[Senate Hearing 111-894]
[From the U.S. Government Publishing Office]
S. Hrg. 111-894
VA'S IT PROGRAM: LOOKING AHEAD
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
OCTOBER 6, 2010
__________
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Lindsey O. Graham, South Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Roger F. Wicker, Mississippi
Jim Webb, Virginia Mike Johanns, Nebraska
Jon Tester, Montana Scott P. Brown, Massachusetts
Mark Begich, Alaska
Roland W. Burris, Illinois
Arlen Specter, Pennsylvania
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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Wednesday, October 6, 2010
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
Burr, Hon. Richard, Ranking Member, U.S. Senator from North
Carolina....................................................... 2
Johanns, Hon. Mike, U.S. Senator from Nebraska................... 3
Brown, Hon. Scott, U.S. Senator from Massachusetts............... 4
WITNESSES
Baker, Roger W., Assistant Secretary for Information and
Technology, U.S. Department of Veterans Affairs................ 4
Prepared statement........................................... 6
Enclosure................................................ 11
Meagher, Edward Francis, Chairman, VistA Modernization Committee
of the American Council for Technology Industry Advisory
Council and Vice President, Healthcare Strategy, North American
Public Sector, Computer Sciences Corporation................... 12
Prepared statement........................................... 14
ACT-IAC VistA Modernization Report........................... 16
Finn, Belinda J., Assistant Inspector General for Audits and
Evaluations, Office of Inspector General, U.S. Department of
Veterans Affairs............................................... 116
Prepared statement........................................... 118
Tullman, Glen, Chief Executive Officer, Allscripts............... 121
Prepared statement........................................... 123
Munnecke, Tom, Former Information Technology Official, U.S.
Department of Veterans Affairs................................. 125
Prepared statement........................................... 127
Appendix................................................. 130
VA'S IT PROGRAM: LOOKING AHEAD
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WEDNESDAY, OCTOBER 6, 2010
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 9:33 a.m., in
room 418, Russell Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
Present: Senators Akaka, Burr, Johanns, and Brown of
Massachusetts.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. This hearing of the United States Senate
Committee on Veterans' Affairs will come to order.
Today, the Committee examines VA's IT program with an eye
toward the future. I thank the Ranking Member, Senator Burr,
very much for his deep interest in this issue.
Many important VA benefits depend on information
technology, from the delivery of quality care to the processing
of education and disability claims, and to any effort to ensure
seamless transition from DOD to VA. While it is true that VA
has been a leader in adopting electronic health records, VA's
overall history with IT projects is far from perfect. VA has
stumbled over the years on its path toward the goal of an
electronic VA.
More recently, we had a financial and logistics system fail
known as CoreFLS. To make matters worse, the contractor was
paid a bonus. Software systems processing G.I. Bill claims
suffered many false starts. And last summer, VA halted 45
projects that were dramatically over budget and overdue,
including an outpatient scheduling system that was 3 years
overdue.
I do not wish to dwell in the past. We must, however, learn
from these mistakes and take action to avert them in the
future.
The administration has made it a priority to improve the
delivery of veterans' benefits through technology. With
appropriate technologies VA will more efficiently serve
veterans by reducing the time it takes to process benefits.
Moving forward, VA must clearly articulate a vision for its IT
program. VA's day-to-day management must reflect this vision,
and the lines of communication that compel IT development must
remain open between VA leadership and users.
Every VA medical facility across the Nation must operate
with a fully electronic medical record. The Lifetime Electronic
Record also needs to become a reality. G.I. Bill processing
software needs to be good enough to allow veterans, the
schools, and VA to access and file claims in hours instead of
weeks. And we must be in line to eventually replace the paper-
centric disability claims process with an electronic business
solution.
This hearing is one effort among many to carry out
oversight of IT. Again, I welcome everyone to today's hearing.
I look forward to the testimony from our panel and to
continuing work with the many interested parties as we seek to
ensure VA is on the right track.
Let me call on our Ranking Member, Senator Burr, for his
statement.
STATEMENT OF HON. RICHARD BURR, RANKING MEMBER,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Aloha, Mr. Chairman.
Chairman Akaka. Aloha.
Senator Burr. Welcome to our witnesses.
Mr. Chairman, I thank you for your willingness to schedule
this hearing even though the Senate is out of session. I want
to thank my colleagues, Senator Johanns and Senator Brown, for
being here.
Mr. Chairman, seldom do we have a witness that you and I
share from the standpoint of their State presence, but I would
like to welcome Glen Tullman, the CEO of Allscripts. They have
a presence in 15 States. I am proud to tell you two of those
are Hawaii and North Carolina, so it is appropriate that we
would have him here today and I want to thank him for taking
time out of his busy schedule to discuss the company's
experience with electronic health records and interoperability
in the private sector.
We are here to discuss an integral tool of VA's mission,
the use of technology to deliver effective benefits and
services to the American veterans. Within VA, the Office of
Information and Technology is responsible for the management
and oversight of VA's information technology assets. With a
budget of over $3 billion and a mission so important to the
successful delivery of services to veterans, Congressional
oversight and involvement is critical.
Today, we take a step toward strengthening the partnership
between this Committee and the Office of Information and
Technology in addressing the challenges confronting VA's
effective management of its IT assets. We have seen a number of
IT projects important to VA's mission fail and others
discontinued over the last decade. These failures and
discontinuations have cost taxpayers hundreds of millions of
dollars. Despite continued warnings from the IG, GAO, and
Members of Congress, problems delivering useful IT projects on
time and on budget persist at VA. At times, these failures have
left me wondering whether or not VA has the capability to
deliver IT programs of significance on time, on budget, and
within specifications.
However, since Mr. Baker's appointment at VA 16 months ago,
there seems to be a genuine effort to overhaul this portion of
VA's operations. The installation of the Project Management
Accountability System by the Assistant Secretary appears to be
a strong first step in reigning in out of control and oversized
contracts and projects. I look forward to hearing Mr. Baker's
assessments about how PMAS has affected the culture at the VA.
With today's modern technology, there are several IT
capabilities that are expected from companies and health
networks doing business across the country. These include the
ability to process claims, schedule appointments, conduct real-
time accounting, and share information seamlessly with other
partners. Unfortunately, these are all areas where VA continues
to struggle, oftentimes producing not a single result that was
desired at the outset of the program.
One example of this is their proposed scheduling program
that took 9 years, $127 million to produce nothing. VA still
needs a new scheduling program in order to improve patient
health care delivery at each VA facility.
The cancellation of the proposed accounting system is also
concerning. Although this decision should be applauded as a
sign that the VA is moving away from bloated and oversized
projects and contracts, let me state that the inability to
identify expenditures in real time is hamstringing VA's
capability to know how much their cost of conducting business
really is.
Interoperability with DOD is another area that continues to
need improvement. As witnesses will testify, the capability to
share information across systems is available, but to date, it
appears that even though there has been nominal success by VA,
we are far from where we need to be.
I look forward to hearing specifically where VA currently
stands with regard to having the appropriate technological
capabilities to deliver veterans the time-sensitive services
that they have earned, and more importantly, they deserve.
Again, I thank you, Mr. Chairman. I thank our witnesses.
Chairman Akaka. Thank you very much, Senator Burr.
Now we will have the opening statement from Senator
Johanns.
STATEMENT OF HON. MIKE JOHANNS,
U.S. SENATOR FROM NEBRASKA
Senator Johanns. Mr. Chairman and Ranking Member, thank you
very much for putting this hearing together and welcome to the
witnesses.
As I was listening to the Chairman and Ranking Member
speak, I thought back to my days as Secretary of Agriculture,
and I have to tell you, IT systems were the bane of my
existence. [Laughter.]
So I start out telling you that because I think I
understand what you are going through here.
This is not a good history. There is just no way of getting
around it. It is frustrating to me as it is to you, I am sure,
that projects come in over budget; that after working on a
project and spending enormous amounts of money, the project is
abandoned.
The other thing that is a little harder to quantify but is
enormously real is the amount of staff time that is invested.
Again, that is just very, very difficult to quantify, but those
staff members who are committing their time to a project are
not doing other things, and so they are constantly playing
catch-up.
So, I think this hearing is enormously important. I will
say this, Secretary Baker, I do think you are trying to get on
top of this and I think you are trying to move in the right
direction. My hope for today's hearing is that we get an honest
assessment from all the witnesses as to where we are at to
date, and although it is never pleasant to talk about the
problems that are out there that you know are going to end up
on our desk and then your desk, I would like to hear some
thoughts about where we are as we head toward the future here.
So, Mr. Chairman and Ranking Member, thanks for pulling
this hearing together. I look forward to the testimony.
Chairman Akaka. Thank you very much, Senator Johanns.
Now we will have the opening statement of Senator Brown of
Massachusetts.
STATEMENT OF HON. SCOTT BROWN,
U.S. SENATOR FROM MASSACHUSETTS
Senator Brown of Massachusetts. Thank you, Mr. Chairman. I
concur with the opening statements of the Ranking Member,
Senator Johanns, and yourself: I am here to learn and to see
what tools and resources we can either provide or are needed to
do your job better for the folks that need your help. So thank
you.
Chairman Akaka. Thank you very much, Senator Brown.
I want to welcome the witnesses on today's panel. In the
interest of opening a dialog amongst our witnesses, we have
only one panel.
First, we have the Honorable Roger Baker, Assistant
Secretary for Information and Technology at the Department of
Veterans Affairs.
We have Belinda Finn, Assistant Inspector General for
Audits and Evaluations, Office of Inspector General for the
Department of Veterans Affairs. Ms. Finn is accompanied today
by Mario Carbone, Director of the Dallas Office of Audits and
Evaluations.
We also have Ed Meagher, Vice President of Healthcare
Strategy for the Computer Science Corporation.
We have Tom Munnecke, a former VA IT official.
Finally, we have Glen Tullman, Chief Executive Office of
Allscripts.
I thank you all for being here this morning. Your testimony
will appear in the record.
Mr. Baker, you are now recognized for 5 minutes.
STATEMENT OF ROGER W. BAKER, ASSISTANT SECRETARY FOR
INFORMATION AND TECHNOLOGY, U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Baker. Well, thank you, Chairman Akaka, Ranking Member
Burr, Members of the Committee. It is indeed a pleasure to
appear in front of you again to discuss the state of VA's
Office of Information and Technology.
Sixteen months ago the Members of this Committee confirmed
me as President Obama's choice for Assistant Secretary for
Information and Technology. At that time, you made it clear
that you understood the significant challenges VA faces with
information technology. I have appreciated your insights and
your support over the last 16 months as we have worked to
address those challenges.
As my written testimony goes into much more detail, we have
aggressively dealt with the largest issues facing IT at VA.
First, Senator Burr, as you noted, we introduced the Program
Management Accountability System, which has already had a
dramatic impact in transforming the results of our development
organization. Today, VA hits its system development milestones
80 percent of the time, a rate that nearly every CIO, public or
private sector, would envy. We achieved this transformation by
forcing projects to deliver functionality in small increments
and communicating a schedule adherence in the organization.
During 2010, we generated over $200 million of cost avoidance
in our development organization by stopping or reforming poorly
performing projects, money we have asked to reprogram to other
uses to benefit veterans.
Second, in information security we have achieved our goal
of having visibility to every desktop computer in the
organization--as of yesterday, that is 310,722 of them--by
September 30. What this means is that we can begin dealing with
IT security holes in our infrastructure based on objective
metrics and factual observations, not anecdotal incidents.
Third, we are now publishing metrics from across our
operations organization to measure our operational excellence.
At an enterprise level, our metrics show that our key systems
are highly available. For example, our VistA systems across the
country average 99.95 percent availability. We also know that
customer support is a local experience so we are focused on
measuring and publishing metrics on customer experience and
customer satisfaction at an individual facility level.
Fourth, we once again have established for fiscal year 2011
a prioritized operating plan that will guide our decisions
about where to invest our resources during the year. The intent
of this is to give us clear visibility from plan to budget to
spend to results, on every one of those more than $3 billion in
our appropriation.
My written testimony also highlights several notable
product delivery successes, deliveries that are tangible
results of our disciplined approach to managing IT, including
the new G.I. Bill Long Term Solution, Pharmacy Re-Engineering,
and the Virtual Lifetime Electronic Record. These systems are
already having an impact on the quality of care and the speed
of benefits for our Nation's veterans.
While I am proud of the accomplishments of the VA IT
organization over the last 16 months, I recognize that much
more work remains to be done. As the only department-level
consolidated IT organization in the Federal Government, I
believe that VA IT must strive to be a leader both inside and
outside of government. The Office of Information and Technology
has made substantial strides forward and is well on its way
toward achieving this goal. Indeed, in a number of areas, VA
has blazed a trail of innovation that the rest of the
government is beginning to follow.
Looking forward, we must use our new and disciplined
management approaches to help us deliver improved IT systems
that will have a direct impact on veterans, including the new
Veterans Benefits Management System that will aid the Veterans
Benefits Administration in achieving the Secretary's goal of
``breaking the back of the backlog.'' We must deliver the
Virtual Lifetime Electronic Records Initiative, ensuring that
all providers of services to veterans have ready access to the
information they need to provide quick and effective services.
We must deliver on the IT projects essential to the other
14 major initiatives, including ending veterans' homelessness
and improving access to care, that will promote the
transformation of VA as envisioned by Secretary Shinseki. And
we must create an open source model for the VistA Electronic
Health Record System, bringing back the innovation that made
VistA the best Electronic Health Record System in the country.
