Keeping a promise its CIO made a week earlier, the Department of Veterans Affairs released a request for proposals on Wednesday to build a new patient scheduling system — an endeavor that could cost up to $690 million over seven years.
The current Medical Appointment Scheduling System (MASS) has been up and running since 1985, and its shortcomings came to the fore most recently in the department’s scandal over manipulated patient waiting times in Phoenix and elsewhere.
To replace it, VA plans to award an indefinite delivery/indefinite quantity contract to a vendor by next spring, and bids are due on Jan. 9. The department plans to make the ID/IQ award by next spring for a period of five-years plus two option years. From there, VA plans to award the actual work via firm-fixed price or time and materials task orders as it deploys the new system into all of its clinics in the U.S. and Philippines.
For the scheduling system itself, VA wants to buy an existing commercial-off- the-shelf product, confident that the existing health IT market can deliver something that more than suits its needs. The toughest work will involve integrating that COTS product with the department’s existing medical records system, VistA.
And Wednesday’s solicitation offers vendors some insight into the complexity of that task. Even though the existing scheduling system relies heavily on manual processes and doesn’t exchange information with the systems VA says it needs to, it nonetheless depends on a complex set of data interfaces: 71 of VistA’s applications depend on the scheduling system and 31 of the MASS’ packages depend on VistA, making for a total of more than 1,000 separate data interfaces that will need to be built and maintained under the new system.
The department says it’s on an aggressive schedule: It wants “core capabilities” of the new MASS to be fully deployed across the Veterans Health Administration within the next two years. “Non-core” capabilities would be rolled out in increments throughout the rest of the contract.
As for the award process, VA is planning two phases: vendors will first have to submit written proposals, and those that the department deems acceptable with then head into a final round in which they will demonstrate their systems to a team of evaluators, and the team will include members of VA’s existing scheduling staff.
“We are seeking vendors who will work closely with us and can meet our timeline,” Stephen Warren, VA’s chief information officer said in a statement Friday. “We are dedicated to finding the right partner to help us create and implement our modern scheduling system.”
In the meantime, the department says it’s rolling out some interim fixes to make the existing system more useful. In December, it plans to deploy a mobile application that will let veterans make primary care and mental health appointments from their smartphones. And in January, VA says it will update the existing MASS so that schedulers can see available appointments on an actual calendar rather than in a rolling stream of text across multiple screens.
But those short-term patches won’t fix some of the fundamental weaknesses of the aging system. As VA puts in in the RFP:
“In the current state, clinic grids are inflexible, productivity is not measurable, there is no method for scheduling resources (staff, rooms, equipment), and there are no links between scheduled appointments and ancillary appointments, i.e. lab and radiology. These broken links cause unnecessary bookings and re-bookings as well as increased travel costs and patient dissatisfaction with VHA scheduling practices.”