row, and increased from 30 percent four years ago.

The Government Accountability Office recently found VA was the only agency among the five it reviewed to meet all requirements under the Office of Management and Budget’s 2012 guidance for agile or incremental development.

DoD to release updated draft RFP

The subcommittee also wanted to hear from VA and the Defense Department on how they are working together to ensure each of their electronic health records system interoperate.

Chris Miller, the program executive officer for the Defense Department’s Healthcare Management System and acting director of the DoD-VA interagency program office, oversees the electronic health record effort. As DoD begins the acquisition phase of the program, Sen. Tammy Baldwin (D-Wis.) said she was concerned over the military’s plan not to ask vendors to demonstrate their technology for doctors and nurses.

“One of the things we are trying to do is make sure we build an evaluation process that is open, fair and transparent for all providers. So when you come to things like demonstrations, they potentially open up things that are difficult,” Miller said. “We are trying to work through how we can still gain the insight and get people the access they need without compromising the integrity of our acquisition. We are in the process of releasing an update to our RFP, a draft. But we are close this week to issuing one. It will have updates in those areas. We are trying to balance moving expeditiously with doing it right. And just so you are aware, we’ve had over 1,000 comments on our RFP to date, and we’ve addressed every single one of those, and we will continue to engage industry and learn, and provide feedback in those areas.”

Miller added the acquisition team includes contracting, legal and clinical experts to determine what is best for DoD, which is part of the reason DoD isn’t thinking as of now it needs a demonstration program.

He said DoD also is establishing a functional champion for the new electronic health record. He said Rear Adm. Raquel Bono, the Navy Medical Corps director of the National Capital Region Medical Directorate, is acting as the functional champion until a permanent one is named.


VA to offer more public details on paused projects

More problems with VA scheduling systems revealed

Agencies given how-to guide for modular, agile IT contracting

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