Mr. Chairman, while we have made significant improvements
and had many successes over the last 16 months, as we look
forward, I think it best to look back to the words of my
confirmation testimony, and that is that there is no easy path,
no simple answer, and no short-cut solution to creating a
strong IT capability at VA. Achieving this will require hard
work, disciplined management, and honest communications.
Thank you, Mr. Chairman, Ranking Member Burr, and Members
of this Committee for your continued support of veterans, their
families and their survivors, of the VA, and specifically of
our efforts to transform VA IT. I am prepared to answer any
questions you might have at this point. Thank you.
[The prepared statement of Mr. Baker follows:]
Prepared Statement of Roger W. Baker, Assistant Secretary for
Information and Technology, U.S. Department of Veterans Affairs
Thank you Chairman Akaka, Ranking Member Burr, and Members of the
Committee. It is indeed a pleasure to appear in front of you again to
discuss the state of VA's Office of Information and Technology. My
testimony will address the current status of the Department's major
Information and Technology (IT) transformation initiatives as well as
our future plans.
Sixteen months ago, the Members of this Committee confirmed me as
President Obama's choice for Assistant Secretary of Information and
Technology. During our pre-hearing discussions, you made it clear that
you understood the significant challenges VA faced with information
technology. I have appreciated your insights and support over the last
16 months to bring VA's technology into the 21st century.
Under this Administration, the Office of Information and Technology
has made substantial strides forward, and is well on its way toward
achieving the goal of being the best IT organization in the Federal
Government, and comparable to many well-run private sector IT
organizations. Indeed, in a number of areas VA has blazed a trail of
innovation that the rest of government is beginning to follow. I would
like to hit the high points of the last 16 months for you.
Customer Service:
The most dramatic change at VA has been in the relationship between
OI&T and the Administrations (Veterans Health, Veterans Benefits, and
National Cemeteries). With the Under Secretaries, and with the
continuous support of Secretary Shinseki, we have set a tone of
cooperation that has made it possible for us to effectively address
many difficult problems at the second largest agency in the Federal
Government. As an example, the successful delivery of the new GI Bill
long-term processing solution, discussed in detail later in my
testimony, was clearly an intense cooperative venture between OI&T and
the Veterans Benefits Administration (VBA). Whenever asked by the
Secretary about an issue or a success regarding the GI Bill, our team's
answer consistently starts with ``we.'' We built the system as a team,
and we delivered the system as a team and that relationship is the
single largest contributing factor to what is, for VA, a stunning
victory and reversal of past practices--the successful installation of
the GI Bill system on schedule in March of this year, and the complete
conversion of all GI Bill processing to this system next August.
Thanks to Robert Petzel, M.D., Under Secretary for Health, Mr.
Michael Walcoff, Acting Under Secretary for Benefits, and Mr. Steve
Muro, Acting Under Secretary for Memorial Affairs, that same
cooperative approach has spread throughout VA and continues to thrive.
Together, we are ensuring that our staffs ``get the message'' that only
by working together can we solve problems and not point fingers.
Program Management Accountability System:
In June of last year, after dealing with the failure of the
Replacement Scheduling Application (RSA), this administration
introduced the Program Management Accountability System, or PMAS. Soon
after, we stopped 45 ongoing and failing IT projects and, after
analysis, canceled 12 and re-formed the other 33 to meet the strict
requirements of PMAS. Our actions on those 45 projects generated $54
million in cost avoidance in 2010, allowing us to put those dollars to
use on other critical investments to serve America's Veterans, their
families and survivors. More importantly, we substantially decreased
the risk of failure in the 33 projects that were re-planned and re-
formed.
Under PMAS, all projects must deliver customer-facing functionality
every 6 months (or less) without exception. This rapid delivery
approach, with names such as Incremental or Agile development, is
already used extensively throughout the private sector, where they
cannot afford to waste millions on IT projects that never deliver. For
VA, we combined rapid delivery with a management methodology that
enforces strict adherence to project milestones.
The level of culture change accomplished within the VA IT
development area over the last year simply cannot be understated. In
March of this year, it became VA policy that all systems development
projects would be managed under PMAS. Over 2,500 development staff,
employees and contractors, now focus on making committed schedule dates
as paramount, and break down all projects into deliverables that can be
accomplished in less than 6 months. The measurable results are
dramatic.
Last year, approximately 283 development projects at VA met their
milestone dates an estimated 30 percent of the time. I say estimated
because we have no real way of knowing, as IT development projects
simply weren't tracked to their committed dates prior to PMAS. Today,
VA has 97 active development projects, tracked in real-time through a
project database and dashboard--they are meeting their milestone dates
over 80 percent of the time. I know of no other Chief Information
Officer (CIO), government or private sector, who has this level of
insight into such a large portfolio of development projects. I can
assure you, however, that most IT development organizations, public or
private sector, would be ecstatic with meeting 80 percent of their
committed milestones.
In 2010, VA had a cost avoidance of nearly $200 million by
eliminating poorly performing projects and restructuring many others to
lower risk, reduce spend rates, and incremental development plans.
Information Security:
As you are aware, the VA IT enterprise is massive, with 153
hospitals, 853 community-based outpatient clinics (CBOC), 57 benefits
processing offices, and 131 cemeteries and 33 soldier's lots and
monument sites on a single, consolidated network. Our mission requires
that we hold Personally Identifiable Information and Personal Health
Information on approximately 26 million Veterans, and that we make that
information available quickly to health care providers and benefits
personnel who need it to provide the most effective services to
Veterans. Our network supports over 400,000 users, and over 700,000
devices.
To vastly improve our information security posture, this spring we
embarked on a project to provide visibility to every desktop on the
network by the end of the fiscal year. I am pleased to report that we
achieved that goal, thanks to a lot of hard work on the part of many
OI&T employees. By the end of the calendar year, we will also have
achieved full implementation of our medical device isolation
architecture, which is essential to mitigating security vulnerabilities
in our medical devices. Finally, we will achieve full visibility to
every device on our network during fiscal year 2011, putting us on par
with the best managed private sector organizations. Our ability to
provide immediate response to vulnerabilities and threats within our
enterprise, as well as enacting a proactive approach to centralized
monitoring, reporting, compliance validation and providing maximum
service availability, is quickly establishing VA as a model of
excellence for the rest of the Federal Government.
Operational Excellence:
I am proud to tell you that our operations organization provides
excellent service to our hospitals, benefits offices, and cemeteries. I
can tell you this because, starting in my first month at VA, we began
to measure and publish key metrics that tell us how we are doing. We
started at the core, measuring network availability (which averages
99.99 percent), Veterans Health Information Systems and Technology
Architecture (VistA) system availability (99.95 percent), and help desk
wait times. We have expanded these measurements to include a list of
nearly 167 metrics covering aspects of our network, our service
provision and our system/application provisioning that help us
understand what works well and what does not.
Along our customer service theme, we are now focusing on providing
metrics on how well we are doing at each individual VA facility. We
will soon begin reporting key IT support metrics at each VA facility,
allowing national operations staff to work more easily and more quickly
with the facility CIO and the facility director to identify and address
issues that cause poor support. We also recently introduced a program
to allow continuous monitoring of customer satisfaction at each
facility, measured in a way that lets us compare customer satisfaction
for our services versus those of similar private sector organizations.
We intend to continue to augment the reporting of metrics and automate
the collection of vital information thru the implementation of
Enterprise Management Framework (EMF). The ability to measure these key
processes and adjust accordingly is central to continuous operational
improvement--a hallmark of a mature operation. Customer satisfaction is
a local issue. In an enterprise the size of VA, it is not enough to
focus on the averages. We must work to identify and address issues that
affect local customer support and satisfaction, and to play our part in
ensuring that each Veteran receives the best services possible.
Financial Management:
Finally, we created a detailed financial plan for OI&T in both 2010
and 2011, known as the Prioritized Operating Plan. This plan has two
main purposes. First, it creates a vehicle for us to agree, with our
customers, on what the high priority IT services and projects are, and
allocate our resources to ensure success on the most important items.
It also allows us to communicate, clearly and objectively, which
projects and services will not be accomplished. Second, it allows us to
track our expenditures, from plan to budget to spend to results, and
know the business purpose for spending each dollar and then track the
results we expect to obtain from the expenditure.
project delivery highlights
I would like to take a moment to talk about three projects that
have been notable successes for VA IT over the last year.
New GI Bill Long Term Solution (LTS):
As I mentioned earlier, I'm pleased to report that VA has made
tremendous strides in delivering Post-9/11 GI Bill benefits in a timely
and accurate manner. We've also made significant progress in the
development and deployment of our new processing and payment system. As
a result of these significant strides, VBA recently reported that at
the end of August last year, VA had processed payments for only 8,185
students for the fall 2009 semester. For the current fall term, VA has
already processed payments for more than 135,000 students. The average
time to process an enrollment certification in August 2010, was 10
days, down from 28 days one year ago.
We delivered and deployed Release 1.0 of the long-term solution
(LTS) on schedule on March 31, 2010. In June and August 2010, we
successfully deployed Releases 2.0 and 2.1 of the LTS. Release 2.0
allowed the complete processing of all new claims under the LTS, while
Release 2.1 allowed the conversion of all previously processed records
from the ``Interim Solution'' to the LTS. Through these deployments, we
successfully converted over 500,000 Chapter 33 claimant records from
our interim processing system into the LTS and are paying over 600,000
claimants from the LTS. We also added greater functionality to that
originally planned for the LTS, adding functionality to include:
enabling payment of retroactive housing allowance adjustments to those
individuals eligible for the increased rates in 2010; automatically
generating letters to individuals to provide them better information on
their benefits; and facilitating claims processing for the Fry
Scholarship recipients. VA is now processing all Post-9/11 GI Bill
claims in this new system, thereby replacing the interim processing
system and its associated manual job aides.
Most importantly, the new system was installed, and record
conversion accomplished, with no significant errors. This meant that we
were able to achieve our primary goal, which was to have the LTS
installed in time to process fall semester claims without introducing
processing errors or delays that might affect claims processing. The
success of this roll-out is well above the industry norm.
While delivery of the LTS has been accomplished, functionality to
automate interfaces to other systems has been delayed. The interfaces
with the VA-ONCE system for certification of enrollment, and the
benefits delivery payment system, previously scheduled for
September 30, 2010, are now scheduled for October 30, 2010, and
December 31, 2010, respectively. These delays are due primarily to the
level of effort required to ensure that data conversion and basic
allowance for housing (BAH) retroactive payment calculations were
accomplished without introducing processing errors that would require
manual correction and thus impact fall benefit processing.
Pharmacy Re-Engineering:
Pharmacy Re-Engineering (PRE) was one of the original 45 projects
stopped in June 2009 under PMAS. At that time, PRE was a classic case
of a VA IT project that had been unable to deliver functionality to
customers over a period of many years. At the time it was stopped, PRE
had just announced another one year slip in its delivery schedule, and
management was not confident that no further slips would be
encountered.
In October 2009, we re-formed and re-started the project under an
incremental delivery project plan, with six increments originally
defined. I am pleased to report that Pharmacy Re-Engineering is now in
production in our Charleston, SC facility, and will soon move into beta
test at additional facilities.
PRE Increment 1 (Foundational Enhancements) reached Initial
Operating Capability (IOC) on October 23, 2009, a full 39 days ahead of
schedule. This release provides tools to allow sites to begin setup
required for Increments 3-4 and minor enhancements to the existing
pharmacy system.
PRE Increment 2 (Pharmacy Enterprise Customization System) reached
IOC as scheduled on March 5, 2010. This release provides tools to allow
customization of commercial software system data used for medication
order checking to better meet VA business practices.
PRE Increment 3 (Medication Order Check Healthcare Application--Non
Dosing) reached IOC on June 29, 2010. This release was delivered 28
days beyond its planned due date because of delays in dependent
projects and issues related to testing required before going live in a
hospital environment. Enhanced order checks included in this release
address a number of critical patient safety issues in legacy pharmacy
applications.
PRE Increment 4 (Medication Order Check Healthcare Application--
Dosing) reached IOC as scheduled on August 30, 2010. New maximum daily
dose, daily dose range, and dosing guidelines provide clinicians with
tools to reduce potential over- or under-dosing of prescribed
medications.
When fully deployed, PRE increments 1-4 are expected to reduce
accidental dosing errors (ADEs) by approximately 10 percent and will be
used by approximately 10,000 pharmacy employees in the processing of
108 million outpatient prescriptions and 15 million inpatient orders
annually. All of this will enhance the continued success of our Malcom
Baldridge Award-winning VA Pharmacy system.
vler
In April 2009, President Obama charged the Secretaries of Defense
and Veterans Affairs with creating a Virtual Lifetime Electronic Record
(VLER) to improve our ability to provide services to our Nation's
Servicemembers, Veterans, their families and their beneficiaries. We
have made substantial progress. Most visibly, we are now ``live'' in
two pilots of the Nationwide Health Information Network in San Diego,
CA and Hampton Roads in Norfolk, VA. This Nationwide Network is
critical to VLER in that it will provide access to private sector
records that are a large part of the lifetime of care received by
Servicemembers and Veterans.
We have also implemented a consolidated eBenefits portal where
Servicemembers and Veterans can access information on the benefits they
are receiving or may be due. The eBenefits portal will eventually be
the single point of entry for all benefits information. Perhaps most
importantly, the eBenefits portal effectively bridges the conversion
from active duty to Veteran status by allowing Servicemembers to retain
the same login information they had as an active duty participant. This
simple change is critical to the VLER concept.
