The patient scheduling system used by the Department of Veterans Affairs dates back to the Vietnam War.
But this April the agency is rolling out a pilot program that officials hope will bring VA scheduling into the 21st century and veterans more quickly to medical care.
LaVerne Council, VA assistant secretary in the Office of Information and Technology and chief information officer, briefed members of Congress on the pilot program March 16, during an update on the overall cybersecurity and IT environment at VA.
“The current scheduling system is something from … probably from the ’60s,” Council said. “It’s an old dot-matrix screen that also doesn’t allow people to really know what they’re leading to. The VAR [Veteran Appointment Request App] and VSE [VistA Scheduling Enhancement] addresses this.”
Council told committee members that the update to VA’s current scheduling system, the Medical Appointment Scheduling System (MASS), has been put on hold until a determination is made on the success of VAR and VSE.
That announcement caught the ear of House Oversight and Government Reform Subcommittee on Information Technology Chairman Will Hurd (R-Texas).
“Why pursue this versus trying to get something off the shelf that you could possibly deploy a little bit sooner, especially if we had $624 million available for that?” he asked.
Council said when VA looked at what was needed, it was “pure scheduling” with a mobile capability. And the way the software team was best able to do that was to integrate through the department’s existing medical records system, VistA.
“MASS also includes a workflow and scheduling capability of rooms, so it was a much broader look and we wanted something for scheduling right away,” Council said. “Right now the VSE and VAR seem to meet the needs.”
During a hearing in early March, Council and Dr. David Shulkin, VA’s new undersecretary for health, called VistA’s future into question, as well as mentioned the possibility of postponing the MASS update.
“Our schedulers are in such desperate need of trying to meet veterans’ needs that we want to get them tools right now,” Shulkin said. “We don’t want to hold that up. If it turns out that VSE meets the majority of needs of our schedulers, probably the right decision is to not spend another $663 million on MASS. The pilot we’re doing right now is going to be very, very important for us to understand that.”
The pilot plans were met with cautious optimism by VA Office of Inspector General auditors who also testified at the hearing.
Brent Arronte, deputy assistant inspector general for audits and evaluations, said it was still too early to review the pilot system, though the OIG planned to do so in the future.
“What’s kind of longstanding that we have seen with VA is with IT they’re trying to centralize at the headquarters level. I think the field is not always acceptable of that centralization,” Arronte said. “So sometimes we see in our previous work, there’s a good plan, it looks good on paper, but getting out of the gate, getting it implemented, seem to be some of the issues historically.”
Michael Bowman, director of the OIG’s Information Technology and Security Audits Division, said that VA’s involvement in software development usually ends up as a “high-risk venture.”
“Some of the projects that we’ve looked at VA tends to go over budget on cost. They seem to not deliver the intended functionality so I think oversight of this project is essential, especially as it impacts veteran scheduling,” Bowman said. “VA just does not have a good history of delivering systems on time and within budget.”
Costly, risky and counterproductive
Aside from the scheduling pilot, Council shared with congressional members that VA had hired five senior leaders to the Office of Information and Technology and it would be adding another 11 in the next 3 months.
She said that for the first time, security efforts are fully funded — $370 million for fiscal 2016 and 2017 — and that VA was on track to close 30 percent of the 30 material weaknesses highlighted annually by auditors, by the end of calendar year 2016. She anticipated 100 percent closure by 2017.
But Arronte pointed out that in the past 3 years the OIG has made 69 recommendations to VA to improve its IT systems management and security, but as of this February, 57 of them remained open. Of those 57, about half of them are repeated or modified-repeated recommendations.
“For fiscal year 2016, VA estimates a total IT investment of $4.1 billion to fund information systems security, system development initiatives and system operations and maintenance,” Arronte said. “If not properly planned and managed, these IT investments can become costly, risky and counterproductive.”
The IG released its annual Federal Information Security Management Act (FISMA) report for fiscal 2015 and for a 17th straight year failed. The IG found “VA had not fixed approximately 9,500 outstanding system security risks in its corresponding Plans of Action and Milestones to improve its information security posture.”
The IG made 35 recommendations, including six new ones since the 2014 report.
VA to spend up to $690 million on new patient scheduling system