Also critical to the VLER concept is the adoption by VA this summer
of the Department of Defense's (DOD) Electronic Data Interchange--
Personal Identifier, or EDI-PI, as the common identifier to be included
in all VA records. This ensures that, once authenticated, both VA's and
DOD's systems will have a shared, common way of identifying all records
about a single individual. Thanks to outstanding DOD cooperation, we
have also agreed that DOD will provide an EDI-PI for all individuals
seen by VA, even if they were not known to DOD when the Veteran served.
Looking Forward:
While I am proud of the accomplishments of the VA IT organization
over the last 16 months, I also recognize that much, much more work
remains to be done. As the only Department-level consolidated IT
organization, I believe that VA IT must strive to be a leader both
inside and outside of government. To that end, I would tell you what my
goals are for us in the coming years:
1. Deliver effectively and efficiently the new Veterans Benefits
Management System, aiding Veterans Benefits Administration in achieving
the Secretary's goal of ``breaking the back of the backlog.''
2. Achieve the Virtual Lifetime Electronic Records initiative.
3. Deliver the IT projects essential to the other 14 major
initiatives that will promote the transformation of VA as envisioned by
Secretary Shinseki.
4. Create an Open Source model for the VistA electronic health
record system, bringing back the innovation that made VistA the best
electronic health record system in the country.
5. Solidify and refine PMAS to ensure that VA IT development
projects continue to meet aggressive yet realistic customer delivery
milestones.
6. Leverage the ``visibility to the desktop'' initiative to ensure
compliance with critical information security policies throughout the
enterprise.
7. Continue to ensure VA IT transparency by publicly publishing
PMAS data, operational metrics, privacy breaches, and other management
information of interest to the public.
8. Increase internal customer satisfaction with VA IT services by
focusing on local support metrics and satisfaction.
9. Maintain the prioritized operating plan as the primary vehicle
for communicating with our internal customers on budget decisions.
10. Continue to implement IT infrastructure improvements that
increase our service levels and decrease cost.
conclusion
Mr. Chairman, while we have made many significant improvements and
had many successes over the last 16 months, we have only just begun
down the path that we must follow to achieve our ultimate goal of a
21st Century VA. I think it best to reiterate the words from my
confirmation testimony that are still quite true today: ``There is no
easy path, no simple answer, and no short-cut solution to creating a
strong IT capability at VA. Achieving this will require hard work,
disciplined management, and honest communications.'' Thank you Mr.
Chairman, Ranking Member Burr, and Members of this Committee for your
continued support: of Veterans, their families and survivors; of VA;
and of our efforts to transform VA IT. I am prepared to answer any
questions at this time.
Enclosure
Chairman Akaka. Thank you very much, Mr. Baker.
Now, we will accept the testimony of Mr. Meagher.
STATEMENT OF EDWARD FRANCIS MEAGHER, CHAIRMAN, VISTA
MODERNIZATION COMMITTEE OF THE AMERICAN COUNCIL FOR TECHNOLOGY
INDUSTRY ADVISORY COUNCIL AND VICE PRESIDENT, HEALTHCARE
STRATEGY, NORTH AMERICAN PUBLIC SECTOR, COMPUTER SCIENCES
CORPORATION
Mr. Meagher. Aloha, Chairman Akaka, Ranking Member Burr,
and Members of the Committee. I am honored to be here and I
thank you for the opportunity to appear before you today to
discuss the findings of the Industry Advisory Council's report,
``VistA Modernization Report: Legacy to Leadership,'' and as
you requested, to provide my views on current successes and
failures in VA IT and recommendations for success in the
future.
While discussing the VistA Modernization Report, I will be
representing the Industry Advisory Council. However, while
discussing any other issue, I will be representing myself only.
ACT-IAC is a unique nonprofit public-private partnership
dedicated to advancing the business of government through the
application of technology. The agenda is government-driven.
ACT-IAC provides an ethical forum for collaboration where
government and industry can create solutions for the most
pressing government IT issues and challenges. That forum is
objective and vendor and technology neutral. ACT-IAC also
provides education and training to build essential knowledge
and skills for government and industry professionals who want
to serve the IT community. The greatest value of ACT-IAC is in
its ability to deliver strategic insight and actionable
solutions to advance government's ability to serve citizens and
the Nation. Participation in the organization is open to any
member of the government IT community who shares our commitment
to advancing the business of government.
In September 2009, VA's Assistant Secretary Roger Baker
asked IAC to assess the issues, challenges, and opportunities
associated with modernizing the current legacy VistA system and
make recommendations to address these issues and challenges to
take advantage of the opportunities that are presented. At no
expense to the government, IAC formed a committee of senior
executives representing 42 of its over 500 member companies,
and I was asked to chair this committee.
We began a process of first educating ourselves about the
issues involved in modernizing a large, mission-critical legacy
system and then specifically looking at the current state of
VA's legacy VistA system. We looked at 24 alternative
approaches to modernizing, and after narrowing those to six
approaches, we examined those six in greater detail. In
addition to the alternative subcommittee, we created
subcommittees to explore and analyze options concerning
architecture, implementation models, deployment models,
governance, opportunities and impact, terms and definitions,
and finally, reports and presentations. We estimate that over
7,000 man hours over a 6-month period went into the preparation
and development of this report.
The committee operated on a consensus-based model, and we
are all very proud of the fact that the final report was
unanimously endorsed by all members of the committee. Our
recommendations can be summarized as two high-level strategic
recommendations and seven specific actionable recommendations
that describe programmatic next steps to implement our
strategic recommendations. We believe we successfully
negotiated the middle path such that our recommendations are
not overly prescriptive nor are they just simply well intended
generalizations. We believe we have recommended a sound,
realistic approach that, while challenging, has a high
probability of success and the potential to reaffirm VA's
position as the preeminent leader in health information systems
and electronic health records.
The two high-level strategic recommendations are: one, that
VA commit to and announce a plan to move to an open source,
open standards model for the reengineering of the next
generation of VistA. This action should be a strategic policy
for the VA. The working group recommended, second, that current
VistA applications be placed on an aggressive program of
stabilization with limited tactical upgrades and enhancements,
driven only by patient safety and other mandated requirements.
If implemented, these recommendations will put the VA on a
clear path to a future state where the next generation of VistA
will be developed and deployed in a comprehensive state-of-the-
art ecosystem that is more easily, robustly, and cost-
effectively maintained; that allows for growth and change that
encourages innovation; that promotes collaboration and
interoperability; and most importantly, facilitates the
delivery of the most advanced health care possible to the most
deserving of populations, our Nation's veterans.
The working group then made four specific recommendations.
So, based on their reputation for objectivity and sound
judgment, the VA reached out to the federally Funded Research
and Development Center community to rapidly tap into their
skills and knowledge base resources to rapidly design and build
a working model of the core ecosystem and to identify and
validate the best model for the governance and business
operation of this open source organization. Finally, FFRDC
should be used to provide the functional decomposition of the
current VistA application suite to deliver state-of-the-art
functional specifications.
Finally, we made three additional recommendations as to how
the VA should acquire the functionality in the new ecosystem
and manage the transition between legacy VistA and the new open
source-based VistA 2.0. I would ask that the Committee include
the entire ACT-IAC VistA Modernization Report as part of my
testimony.
[The report follows Mr. Meagher's prepared statement.]
Mr. Meagher. Now, speaking for myself exclusively as a
former VA Acting Assistant Secretary, Acting CIO, Deputy
Assistant Secretary, and also former Chief Technology Officer
over a 6-year period, I would offer this personal assessment of
the current VA IT environment. The centralization of all IT
functions, funding, and personnel under the leadership of the
CIO was and remains critical for the long-term success of IT at
the VA. While a transition from decentralized to centralized
management may have not gone smoothly, I believe that most of
the issues have been addressed by Mr. Baker and his team. He
has instituted a customer service orientation that puts the
needs and requirements of the veteran and the VA employee
serving the veteran first and foremost. It is important to
continue support for this centralized model.
Next, while there are literally dozens of high-priority IT
requirements that need to be addressed, I believe it is
critical that two of them be assigned the highest priority and
that critical resources, funding, and focus be applied to them
first and continuously. They are the modernization of VistA and
the movement of the benefit claim processing to an all-digital
fully computable system with the expeditious phasing out of
paper-based records and a minimalization of the use of imaging
of paper to only those situations where a digital computer
representation is not possible. The successful prosecution of
these two programs----
Chairman Akaka. Mr. Meagher----
Mr. Meagher [continuing]. Will yield the greatest
improvements.
Chairman Akaka. Please summarize your statement.
Mr. Meagher. Yes, sir. I would like to ask that the rest of
my comments be submitted for the record. Thank you, sir.
[The prepared statement of Mr. Meagher follows:]
Prepared Statement of Edward Francis Meagher, Chairman, VistA
Modernization, Committee of the American Council for Technology
Industry Advisory Council and Vice President, Healthcare Strategy CSC
Aloha Chairman Akaka, Ranking Member Burr, and Members of the
Committee: I am honored to be here and I thank you for the opportunity
to appear before you today to discuss the findings of the Industry
Advisory Council's report, ``VistA Modernization Report; Legacy to
Leadership'' and as you requested to provide my views on current
successes and failures in VA-IT and recommendations for success in the
future. While discussing the VistA Modernization Report I will be
representing the Industry Advisory Council. However, while discussing
any other issue I will be representing myself only. ACT-IAC is a unique
non-profit, public-private partnership dedicated to advancing the
business of government through the application of technology. The
agenda is government driven. ACT-IAC provides an ethical forum for
collaboration where government and industry can create solutions to the
most pressing government IT issues and challenges. That forum is
objective and vendor and technology neutral. ACT-IAC also provides
education and training to build essential knowledge and skills for
government and industry professionals who want to serve the IT
community. The greatest value of ACT-IAC is in its ability to deliver
strategic insight and actionable solutions to advance government's
ability to serve citizens and the Nation. Participation in the
organization is open to any member of the government IT community--
government or private sector--who shares our commitment to advancing
the business of government.
In September 2009, VA's Assistant Secretary for Information and
Technology, Roger Baker asked IAC, ``to assess the issues, challenges,
and opportunities associated with modernizing the current legacy VistA
system and make recommendations to address these issues and challenges
and take advantage of the opportunities presented. IAC formed a
committee of senior executives representing 42 of its over 500 member
companies and I was asked to chair this Committee. We began a process
of first educating ourselves about the issues involved in modernizing a
large, mission critical legacy system and then specifically looking at
the current state of VA's legacy VistA system. We looked at 24
alternative approaches to modernization and after narrowing those to 6
approaches we examined those 6 in greater detail. In addition to the
alternatives subcommittee we created subcommittees to explore and
analyze options concerning architecture, implementation models and
extensions, deployment models, governance, opportunities and impacts,
terms and definitions and finally reports and presentations. We
estimate that over 7000 man hours over a six month period went into the
preparation and development of this report. The Committee operated on a
consensus based model and we are all very proud of the fact that the
final report was unanimously endorsed by all Members of the Committee.
Our recommendations can be summarized as two high level strategic
recommendations and seven specific, actionable recommendations that
describe programmatic next steps to implement our strategic
recommendations. We believe we successfully negotiated a middle path
such that our recommendations are not overly prescriptive nor are they
well intended generalizations. We believe we have recommended a sound,
realistic approach that while challenging has a high probability of
success and the potential to reaffirm the VA's position as the
preeminent leader in health information systems and electronic health
records.
The two high level strategic recommendations are:
1. The working group recommends that the VA commit to and announce
a plan to move to an open source, open standards model for the
reengineering of the next generation of VistA (VistA 2.0). This action
should be a strategic policy for the VA.
2. The working group recommends that the current VistA application
be placed on an aggressive program of stabilization, with limited
tactical upgrades and enhancements driven only by patient safety and
other mandated requirements
If implemented these recommendations would put the VA on a clear
path to a future state where the next generation of VistA would be
developed and deployed in a comprehensive, state-of-the-art ecosystem
that is more easily, robustly, and cost effectively maintained; that
allows for growth and change; that encourages innovation; that promotes
collaboration and interoperability; and most importantly facilitates
the delivery of the most advanced healthcare possible to the most
deserving of populations, our nations veterans.
The working group then made four specific recommendations that the
VA reach out to federally Funded Research and Development Centers
(FFRDC) to tap into their skills and knowledge based resources to
rapidly design and build a working model of the core ecosystem and to
identify and validate the best model for the governance and business
operation of the Open Source organization that will operate this
ecosystem. Finally an FFRDC should be used to provide the functional
decomposition of the current VistA Application Suite to deliver state-
of-the-art:
functional and design specifications of current
application functionality
functional and design specifications for required
application functionality
functional and design specifications for additional
application functionality
Finally, we made three additional recommendations as to how the VA
should acquire the functionality in the new ecosystem and manage the
transition between legacy VistA and the new, Open source based VistA
2.0. I would ask that the Committee include the entire ACT-IAC Vista
Modernization Report as part of my testimony.
Speaking for myself, as a former VA Acting Assistant Secretary and
Acting CIO and Deputy Assistant Secretary and Deputy CIO as well as the
VA's former Chief Technology Officer over a six year period I would
offer this personal assessment of the current VA-IT environment. The
centralization of all IT functions, funding, and personnel under the
leadership of the CIO was and remains critical to the long term success
of IT at the VA. And while the transition from decentralized to
centralized management may not have been handled in the wisest, most
thoughtful manner in the past I believe most of the oversights and the
heavy handed approaches to operating within a centralized management
model have been addressed by Assistant Secretary Baker and his team. He
has instituted a customer service orientation that puts the needs and
requirements of the veteran and the VA employee serving the veteran
first and foremost. It is important to continue to support this
centralized model. Next, while there are literally dozens of high
priority IT requirements that need to be addressed I believe it is
critical that two of them be assigned the highest priority and critical
resources, funding, and focus be applied to them first and
continuously. They are the modernization of VistA and the movement of
all benefit claims processing to an all digital, fully computable
system with the expeditious phasing out of paper based records and the
minimalization of the use of the imaging of paper to only those
situations where a digital, computable representation is not possible.
The successful prosecution of these two programs will yield the
greatest improvements to VA healthcare and benefits delivery that will
allow the VA to deliver on Secretary Shinseki's promise to transform
the VA into a 21st century organization. Finally, I believe there must
be a practical, over arching vision established that describes how all
of this comes together and the long discussed but not yet realized goal
of ``One VA'' becomes a reality. This will require the setting aside of
traditional boundaries between VA healthcare and benefits delivery,
between VA and DOD, and ultimately between VA and all of the other
public and private sector entities that provide or could provide our
veterans with the best care possible. The modernization of VistA along
the lines our report recommends and the commitment to finally build and
operate an all digital, all computable benefits administration system
are critical, essential steps to achieving what we all want, a veteran
centric VA capable of delivering on our nations sacred commitment to
``care for him who shall have borne the battle and for his widow and
his orphan.''
Chairman Akaka. Thank you. It will be placed in the record.
Now we will receive the testimony of Ms. Finn.
STATEMENT OF BELINDA J. FINN, ASSISTANT INSPECTOR GENERAL FOR
AUDITS AND EVALUATIONS, OFFICE OF INSPECTOR GENERAL, U.S.
DEPARTMENT OF VETERANS AFFAIRS
Ms. Finn. Thank you, Mr. Chairman and Members of the
Committee. Thank you for the opportunity to discuss VA's
management of its information technology projects. Mr. Mario
Carbone, who is with me today, is responsible for several of
the audit reports I will be discussing.
The OIG has reported on the Department's management of its
IT projects over recent years. My testimony today will
summarize our work, highlight our insights regarding the IT
governance structure, and discuss some key themes that we see
reoccurring.
As part of our audit of VA's management of information
technology capital investments, we examined VA's realignment of
its IT program from a decentralized to a centralized management
structure. We reported that the ad hoc manner in which the
Office of Information and Technology, or OI&T, had managed the
realignment had resulted in an environment with inconsistent
management controls and inadequate oversight.
In September 2009, we reported that VA needed to manage its
major IT development projects in a more disciplined and
consistent manner. In general, we found that VA's processes
were adequate. However, OI&T had not always communicated,
complied with, or enforced its software development
requirements. Once again, we attributed these management lapses
to the centralization in an ad hoc manner.
Over the past 2 years, our audit work on several IT system
development projects has identified problems with inadequate
project and contract management, staffing shortages, and a lack
of guidance. These recurring themes have repeatedly hindered
OI&T's efforts to develop their systems.
For example, we have issued three reports on the Financial
and Logistics Integrated Technology Enterprise. This is
commonly known as FLITE. Our review of these programs concluded
that program managers were repeating problems from the failed
CoreFLS project. Specifically, the FLITE program managers did
not always take well-timed actions to ensure the achievement of
cost, schedule, and performance goals have sufficient staff in
critical areas or clearly define staff roles and
responsibilities; clearly define VA's training requirements for
the pilot project; effectively identify and manage all risk
associated with the Strategic Asset Management pilot project.
This was a key component of the FLITE system.
We recommended that VA establish stronger program
management controls to improve the deployment of the SAM pilot,
beta, and national projects. Specifically, we recommended that
the program establish controls to facilitate achieving cost,
schedule, and performance goals, as well as mitigating program
risk.
Finally, our audit of the Post-9/11 G.I. Bill Long Term
Solution reported that OI&T had developed and deployed both LTS
releases one and two on time. However, these releases did not
always meet the functionality that was expected for those
releases. We concluded that the program still needed more
management discipline and processes to ensure the project meets
both the performance and the cost goals required.
In conclusion, the Department historically has struggled to
manage IT development projects to successfully deliver desired
results within the cost and schedule constraints.
Mr. Chairman, thank you for the opportunity to be here
today. We would be pleased to answer any questions that you or
the other Members of the Committee may have.
[The prepared statement of Ms. Finn follows:]
Prepared Statement of Belinda J. Finn, Assistant Inspector General for
Audits and Evaluations, Office of Inspector General, U.S. Department of
Veterans Affairs
Mr. Chairman and Members of the Committee, thank you for the
opportunity to discuss the Office of Inspector General's (OIG) findings
regarding VA's management of its information technology (IT) projects.
I am accompanied today by Mr. Mario Carbone, Director, Dallas Office of
Audits and Evaluations, Office of Inspector General.
background
The use of IT is critical to VA providing a range of benefits and
services to veterans, from medical care to compensation and pensions.
If managed effectively, IT capital investments can significantly
enhance operations to support the delivery of VA benefits and services.
However, when VA does not properly plan and manage its IT
investments, they can become costly, risky, and counterproductive. As
we have reported, IT management at VA is a longstanding high-risk area.
Historically, VA has experienced significant challenges in managing its
IT investments, including cost overruns, schedule slippages,
performance problems, and in some cases, complete project failures.
Some of VA's most costly failures have involved management of major IT
system development projects awarded to contractor organizations.
My statement today focuses on the results of our audits of the
Department's management of its IT projects over recent years. In
summarizing this work, I will highlight initial insights regarding VA's
IT governance structure and process and discuss some key themes that
reoccur in VA's IT system developments.
it governance challenges
In 2009, we provided an overarching view of VA's structure and
process for IT investment management [Audit of VA's Management of
Information Technology Capital Investments (Report No. 08-02679-134,
May 29, 2009)]. As part of the audit, we examined VA's realignment of
its IT program from a decentralized to a centralized management
structure. The realignment was to provide greater accountability and
control over VA resources by centralizing IT operations under the
management of the Chief Information Officer (CIO) and standardizing
operations using new processes based on industry best practices--goals
that have only partially been fulfilled.
We reported that the ad hoc manner in which the Office of
Information and Technology (OI&T) managed the realignment inadvertently
resulted in an environment with inconsistent management controls and
inadequate oversight. Although we conducted this audit more than two
years after VA centralized its IT program, senior OI&T officials were
still working to develop policies and procedures needed to effectively
manage IT investments in a centralized environment. For example, OI&T
had not clearly defined the roles of IT governance boards responsible
for facilitating budget oversight and IT project management. OI&T also
had not established the governance board criteria needed to select,
review, and assess IT projects. OI&T does not expect to complete key
elements of these new critical processes until FY 2011.
Further, in September 2009, we reported that VA needed to better
manage its major IT development projects, valued at that time at over
$3.4 billion, in a more disciplined and consistent manner [Audit of
VA's System Development Life Cycle Process (Report No. 09-01239-232,
September 30, 2009)]. In general, we found that VA's System Development
Life Cycle (SDLC) processes were adequate and comparable to Federal
standards. However, OI&T did not communicate, comply with, or enforce
its mandatory software development requirements. OI&T did not ensure
that required independent milestone reviews of VA's IT projects were
conducted to identify and address system development and implementation
issues. Once again, we attributed these management lapses to OI&T
centralizing IT operations in an ad hoc manner, leaving little
assurance that VA was making appropriate investment decisions and best
use of available resources. Moreover, VA increased the risk that its IT
projects would not meet cost, schedule, and performance goals,
adversely affecting VA's ability to timely and adequately provide
veterans health services and benefits.
These audits demonstrated that OI&T needed to implement effective
centralized management controls over VA's IT investments. Specifically,
we recommended that OI&T develop and issue a directive that
communicated the mandatory requirements of VA's SDLC process across the
Department. We also recommended that OI&T implement controls to conduct
continuous monitoring and enforce disciplined performance and quality
reviews of the major programs and projects in VA's IT investment
portfolio. Although OI&T concurred with our recommendations and
provided acceptable plans of actions, OI&T's implementation of the
corrective actions is not yet complete.
project management shortfalls in recent years
Over the past two years, our audit work on several IT system
development projects has identified themes as to why VA has continued
to fall short in its IT project management. These issues include
inadequate project and contract management, staffing shortages, lack of
guidance, and poor risk management--issues that have repeatedly
hindered the success of IT major development projects undertaken by
OI&T.
VA's Replacement Scheduling Application (RSA)
In August 2009, we reported that the RSA project failed because of
ineffective planning and oversight [Review of the Award and
Administration of Task Orders Issued by the Department of Veterans
Affairs for the Replacement Scheduling Application Development Program
(Report No. 09-01926-207, August 26, 2009)]. RSA was a multi-year
project to replace the system the Veterans Health Administration used
to schedule medical appointments for VA patients. Lacking defined
requirements, an IT architecture, and a properly executed acquisition
plan, RSA was at significant risk of failure from the start. We
suggested that VA needed experienced personnel to plan and manage the
development and implementation of complex IT projects effectively. We
also suggested that a system to monitor and identify problems affecting
the progress of projects could support VA's leadership in making
effective and timely decisions to either redirect or terminate troubled
projects.
Financial and Logistics Integrated Technology Enterprise (FLITE)
In September 2005, VA began developing the FLITE program to address
the longstanding need for an integrated financial management system. As
a successor to the failed Core Financial and Logistics System
(CoreFLS), FLITE was a multi-year development effort comprised of three
components: an Integrated Financial Accounting System (IFAS), Strategic
Asset Management, and a Data Warehouse. FLITE was intended to provide
timely and accurate financial, logistics, and asset management
information. FLITE was also to resolve material weaknesses cited in the
annual financial statement audit by integrating multiple systems and
reducing manual accounting processes. In the past year, we issued three
reports identifying project management shortcomings that hindered VA's
efforts to accomplish the FLITE program's stated goals.
Audit of FLITE Program Management's Implementation of Lessons Learned
Our first report on FLITE determined that program managers did not
fully incorporate lessons learned from the failed CoreFLS program to
increase the probability of success in FLITE development [Audit of
FLITE Program Management's Implementation of Lessons Learned, (Report
No. 09-01467-216, September 16, 2009)]. We found deficiencies similar
to those identified in CoreFLS reviews also occurred within FLITE
because program managers had not implemented a systematic process to
address lessons learned. For example, critical FLITE program functions
were not fully staffed, non-FLITE expenditures were improperly funded
through the FLITE program, and contract awards did not comply with
competition requirements. We recommended that FLITE program managers
develop written procedures to manage and monitor lessons learned and
expedite actions to ensure full staffing of the FLITE program.
Audit of the FLITE Strategic Asset Management (SAM) Pilot Project
Our second report on the Strategic Asset Management (SAM) pilot
project disclosed that FLITE program managers did not take well-timed
actions to ensure VA achieved cost, schedule, and performance goals.
Further, the contractor did not provide acceptable deliverables in a
timely manner [Audit of the FLITE Strategic Asset Management Pilot
Project (Report No. 09-03861-238, September 14, 2010)]. Once again, we
identified instances where FLITE program managers could have avoided
mistakes by paying closer attention to lessons learned from the CoreFLS
effort.
Specifically, FLITE program managers:
Awarded a task order on April 21, 2009 to General Dynamics
for implementation of the SAM pilot project, even though the FLITE
program suffered from a known shortage of legacy system programmers
critical to integration efforts required to make FLITE a success.
Did not clearly define FLITE program and SAM pilot project
roles and responsibilities, resulting in confusion and unclear
communications between VA and General Dynamics. Contractor personnel
indicated that they received directions and guidance from multiple
sources. One of their biggest obstacles was trying to overcome the lack
of one clear voice for VA's FLITE program.
Did not ensure that the solicitation for the SAM pilot
project clearly described VA's requirements for SAM end-user training.
As such, VA contractually agreed to a training solution that did not
meet its expectations. General Dynamics subsequently revised its
training approach to meet VA's needs, but at a total cost of
$1,090,175, which was more than a 300 percent increase from the
original $244,451 training cost.
Did not always effectively identify and manage risks
associated with the SAM pilot project even though inadequate risk
management had also been a problem with the failed CoreFLS.
Specifically, FLITE program managers did not take steps early on to
ensure that the contractor participated in the risk management process
and that the Risk Control Review Board adequately mitigated risks
before closing them.
Because of such issues, at the time of our audit, VA was
considering extending the SAM pilot project by 17 months (from 12 to 29
months), potentially more than doubling the original contract cost of
$8 million. We recommended that VA establish stronger program
management controls to facilitate achieving cost, schedule, and
performance goals, as well as mitigating risks related to the
successful accomplishment of the SAM pilot project.
Review of Alleged Improper Program Management within the FLITE
Strategic Asset Management Pilot Project
This third report, in response to a hotline allegation, disclosed
that FLITE program managers needed to improve their overall management
of the SAM pilot project [Review of Alleged Improper Program Management
within the FLITE Strategic Asset Management Pilot Project, (Report No.
10-01374-237, September 7, 2010)]. FLITE program managers did not
develop written procedures that clearly defined roles and
responsibilities, provide timely guidance to program and contract
staff, or foster an effective working environment within the FLITE
program. FLITE program managers also did not ensure certain elements
considered necessary for a successful software development effort, such
as ``to be'' and architectural models were included as project
deliverables in the FLITE program. In general, we recommended that VA
strengthen project management controls to improve the SAM pilot, beta,
and national deployment projects.
New Office of Management and Budget (OMB) guidance on financial
systems IT projects, issued on June 28, 2010, also had a major impact
on the FLITE Program. OMB issued the guidance because large-scale
financial system modernization efforts undertaken by Federal agencies
have historically led to complex project management requirements that
are difficult to manage. Moreover, by the time the lengthy projects are
finished, they are technologically obsolete. Consequently, OMB directed
all Chief Financial Officer Act agencies immediately to halt the
issuance of new procurements for financial system projects until it
approves new project plans developed by the agencies. On July 12, 2010,
VA's Assistant Secretary for Information and Technology announced the
termination of IFAS and Data Warehouse portions of FLITE.
GI Bill Long Term Solution (LTS)
In September 2010, we reported that OI&T's plan for deployment of
the LTS was effective in part [Audit of VA's Implementation of the
Post-9/11 GI Bill Long Term Solution, (Report No. 10-00717-261,
September 30, 2010)]. LTS is a fully automated claims processing system
that utilizes a rules-based engine to process Post-9/11 GI Bill Chapter
33 veterans' education benefits.
OI&T developed and deployed both LTS Releases 1 and 2 on time.
Lacking the management discipline and processes necessary to control
performance and cost in project development, OI&T has relied upon
Project Management Accountability System (PMAS) to achieve project
scheduling goals. PMAS is VA's new IT management approach that focuses
on achieving schedule objectives while the scope of functionality
provided remains flexible. With this schedule-driven strategy, OI&T has
been able to satisfy users and incrementally move VA forward in
providing automated support for education benefits processing under the
Post-9/11 GI Bill.
However, OI&T's achievement of the timeframes for LTS Releases 1
and 2 required that VA sacrifice much of the system functionality
promised. Specifically, due to unanticipated complexities in developing
the system, OI&T deployed Release 1 as a ``pilot'' to approximately 16
claims examiners, with the functionality to handle only 15 percent of
the Chapter 33 education claims that VBA anticipated processing.
Release 2 caught up on the functionality postponed from Release 1,
while providing the capability to process 95 percent of all Chapter 33
education claims. However, due to data structure and quality issues
that still had to be overcome, users could not make use of all of the
functionality provided through Release 2 and were able to process only
30 percent of all Chapter 33 education claims. In addition to these
performance issues, OI&T did not have processes in place to track
actual LTS project costs.
In the absence of effective performance and cost controls, OI&T
runs the risk that future LTS releases may continue to meet schedule,
but at the expense of performance and cost project goals. We
recommended that OI&T improve LTS management by conducting periodic
independent reviews to help identify and address system development and
implementation issues as they arise. We also recommended that OI&T
adopt cost control processes and tools to ensure accountability for LTS
costs in accordance with Federal IT investment management requirements.
conclusion
VA continues to rely on IT advancements to provide better services
to our Nation's veterans. Historically, the department has struggled to
manage IT developments that successfully deliver desired results within
cost, schedule, and performance objectives. OI&T recently implemented
PMAS to strengthen IT project management and improve the rate of
success of VA's IT projects. Our oversight of the department's IT
initiatives should provide valuable information to VA and Congress as
the Department moves forward in managing its IT capital investments.
Mr. Chairman, this concludes my statement. I would be pleased to
answer any questions that you or other Members of the Committee may
have.
Chairman Akaka. Thank you very much, Ms. Finn.
Now we will accept the testimony of Mr. Tullman.
STATEMENT OF GLEN TULLMAN, CHIEF EXECUTIVE OFFICER, ALLSCRIPTS
Mr. Tullman. Thank you, Mr. Chairman, thank you, Ranking
Member Burr and other distinguished Members of the Committee.
Thank you for the opportunity to share our perspectives on the
use of health information technology within the Veterans
Affairs Administration and the best path forward.
My name is Glen Tullman and I serve as the Chief Executive
Officer of Allscripts. Allscripts is the largest provider of
health information technology software that physicians,
hospitals, and other caregivers use to manage care. We serve
more than 180,000 physicians, 1,500 hospitals, and more than
10,000 post-acute care facilities and home care agencies who
use Allscripts solutions to improve their clinical and business
operations, and importantly, to connect with each other to
provide care across health care stakeholders. Physicians and
other health care professionals who use our systems in the
civilian sector care for thousands of active duty and retired
military personnel, and we process almost 3.5 million TRICARE
claims each year.
In the 19 months since the passage of the HITECH Act, the
conversation about health care information technology has been
changed forever. It is my belief that we are at the beginning
of the single fastest transformation of a major industry in the
history of our country. Beyond the positive effect on hiring,
which in our case equates to more than 600 new jobs since ARRA
passed, new standards, certification, and the concept of
meaningful use combined with incentives have combined with
private sector ingenuity to create a new best of breed in
health care information technology platforms.
While the private sector has been moving forward in light
of these incentives, the government has been investing in their
own proprietary systems for many years. The VA system is made
up of some of the country's best physicians and has played a
critical role in demonstrating the value of technology,
specifically electronic medical records. There is no question
that VistA was a groundbreaking technology when it was first
developed. However, today, things are different. The military
is different. The care delivery model is different. And the
technology is different. All of this necessitates a change.
The military has evolved, and during the Iraq and
Afghanistan conflicts has drawn extensively from the civilian
ranks, namely the National Guard. That flexibility poses a new
requirement on electronic medical records. The ability to move
those records around the world and between civilian and
military systems is now a must, as compared with the past,
where treatment was delivered mostly inside of the military and
VA.
Just as the military has changed, so has the care delivery
model. We are saving more wounded warriors. Military and VA
providers are relying on advanced technologies and newly
designed collaborative care models. Then, once home, many of
our wounded soldiers are living examples of the fact that it is
not just the surgery, but the rehabilitation that is critical.
Complex patients require teams of physicians to drive
successful outcomes, and the trends in the civilian world move
toward Accountable Care Organizations, the Patient Centered
Medical Home, and efficient care coordination as a means of
improving quality and better managing cost will be critical for
the military, as well.
Patients already increasingly move between the military
health system, the VA, and the private sector, with physicians
thus being required to manage patient hand-offs through the
formation of care teams. It is clear that they need systems
that can track, manage, and facilitate this communication.
Even with its strong start and the good work by Assistant
Secretary Baker over the last year in trying to implement
positive changes, the fact remained that VistA's basic
platform, which relies on 25-year-old technology called MUMPS,
cannot support the open, flexible approach needed to provide
care to our Nation's wounded servicemen and women. Rather, the
demands of today's military and veteran health care environment
necessitates the use of technologies such as those based on
Microsoft architecture and open source that can support an
open, shared approach that will not just be desirable, but a
fundamental requirement in the near future. A fitting analogy
is the move the world made from a reliance on self-contained
mainframes to a distributed flexible system like the Internet.
To optimize both care and cost, we need a system that
easily and natively can talk with each other. Our belief is
that usability and interoperability are core to the success of
true IT adoption and should drive not only the development of
individual products, but also the infrastructure underpinning
health information technology exchange efforts.
Allscripts clients share information successfully today in
the private sector with colleagues in the VA and the military
health system. For example, in Hartford, CT, we have been
partners with a project for almost 2 years that led to
widespread health care IT adoption as well as successful
implementation of open source health care information
connectivity. Our partnership with Karen Fox and her team at
Delta Health Care Alliance in Mississippi has enabled VHA to
make substantial progress on information exchange. The
University of Massachusetts is another example of fostering
connectivity between communities and large organizations
providing health care. Finally, last but not least, we are
partnered with TeamPraxis, an organization based in Hawaii
where we are connecting almost one-third of the physicians in
Hawaii.
In the end, health care is about information and we simply
cannot address the challenges the Nation is experiencing today
in both private and public sector health care without ensuring
providers have the information they need to make better
decisions and the ability to communicate with others on a
patient's care team, independent of the system they are using.
It is time to learn from the successes in the private sector
and make technology work for the Veterans Health Care
Administration and the military health system.
So I want to thank you for the opportunity to share my
thoughts today and I look forward to your questions.
[The prepared statement of Mr. Tullman follows:]
Prepared Statement of Glen Tullman, Chief Executive Officer, Allscripts
Chairman Akaka, Ranking Member Burr, and other distinguished
Members of the Committee, thank you for the opportunity to share with
you today our perspectives on the use of health information technology
within the Veterans' Affairs Administration and the best path forward.
My name is Glen Tullman, and I serve as the Chief Executive Officer
of Allscripts. Allscripts is the largest provider of health information
technology software that physicians, hospitals and other caregivers use
to manage patient care. Following our merger with Eclipsys in August,
there are now more than 180,000 physicians, 1,500 hospitals and more
than 10,000 post-acute care facilities and homecare agencies utilizing
Allscripts solutions to improve their clinical and business operations
and to connect to a variety of healthcare stakeholders. Allscripts is
also the largest provider of electronic prescribing solutions, and
through our revenue cycle management clearinghouse, we process more
than 300 million claims, remittance and eligibility transactions each
year.
Physicians and other healthcare professionals who use our systems
in the civilian sector care for thousands of active duty and retired
military personnel, and we process almost three-and-a-half million
TRICARE claims each year. For example, in North Carolina, where one of
every two physicians in the State is an Allscripts client, there are
750 physician practices using our systems while caring for the large
local military population.
In the 19 months since the passage of the HITECH Act within the
Stimulus legislation, the conversation about health information
technology has been changed forever. It is my belief that we are at the
beginning of the single fastest transformation of a major industry in
the history of our country. Beyond the positive effect on hiring, which
in our case equates to more than 600 new jobs since ARRA passed (most
of which are in North Carolina, Illinois and Vermont), the incentives,
along with new standards, certification, and the concept of Meaningful
Use, have combined with private sector ingenuity to create a new
``best-of-breed'' in healthcare information technology platforms. The
investment Congress and the Administration has made will lead to the
delivery of better care, yield savings due to efficiency improvements,
and markedly improve patient safety in the private sector.
While the private sector has been moving forward in light of these
incentives, the Government has been investing in their own proprietary
systems for many years. Billions of dollars have been spent to build
and implement the VistA/CPRS system within the Veteran Health
Administration and the AHLTA system within the Military Health System.
The VA health system is made up some of the country's best
physicians and has played a critical role in demonstrating the value of
technology, specifically electronic medical records. There is no
question that VistA was a groundbreaking technology when it was first
developed, and over the years it has been improved with the development
of CPRS, VistARad and other expansions. However, today things are
different: the military is different. The care delivery model is
different. And the technology is different. All of this necessitates a
change. Let me explain.
The military has evolved significantly when compared to what
existed even only a few years ago. It moves people around frequently,
conducting joint exercises and, during the Iraq and Afghanistan
conflicts, has drawn extensively from the civilian ranks, namely the
National Guard. That flexibility is key to successes by the Armed
Forces, but it also poses a new requirement of medical records--the
ability to move those records around the world and between civilian and
military systems is now a must, as compared to the past when most
treatment was delivered inside of the military and VA systems.
Just as the military has changed, so has the care delivery model.
First and foremost, we are saving more wounded warriors. Military and
VA providers are relying on advanced technologies and newly-designed,
collaborative care models. And, once home, many of our wounded soldiers
are living examples of the fact that it isn't just surgery but
rehabilitation that is critical. Complex patients require teams of
physicians to drive successful outcomes, and the trends in the civilian
world--the move to Accountable Care Organizations, the Patient Centered
Medical Home and efficient care coordination as means of improving
quality and better managing costs--will be critical for the military,
as well. Patients already increasingly move between the Military Health
System, the VA and private sector, with physicians thus being required
to manage the patient hand-offs through the formation of care teams--
either formal or informal--designed to ensure smooth care transitions.
It is clear they need systems which can track, manage and facilitate
this communication.
Even with its strong start and the good work by Assistant Secretary
Baker over the last year in trying to implement positive change, the
fact remains that VistA's basic platform, which relies on the 25-year
old technology called Mumps, cannot support the open, flexible approach
needed by those providing care to our Nation's wounded servicemen and
women. Rather, the demands of today's military and veteran healthcare
environment necessitate the use of technologies--such as those based on
Microsoft's architecture--that can support an open, shared approach
that will not just be desirable, but a fundamental requirement in the
near future. A fitting analogy is the move the world made from reliance
on self-contained mainframes to a distributed, flexible system like the
Internet. The fact is, if you happen to live in one of the few areas
with a closed healthcare system, merely moving healthcare records from
paper silos into electronic silos--which is more or less what we've
been doing for the last decade--can be made to work. But in the
interconnected world that exists today, a closed system is not the norm
for healthcare in the private sector, with patients moving from Point A
to Point B to Point C, and increasingly, it is clear that the
interchangeable requirements of the military environment means that a
closed system approach simply isn't sufficient there, either. To
optimize care and costs, we need systems that easily and natively talk
with each other.
Unfortunately, attempts to share information between AHLTA and
VistA have largely been unsuccessful. The North Chicago project--near
my own home--is an example. Reports, including local newspapers,
indicate that to date, the project has not achieved the goals set out
of delivering interoperability between the two systems, with an
exchange of medication information but no exchange of allergies,
problems or clinical orders. We understand that physicians treating the
patients who move between the two systems have, in many cases, resorted
to housing two workstations in the exam room because of the double
documentation that they are required to complete. It is simply not yet
delivering on its potential, but it is my belief that coupling the
focused effort to date with the right architecture and system design,
as used in the private sector, could right the ship and deliver the
results we seeking.
It is our belief that usability and interoperability are core to
the success of true health IT adoption and should drive not only the
development of individual products but also the infrastructure
underpinning health information exchange efforts. Allscripts clients
share information successfully today in the private sector and with
colleagues in the VA and the military health system. For example, in
Hartford, Connecticut, we have been partners in a project for almost
two years that has not only led to widespread health IT adoption but
successful implementation of open source health information exchange
technologies. Our partnership with Karen Fox and her team at Delta
Health Alliance in Mississippi has enabled DHA to make substantial
progress toward their goals of improving care through improved access
to information. The University of Massachusetts is another example, not
only fostering health IT adoption among local physicians in their area
but also leading the state in connectivity efforts through an active
exchange of information every single day. Allscripts is also working in
the state of Vermont to facilitate Electronic Health Record adoption
and deliver interoperability through a focused partnership with the
Vermont Information Technology Leaders (VITL) project, one that has
established a leadership position that other states in the country have
chosen to emulate.
In the end, healthcare is about information, and we simply can't
address the challenges the Nation is experiencing today in both private
and public sector healthcare without ensuring that providers have the
information they need to make better decisions, no matter where they're
delivering care, and the ability to communicate with others on the
patient's care team, independent of the system they are using. There is
no one who would disagree that patients moving between providers and
sites of care in the healthcare system deserve the best quality
possible, which means that the information about the patient has to be
available where it's needed, when it's needed. We can also agree that
the government should lead the way by delivering world class healthcare
to the Armed Forces of this Country and doing everything it can to make
this happen in a timely and cost-efficient manner. It is time to learn
from the successes of the private sector and make technology work for
the Veterans Health Administration and the Military Health System.
I want to thank you for the opportunity to testify, and I look
forward to your questions.
Chairman Akaka. Thank you very much, Mr. Tullman.
Mr. Tullman. Thank you.
Chairman Akaka. Now we will receive the testimony of Mr.
Munnecke.
STATEMENT OF TOM MUNNECKE, FORMER INFORMATION TECHNOLOGY
OFFICIAL, U.S. DEPARTMENT OF VETERANS AFFAIRS
Mr. Munnecke. Thank you very much, Chairman Akaka and
Members of the Committee, for this opportunity to speak. I
would also like to say that I sympathize with the Senator's
complaints about the VA. As someone who has worked with or
watched the VA for 32 years, I have many of my own complaints
about the central office, but Roger Baker, I think, has a very
good grip on the IT situation. I am impressed with what I hear
he is doing so congratulations.
Thirty years ago, I was a computer specialist at the Loma
Linda VA Hospital, working with a small group of programmers
developing VistA. Things were at a fever pitch of innovation.
Tens of thousands of VA employees from all over the country
were connected on an electronic conferencing system which today
would be called a social networking site. For any given issue,
the VA had world class experts available that could be tapped
internally. From this tiny seed, the VistA system flowered in
one of the world's great medical information systems, as we see
today.
At that time, under a VA/DOD sharing legislation set up by
Representative Sonny Montgomery, Loma Linda and March Air Force
Base made a local agreement to install a modified VistA at
March Hospital. This was a successful case of VA-DOD
information sharing dating back to 1983.
One of the key factors of the success of VistA was the
decentralization and the direct day-to-day involvement of
field-based VA clinical staff. The original developers all came
from a clinical background and were deeply experienced in the
nuances of medical informatics. We were able to focus on
medical needs rather than be distracted by the problems of
administrative computing.
We designed the system to be an adaptive system, starting
with good enough and then putting it out in the field for
direct user involvement to make it better. We did not presume
to know the final answer in advance, so we employed a
generation's, not specifications, approach to controlling the
system's evolution. We were a skunk works--replacing the
bureaucratic procedures with a notion of creating a path of
least resistance to our desired goal.
We used a language called MUMPS, a language that was
designed specifically for medical informatics. This attracted
much criticism at the time, which continues to this day. The
DOD, VA, and Indian Health Service all enjoy, however, stable
long-term electronic health records that are based on
decentralized MUMPS, and in looking toward the future, I would
suggest that we maintain an understanding of what did succeed
in the past.
I would also caution the Committee that the electronic
medical record systems are far more complex and specialized in
their needs than standard IT applications. The open source
technology that is proposed for the next generation of VistA is
a very good move, I think, but I also want to suggest that the
VA carry forward the lessons learned and the innovation learned
with the VistA architecture to future architectures. Future
technologies should not pave the cow path of replicating the
old model, but rather support bold innovations in the delivery
of care to our Nation's veterans.
One of the things I noticed when I first joined the VA was
the difficulty of communicating across the stovepipes. I will
call this a failure to communicate. I also noticed that one of
the most highly used applications in the VistA system was the
Mailman system--simply people communicating their clinical
needs in an informal, person-to-person, peer-to-peer model. At
some points, this reached 25 percent of a hospital's traffic.
It was just people communicating.
So I want to strengthen the idea that part of the role of
IT is to overcome this failure to communicate. There are rich
opportunities for improving communications in general over and
above the current focus on the medical record, which I think
should be viewed as only one form of communication.
While VistA's success was based on the principles of
decentralization, I would like to suggest that future systems
be based on the notion of personalization, in which the veteran
is at the center of their personal health care universe.
Personalization includes the personalized health record,
personalized medicine, personal genomics, home health care,
telemedicine, and others. It also includes the role of social
networks and building communities of health, which allows us to
develop a positive health-oriented model that is integrated and
balanced with the disease model we have today. Perhaps we might
even achieve Jonas Salk's vision of creating an epidemic of
health.
When Pierre Omidyar started eBay, he personalized the
auction experience between millions of buyers and sellers. He
did not try to integrate the auction industry. He provided the
tools to connect the dots. I suggest that we envision a future
consisting of a thriving Federal health care community
personalized around the individual's health needs. Much can be
done with simple, inexpensive, and quick-to-implement tools
that could reduce many of the public fears about privacy and
open the system to innovation to deliver better care to our
Nation's veterans.
Thank you very much for your time, and I look forward to
answering any questions.
[The prepared statement of Mr. Munnecke follows:]
Prepared Statement of Tom Munnecke, Former VA IT Official
Thank you, Chairman Akaka, Ranking Member Burr, and Members of the
Committee. As someone who has been passionately involved with health IT
in the VA for 32 years, it is a pleasure to appear at this hearing to
discuss the elements that led to success in VistA as well as how this
might contribute to a Health IT system of the future.
Thanks to modern day communications technology, your staff reached
me to invite me to this hearing during a vacation in the middle of
Oregon's Cascades mountains. I only had one day at home to prepare for
the hearing, so please understand that this is a rather hurried set of
comments.
I was one of a small set of programmers hired by the VA in 1978 to
work on an ANS MUMPS-based decentralized hospital computer system, what
is now called VistA. I was a computer specialist employed at VA Loma
Linda, California, working with a network of others around the country
who pulled together a most remarkable effort to bring computing
technology to clinical users in the VA. I was one of the lead software
architects of the effort until 1986, when I went to Science
Applications International Corporation in San Diego to play a similar
role for the Composite Health Care System (CHCS) an adaptation of
VistA. I was a consultant to VHA in the late 1990's in which I wrote a
number of papers looking at future applications of IT in the VA (see
Appendix). I took an early retirement as a VP and Chief Scientist at
SAIC to pursue a broader field of philanthropic, humanitarian, and
educational uses of technology, particularly with regard to those at
the ``bottom of the pyramid.'' I became a fellow at Stanford
University, and was funded by Omidyar Foundation to develop a social
network toolkit for philanthropic activities. I founded a group called
the Uplift Academy, and have held workshops and salons around the world
on the broader role of technology and society, including health care.
I appear at this Committee as a private citizen at my own expense,
with the sole motivation of improving service to our veterans through
appropriate uses of information technology.
Twenty-eight years ago, the Decentralized Hospital Computer Program
(DHCP, later called VistA) was at a fever pitch of innovation. Tens of
thousands of VA employees were connected on an electronic FORUM on a
daily basis, sharing ideas, giving feedback, starting up new projects,
complaining about others, and contributing in one way or another to the
clinical application of computer technology to the delivery of service
to our veterans. I would install a new version of the software one
night, and the next day at the hospital cafeteria I would hear about
what was good and what was bad about the changes. I would communicate
these ideas to the developers via FORUM, and we would see changes in
the software in hours or days. I installed a computer running VistA at
the March Air Force Base hospital, an early instance of VA/DOD IT
sharing.
Lesson Learned: Clinical information is vastly different from
administrative information. One of VistA's strengths was that it was
able to focus directly on the clinical.
VistA was developed directly as a clinical tool, by clinicians, for
direct patient care. While there are many administrative needs of an
enterprise for logistics, cost accounting, billing, payroll, and the
like, these are a fundamentally different kind of computing.
Lesson Learned: Decentralization works. The extensive end-user
collaboration was a key factor to the success of VistA.
When I first started at the VA, I ran into the bureaucratic
``stovepipe'' mentality everywhere I went, even though everyone had a
supposedly common goal of providing health care to our veterans.
Recalling the words of the Sheriff in Cool Hand Luke, it seemed that
the core problem could be expressed as ``What we have here is a failure
to communicate.''
In college, I was struck by the Sapir-Whorf hypothesis that
language shapes our thought. I began to focus my attention on ways of
using IT to overcome the failure to communicate. This led to the
development of an integrated data dictionary that served as a
``roadmap'' to the patient data. Today, this would be called a
``Semantic Web'' (See http://www.caregraf.org/semanticvista for a
modern semantic web interface to the VistA database). We integrated
electronic mail directly into the clinical interface, allowing database
activities to generate email messages through an email/discussion/
workflow system called MailMan. I was amazed at how heavily used
MailMan was--in some cases, 25% of the traffic in a VistA system was
email traffic. This demonstrated how communications-intensive clinical
care is, even outside the formal communications traffic in the specific
applications such as pharmacy, laboratory, or radiology. I think that
VistA broke down many of the bureaucratic stovepipe barriers, allowing
people to focus on what was best for their clinical practice.
Lesson Learned: The fundamental goal in health IT should be to
improve communications. The medical record is but one form of
communication.
All of the initial developers of VistA were employed in the field,
working closely with end users. Riding the elevator with a gurney
headed to the morgue was a sobering experience, and helped keep me
focused on the implications of the software I was developing. The trust
we placed in the VistA community was well-placed. People felt respected
and acted accordingly, knowing that they were contributing to a larger,
more successful whole.
The goal of our system was to produce a constantly improving,
evolutionary system. Our goal was to get something ``good enough'' out
into the field, and then begin the improvement process. We had neither
money nor time for gold-plated requirements and specifications. Our
motto was, ``generations, not specifications.'' We didn't claim to know
the end point of the system when we started, but rather created tools
for users to adapt. Someone used to waterfall/requirements driven life
cycle process might find this appalling--that users could interactively
develop a system in tandem with developers--but it was a key factor to
the success of VistA.
Lesson Learned: Generations, not Specifications. Start with ``good
enough'' and allow it to continuously improve through end user
interaction.
VistA was designed to be adaptable to change. When we began, we
were using PDP-11 computers, which now exist only in museums. Over the
years, the system was hosted on VAX, Alpha, IBM Mainframe, PowerPC, and
Intel computers with little or no modification. VistA was designed
around a ``kernel'' architecture, consisting of common foundation that
was used by all applications, but customized for specific needs of the
various departmental needs such as laboratory, pharmacy, radiology,
etc. The closest modern day equivalent to this is Facebook, which
provides all users with a common set of tools, and then allows them to
install ``apps'' to do specific tasks. We used a trimmed down version
of the ANS MUMPS language, using only 19 commands and 22 functions.
Lesson Learned: Create a Path of Least Resistance to where you want
to go.
For example, at the 1978 Oklahoma City conference, we decided on a
standard format for storing dates in the computer. We knew that some
patients had been born in the 1900's, and we also knew that we would
eventually be dealing with dates in the 2000's. We created a program
that would handle dates in this way, making it easier to do it the
right way. We had a design ethic of making it easier to do the right
thing: creating a path of least resistance to where we wanted to go.
comments on the vista modernization report: from legacy to leadership
The report\1\ is an impressive effort by a large number of
committed industry advisors. I applaud the recommendation to move
toward open source, and many of the recommendations.
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\1\ http://www.actgov.org/sigcom/vistapublic/VistA%20Documents/
VistA%20Modernization%20 Report%20-
%20Legacy%20to%20Leadership,%20May%204,%202010.pdf
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However, I did not see the elements that lead to the success of
VistA particularly well-represented in the report. The report focused
on a heavily centralized, Washington-based development effort. User
involvement was not stressed to the degree that it drove the original
VistA development. It did not seem to fully recognize the unique needs
of medical informatics, and seemed to make the all-to-common mistake of
lumping clinical information with transaction-based administrative and
billing systems.
comments on mumps
Key to the success of VistA was the ANS MUMPS programming language.
The Federal health IT systems that have been written have all been
successful, stable systems: VistA, DOD's CHCS, IHS' RPMS. The Health IT
systems that have been programmed in non-MUMPS languages (TRIMIS, IOCs,
AHLTA) have been failures. Kaiser Permanente's EHR system is based on
MUMPS (Epic), and a leading contender for the AHLTA replacement is also
MUMPS-based.
Yes, MUMPS is an old language, but the fact that it has enjoyed all
of this success bears close scrutiny by those seeking to replace it.
Question. Is the weakness of the current VistA due to MUMPS, or the
VA's management of development process?
The report criticizes MUMPS as being a legacy system, as being
brittle and difficult to maintain. However, VA Central Office has been
responsible for the architecture for 25 years now, and has had 25 years
to address these problems. Instead of investing in its basic
infrastructure, it has deferred its maintenance reach the breaking
point we see today.
If you asked a carpenter to build a house for you, and the house
turned out to be crooked, you wouldn't accept the carpenter saying,
``That darn hammer made the house crooked. You are going to have to buy
me a better hammer.'' VA Central Office has been using a tool for 25
years, and rather than keeping it current and up to date, is now
blaming the tool, not their management of it, for the problems we see
today.
If indeed the VA needs to move away from a MUMPS-based
architecture, it is imperative that it understands exactly what worked
in the past. I think that this will require a deeper dive into the
foundations of VistA to be fully appreciated.
Lesson Learned: VistA is not just computer screens.
VistA was an outpouring of creativity of thousands of VA employees
working together to improve service to veterans. This created many
bonds of innovation and a shared sense of purpose that drove the
community. The report seems to reduce VistA to strictly an IT issue--
replicating the screens of the old system. VistA needs a broader
organizational context in order to thrive in the future.
Question. Is the VA just ``paving the cowpaths'' with new
technology?
The recommendation that VA freeze development of the legacy system
while engineering a new one that is functionally equivalent is a high-
risk approach that threatens to stall IT innovation in the VA for a
significant period. If the new approach is delayed or fails, the VA
would be freezing itself out of innovation and years of new
development.
looking forward
A mobile phone today has about 1000 times the computing and
communications capacity of the computer I first used to install VistA
at Loma Linda Hospital. It costs about one one-thousandth the price: a
millionfold price-performance improvement. One would expect that this
drop in the cost of the electronics would lead to a corresponding drop
in the cost of Health IT. Internet users today have access to an
incredible array of free services for email, social networking, photo
and video sharing, text messaging, mailing lists, auction sites, and
the ability to search billions of web pages instantly.
Unfortunately, this is not the case. Health IT costs are spirally
upwards rapidly, and systems that used to cost millions in the 1980s
are costing in the billions today.
Why is this? Why is it that costs outside of health IT are
plummeting and functionality exploding, while the cost of health IT is
exploding and the functionality creeping forward slowly, if at all?
Imagine someone trying to sell the world's greatest automobile. He
offers the best car parts: an engine from a Corvette, the seats from a
Rolls Royce, and a transmission from a Porsche. All that is required,
he says, as a customer leaves with a truckload of these best of breed
parts is ``a little bit of integration.''
So it is with Health IT today. Vendors are offering ``best of
breed'' components (with corresponding premium prices) and then
offering integration services to customize them to specific customer
needs. Yet the integration costs--connecting the dots--are the
overwhelming factor.
One way out of this is to reframe our thinking of IT architecture
as a ``space'' rather than a ``system.'' Consider what Tim Berners-Lee
said about the creation of the World Wide Web:
What was often difficult for people to understand about the
design of the web was that there was nothing else beyond URLs,
HTTP, and HTML. There was no central computer ``controlling''
the web, no single network on which these protocols worked, not
even an organization anywhere that ``ran'' the Web. The web was
not a physical ``thing'' that existed in a certain ``place.''
It was a ``space'' in which information could exist.''
This opens up an extremely fertile discussion on how health IT
might be supported using web-like information structures, as well as
reduce the complexity we see in our systems today.
I have written other papers on this topic (see Appendix). Some of
the more directly pertinent papers include:
HealthSpace architecture: http://munnecke.com/papers/
HealthSpace.doc
Ensembles and Transformations: http://munnecke.com/papers/
D16.doc
Concepts of the Health Data Vault: http://munnecke.com/
papers/D03.doc
summary
VistA was an amazing outpouring of innovative collaboration within
the VA that changed both its information technology and its
organization. Decentralization and direct user involvement were key to
its success, as well as having a technical infrastructure capable of
supporting it.
Going forward, the VA should look to a theme of personalization of
health--both in its IT infrastructure and its delivery of health care
in today's rapidly changing environment.
I would be happy to answer any questions you may have now or from
those reading this transcript.
Appendix:
These were papers relating to the future of Health IT in the VA
that I wrote under contract to the VA from 1998 to 2000. A full list
may be found on the web at http://munnecke.com/blog/?page--id=248
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
HealthSpace (139kb) January, 1998 Some early thoughts on the notion of creating
a ``space'' rather than a ``system'' of
health.
----------------------------------------------------------------------------------------------------------------
Some Applications of Complexity Theory December, 1998 Discusses the concepts of Dee Hock's
to Health Care (93kb) ``Chaordic'' thinking to health care, as
well as general complexity theory issues
----------------------------------------------------------------------------------------------------------------
Shared Meaning and Health Informatics January, 1999 Discusses some of the challenges of
(70kb) overspecific standards efforts, as well as
some of the underlying philosophies.
----------------------------------------------------------------------------------------------------------------
Concepts of the Data Vault (57kb) February, 1999 Introduces the notion of a personal data
vault as a key component of a personal
health space per patient.
----------------------------------------------------------------------------------------------------------------
From Enterprise to Person-Centric April, 1999 Discusses the shift from enterprise-based
Health Information Systems(54kb) health care to person-centric.
----------------------------------------------------------------------------------------------------------------
Health as a Medium (241kb) May, 1999 Portrays health as a medium, and many health
problems as a ``failure to communicate."
----------------------------------------------------------------------------------------------------------------
Personalizing Health (107kb) June, 1999 Discusses the issues of personalization at
several levels
----------------------------------------------------------------------------------------------------------------
Steps towards an Epidemic of Health July, 1999 Discusses some of the initial conditions
(95kb) required to create an epidemic of health.
----------------------------------------------------------------------------------------------------------------
Design Patterns for Health (461kb) August, 1999 Explores the application of architect/
philosopher Christopher Alexander's ideas to
health
----------------------------------------------------------------------------------------------------------------
New Health and the New Economy (67kb) October, 1999 Compares a new vision of health with the
``New Rules of the New Economy'' book by
Kevin Kelly
----------------------------------------------------------------------------------------------------------------
Rethinking Complexity (63kb) November, 1999 Discusses issues of complexity and how to
circumvent them using ``space'' metaphor.
----------------------------------------------------------------------------------------------------------------
Health and the Devil's Staircase (45kb) January, 2000 Applies fractal thinking to health
----------------------------------------------------------------------------------------------------------------
Systemic Issues of Patient Safety March, 2000 Introduces a spectrum of scales to think
(208kb) about health, relates this to the notion of
patient safety.
----------------------------------------------------------------------------------------------------------------
Tipping an Epidemic of Health (95kb) May, 2000 Discusses why the connectivity provided by
the Internet is on the verge of creating an
epidemic of health
----------------------------------------------------------------------------------------------------------------
Ensembles and Transformations (23kb) July, 2000 Introduces ensembles as communities of
interest which provide a context for
transformations.
----------------------------------------------------------------------------------------------------------------
Health and Positive Discourse (109kb) August, 2000 Examines notions of Appreciative Inquiry,
positive discourse, and optimism in light of
Internet technology
----------------------------------------------------------------------------------------------------------------
Flipping from Negative to Positive September, 2000 Examines the effects of negative discourse,
Discourse (25k) how naming a problem can make it worse, and
examples of positive discourse.
----------------------------------------------------------------------------------------------------------------
Assumptions of the Transactional Health October, 2000 Examines some of the assumptions of the
Model transactional model of health, such as
linearity, the economics of scarcity, and
deficit discourse.
----------------------------------------------------------------------------------------------------------------
A Transformational Notion of Health November, 2000 Discusses transformational concepts in
health, flipping assumptions of the above
transformational model
----------------------------------------------------------------------------------------------------------------
New Perspectives July, 2001 Discusses the inversion of enterprise/person
relationship, complementary currencies, and
HailStorm architecture(.pdf) (html)
----------------------------------------------------------------------------------------------------------------
Towards a language of Health (122K) Nov, 2001 Proposes Genos, a language which would allow
expression of health and genomic information
for clinical use. (html) (pdf)
----------------------------------------------------------------------------------------------------------------
Can Health Care IT Adapt? (800K) Jan, 2002 Discusses issues for adaptation in our
information technology infrastructure, in
light of prospective advances in Genomics
and Proteomics (html)
----------------------------------------------------------------------------------------------------------------
From Systems to Spaces June, 2002 A space-based metaphor for patient health
information systems (htm) (pdf)
----------------------------------------------------------------------------------------------------------------
Chairman Akaka. Thank you. Thank you very much, Mr.
Munnecke.
Mr. Baker, what can you point out that would help persuade
the Committee that VA has learned from its past and that we
will not experience expensive IT project failures in the
future?
Mr. Baker. Thank you, Senator. I will keep this answer
brief, because I would love to give you 10 minutes on that one.
I think the biggest lesson that we took from the failure of the
replacement scheduling application was that we have to make
certain that the hard decisions are faced and made. From there,
I think you have seen a series of hard decisions made at the VA
relative to other projects. Stopping 45 projects in July of
last year was, frankly, a hard decision for our customers,
facing up that those projects were not delivering. Stopping
some of those projects and just saying we are not going to be
able to be successful at those, has been a series of hard
decisions. Frankly, reforming a few of them was not viewed
positively, but we recognized that they were not going to
deliver if we did not change them to an incremental delivery.
Some of the more notable ones that I think we get
criticized for, for example, stopping the FLITE program; they
are hard decisions. They are not decisions that we take lightly
and they are not decisions that we view from only one aspect.
But in the end, we have to determine if we can be successful.
If we believe, we cannot be, if we believe it is an overreach,
we need to not do the program. So I would point you to not just
some of the things we have done, some of the programs we have
instituted, but the results of those programs.
Most importantly, we do not allow a project to move forward
today if they do not have a customer facing deliverable within
the next 6 months. What that means is they are not going to go
a long time, like the replacement scheduling project did.
Replacement scheduling went years without delivering anything
before they finally figured out it could not deliver anything.
We now are implementing a technique we are calling Fail
Fast. You know, if it is going to fail, figure it out quickly
and stop spending money on it. That has generated a lot of us
facing up to those hard decisions, again, inside the
organization.
So I would give you those two things. Again, in many ways,
that is my life inside the VA, making certain we do not
replicate those things from the past and that we do not have
any more replacement scheduling scenarios.
One thing I would add is I have also promised Secretary
Shinseki that we will not have another replacement scheduling
while he and I are at the VA.
Chairman Akaka. Well, let me give the other witnesses a
chance to add anything about how to avoid these high-profile
failures. Mr. Munnecke?
Mr. Munnecke. As a software architect being faced with
these demands on the technical side, I find that the users--and
this might come from Senate and Congressional committees, by
the way--want to have the penthouse suite of a skyscraper, but
they do not want to pay for the lower 22 floors and the
foundation of the building. So they say, I want this thing up
at the top. Give it to me tomorrow, or yesterday. Then
everybody has to scramble to build the skyscraper. As an
architect, I have to dig a hole in the ground to build a
foundation. They say, no, no, I want the skyscraper. I want the
penthouse suite.
So I think Mr. Baker's approach, which I wholly endorse,
should also include the requirements that people who are
building not make them gold-plated penthouse suites, but maybe
even accept the tenth floor of an existing building and scale
it down to allow it to evolve over time rather than go for the
big push and the big bang that may not be possible. So it
should be a process of discovery and working forward gracefully
rather than expecting the gold-plated requirement to be met
immediately.
Chairman Akaka. Mr. Meagher?
Mr. Meagher. Thank you, sir. One thing I would add is this
notion of accountability, personal accountability. When you
have the projects broken up into small pieces where you make
sure all the parts are in place before you begin: that there is
an agreed-upon business requirement; there is a business owner;
there is competent, experienced program management. Then you
hold people accountable for their deliverables and for meeting
their milestones. That is a culture change that is taking
place, I would suggest to you, over the last 18 months that is
very dramatic and is probably one of the main pillars to why I
think you are seeing the turnaround that some of you have
recognized and I really believe is there.
Chairman Akaka. Mr. Tullman?
Mr. Tullman. Yes. I would again compliment Assistant
Secretary Baker on the progress in what I heard today. You
know, we believe that the private sector should play an
increasingly large role in developing these systems. We are
developing very similar systems for the civilian health care
system, and increasingly what we are seeing is these two are
meshing together. People are moving back and forth, in and out
of the military and other services, and the government, as
well.
So we would like to make sure that, number 1, the
government is looking at what the private sector has to offer,
and two, we believe that there are much better systems to form
the community that my counterpart here talked about, a
community of the VA. They are out there. There are social
networking systems. There are open platforms. There are
Microsoft-based systems. They are not based on what is
essentially a 25-year-old transaction processing language
called MUMPS. So we would like to see the new systems based on
newer, broader standards and have the government in the role of
setting the standards for what they want and let the private
sector compete to deliver and be punished if they do not.
Chairman Akaka. Let me now ask for questions from our
Ranking Member, Senator Burr.
Senator Burr. Thank you, Mr. Chairman.
Mr. Baker, just a comment. You made the observation that as
you cut IT programs, some of that money was reprogrammed over
to operations and maintenance. At the same time as that is
going on, we had savings in the construction of facilities area
of which we are in the process of reprogramming over to build
additional facilities.
I would only make this comment. VA continues to short
operations and maintenance, year in and year out. Now, you are
going to come back to us and you are going to ask for
additional money for IT programs and we are going to feel
compelled to give it to you. It is going to happen. We keep
moving money around and we do not leave it where it not only
does the most long-term good, but this reprogramming lets us
off the hook from actually making the right decisions on
operations and maintenance for this year, next year, every
year.
So my hope is you will carry a message back. I, for one, as
a Member of the Committee, am going to become much more
observant of the reprogramming of money. If we get at the end
of the year and we see money left over in your account, it will
be because either, one, we projected wrong; two, we got
savings; or three, we eliminated programs. We can reprogram
that money for the next year so that it goes toward the program
needs that you are going to have.
Let me stay with you, Mr. Baker. You listened to two
competing views on future architecture, for MUMPS, against
MUMPS. Who is right?
Mr. Baker. Well, I guess being a political appointee, my
job is to kind of run down the middle of this, and I do,
technically. Several things come together from my standpoint
here. One is an old adage that I have that the definition of a
legacy system is that is the one you know works. We have----
Senator Burr. Let me just ask a follow-up question. If you
maintain MUMPS, can the private sector have full access into
the VA system, into the MUMPS system, for the exchange of
electronic information?
Mr. Baker. I would answer it this way. I believe just as
much as if we implement it in any other language, because at
the bottom, it is the data that is important.
Senator Burr. OK. Now let me turn to Mr. Tullman, if I can,
simply because he is out there in the private sector. Now let
us see what the limitation is.
Mr. Tullman. What I would say is, and again, I think you
can extract data for any system. What we are really talking
about, and I do not want to get too technical, is the native
exchange of information. So you can pull information out of a
mainframe system and put it into a PC if you want two people to
talk to each other. The question is, why would you do that when
you could have two PCs that were talking with each other?
So again, we think MUMPS was the right decision to make
when it was made. We think there is a reason to carry forward.
We are just saying, as we go forward into the future we need to
broaden the understanding of what systems to use, what
architectures to use, and what are the general reason we need
these systems, and that is for communication. And I think that
is this idea that this community is important, yet no one is
using MUMPS to build systems that communicate and exchange data
efficiently today----
Senator Burr. OK. Mr. Munnecke----
Mr. Tullman [continuing]. Anywhere else but the U.S.
Government.
Senator Burr. What is wrong with two PCs?
Mr. Munnecke. Excuse me?
Senator Burr. What is wrong with two PCs?
Mr. Munnecke. Two PCs, that is basically the architecture
we used. I was an avid anti-mainframe designer. We thought that
mainframes were the devils and personal computers and
microcomputers were the angels. I almost went to work for Apple
Computer before I started at the VA and was a total fan of
microcomputers. That was 1977. Mr. Tullman's comments have a
number of technical issues that I think we need to talk about
over coffee sometime. Yet, I probably largely agree with his
conclusions.
I do not want to be characterized as being pro-MUMPS. I do
want to be characterized as understanding that we have a very
successful legacy system that has accomplished a lot, and just
going with the standards of the information technology industry
and thinking that we are going to take these shiny new
technologies and buzzwords on PowerPoint presentations and come
up with a successful system is not going to work. There are
tremendous medical informatic needs that need to be dealt with,
and dealing with them in a way that actually works and is on
the ground and is working in IHS, DOD, and VA is quite a----
Senator Burr. I am not sure I have heard anybody describe
an electronic health component of DOD actually working.
Mr. Munnecke. CHCS, Composite Health Care System, installed
in 1986 in all facilities worldwide. We developed it at SAIC.
That was one of my projects. If you had somebody from DOD here
that was using CHCS, I think they would have very good things--
--
Senator Burr. Well, why do they have such a hard time
building medical records in a fashion that they can actually be
transferred to VA?
Mr. Munnecke. I think that you would have to look at DOD
actually throttling back CHCS and crippling the features that
were designed into it for communication in order to protect
their bureaucratic stovepipes. It is not a matter of
technology. It was not MUMPS. It was the DOD's management of it
and decision to centralize it and pull it apart and replace it
with AHLTA.
Senator Burr. My time has run out, but let me just make one
observation, if I can. There should be no committee of Congress
that is trying to determine whether MUMPS is right or wrong,
but I would say this to the VA: it is absolutely essential, in
my estimation, that private sector companies buy into what
technology decisions you make at VA because of exactly what Mr.
Tullman raised, and that is that this is no longer our
population of people that we are taking care of. They are
bouncing back and forth, and that is going to happen for some
time. As a matter of fact, they bounce back and forth today
based upon what particular problem they have got and whether
they want to be seen on the private sector side or whether they
want to be seen on the VA side. So if we want to reach the
efficiencies, long-term, of private health care, as most have
realized, then we have got to have this interoperability
solved.
So my observation would be, if a company like Allscripts, a
leader, is questioning whether they will be able to exchange
through your system, I think we ought to pause for a minute and
talk to those companies and find out what their concerns are,
how we overcome those concerns. There may be aspects that can
be redesigned that overcome those. If, in fact, we end up at
the end of the day and the private sector says, we cannot play
in your world, well, we have got a big problem. The problem is
we will not get as many efficiencies on the private sector
side. And I certainly do not think that we will get
efficiencies that we are going to have to get out of the VA
side.
I thank the Chairman.
Chairman Akaka. Thank you.
Senator Johanns?
Senator Johanns. Mr. Chairman, thank you.
I have to tell you, I am sitting here and it just brings
back frightful memories. This is enormously expensive. Projects
get abandoned. Huge costs to the taxpayers. Nothing to show for
it while this debate goes on. And for us, I have to tell you
that it is very, very frustrating. But again, I was in your
position at one time.
Now, let me offer an observation or two, hopefully with a
question. One observation I had about IT was that the process
of creating a system was enormously influenced by a legislative
process that was not connected at all to the IT requirements. I
will give you a perfect example. Things would be written into
the farm bill. They would have a nationwide impact, right down
to the nuances of an individual farmer, yet the system was not
able to deal with that.
So let me just start out and ask you, do you feel that kind
of influence also at the Veterans Administration, or was that
unique to USDA?
Mr. Baker. From my observation, I would say we see it more
on the benefits side than on the health side. One of the things
that made the new G.I. Bill Long Term Solution a large-scale
project was that there were substantial additions that are
great features from the veterans' standpoint, and we fully
support them, but they made the software much more complex than
the software that processed the previous G.I. Bill, the
previous educational benefits. Recognizing that we are going to
see continued requests from Congress to enhance what that bill
does for veterans, we have built it to be as flexible as
possible. It is not perfect. Our answer is never going to be
every time, sure, we can do that; no problem. But we have tried
to build things in that would allow us to give an answer of,
that will take a month or two versus that will take a year or
two in----
Senator Johanns. So let me jump right in here, then, and
ask another question. And it is OK to be critical of us. I
mean, we are trying to figure this out. Even though we are your
oversight, it is still OK to be critical.
Those policy determinations may be the absolute right
policy, and I think we can all agree upon that, but is there a
disconnect in the staff work driving that policy, or our work
in driving that policy and the impact it has on the VA?
Mr. Baker. There is an interesting balance in there, and I
will reflect on----
Senator Johanns. You are being so diplomatic.
[Laughter.]
Mr. Baker. Well, I am trying to give you the answer as I
see it. I am a private sector person. These systems should not
take forever to develop. So when the answer comes back to your
staffers, ``if you do that, it will take 3 years,'' they should
not listen. At the same time, sometimes you get to the point
where the answer really is, yes, that is going to take more
than a year. We wrestled mightily with implementing the Chapter
33 system and a lot of it was because of the short timeframe to
get it implemented, and then the fact that it was very popular
with the folks using it. So we had a relatively poor IT system
that VBA had to use in that first semester, which we saw the
impact of. Veterans did not get paid in a timely fashion. With
another year, we are able to implement the Long Term Solution
and it is much better.
Senator Johanns. The other thing I wanted to ask you
about--it is great to go home and tell people how we improved
benefits. They are not quite as understanding when we tell them
that we improved the funding for IT or bureaucrats to run it.
Are you feeling that tension, also?
Mr. Baker. Yes. It is certainly, as you point out, for
example, easier to justify increases in the health accounts
than in the IT accounts. Yet, as Dr. Petzel would tell you,
because of how fundamental the VistA system and IT is to
health, as they open a new facility, as they do new things for
health, as they do the patient centered medical home, IT is
fundamental.
We are constrained in our ability to meet the health
demands by the fact that we are not tightly tied any longer. We
have a separate appropriation for IT. We are wrestling with
that, frankly, inside the VA right now and looking for what we
can bring forward to Congress from a proposal standpoint that
would let us address that issue without breaking down what we
accomplished by centralizing IT management. It is what a
private sector company would face directly. How do we most
optimally do these things? Our difference is that instead of
going to our CEO, we also go to our Board of Directors to do
those sorts of things.
Senator Johanns. I will wrap up with this because I am out
of time, also. One of the things that really, really came home
to me when I was in your position--and you are serving this
role now--is you need strong central management. It is just so
obvious after doing what you are doing for about 3 years. You
just need the very best person you can have in charge of this.
The second thing is, there has to be better coordination
between the policymaking process and what you have to
implement, because if there is a breakdown there, it can really
cause serious problems.
Then, no offense to the private sector, because I agree,
the private sector plays an important role here, but you have
to have somebody who can push back, because my experience is
they love to design the penthouse suite, to use the analogy.
They are not so excited about designing the basement. And yet
you have got to build the basement, the floors. It is kind of
like building an interstate highway system. It is probably not
the sexiest thing to acquire right-of-way, but guess what; if
you do not have the right-of-way, you cannot lay the concrete.
Everybody loves to see the concrete laid down.
So I think that it is enormously important that somebody
there is very, very strong and knows their business, so the
building blocks are there. Even if you do not get to the final
epitome with that first contract, built a step at a time it
just seems to go better and the money is better managed. Does
that make sense?
Mr. Baker. Absolutely. In software terms, we would call
that incremental development. Show the customer something as
quick as you can and get their feedback on whether it is what
they want or not, and then build further to that. It is the way
the private sector builds things. Government has traditionally
done the big bang thing, which is tell me all your
requirements. I will spend 5 years, I will wrap it up in a bow,
and I will hand it to you. The problem is it does not account
for something that we all know is a fact, which is change.
Senator Johanns. Yes.
Mr. Baker. This is why so many large-scale government
projects fail.
Senator Johanns. Thank you, Mr. Chairman, for your
patience.
Chairman Akaka. Thank you, Senator Johanns.
Senator Brown?
Senator Brown of Massachusetts. Thank you, Mr. Chairman.
You know, when I go home, people say, ``Scott, have you
changed? Have you changed at all?'' And I say, well, yes, I
have changed, because I have learned a lot doing my job and at
the Committee hearings. As a matter of fact, I learned that the
Arlington Cemetery folks are still accounting for all the
people on index cards. They are using index cards to identify
where graves are and who is there. They do not have an iPad or
they do not use computers. Can you believe that? It is amazing
to me.
I have learned also that we waste a tremendous amount of
money beginning programs, putting a few hundred million dollars
in it, and then just say, oh, that does not work. We will do
something else. I have learned also that the IT systems in the
various departments are critical, especially with the changing
nature of how we communicate worldwide, and I am not opposed to
providing the tools and resources to update IT. I think it
makes sense. But I do have a problem when we always--and I know
I am still somewhat new here--but we put these tremendous
amounts of money into programs and then we change course
midstream, and do another one and another one.
So I guess my question ultimately is, are you satisfied at
this point that you have the IT system in place to basically do
your job?
Mr. Baker. I am going to start by answering that from my
private sector perspective, which is absolutely not. You know,
this is a large still government-oriented organization. I am
pleased with the progress we have made. I very early learned to
separate our customer support and operations, which are on a
par with the private sector, from our development, which is far
behind what a private sector organization would do.
We are putting in the disciplines in our development
organization that a private sector organization would expect,
but frankly, we have nearly 3,000 developers. We spend about
$800 million a year on development, and while we have started
to change that organization, we are nowhere close to the level
of output I would expect from that level of investment.
We will not have another $100 million ``go off and spend
money and fail'' program in the VA. Like a private sector
organization, we are going to have a lot of a few million
dollar projects, to discover that is not the right program. Let
us go do something different. We want to do speculative things,
take some risks, find things that are going to be big wins, and
stop things early before they turn into big losses. That is the
way the private sector approaches these things.
But to come back fundamentally to your question, we are
trying to get to the point where we can be compared to a good
private sector organization. We are several years away from
that at this point still.
Senator Brown of Massachusetts. Well, considering that, has
your ability to hire and fire improved at all?
Mr. Baker. No.
Senator Brown of Massachusetts. OK. And is there something
that we can do to help you in that mission? Maybe offline, you
can let us know so we can streamline and do whatever we need to
do to give you that authority so you can get your house in
order.
Mr. Baker. Senator, I can certainly tell you what, as a CEO
in the private sector, I had from an authority standpoint.
Senator Brown of Massachusetts. No, I understand that. I
am----
Mr. Baker. I long ago gave up being able to have the
equivalent in the Federal Government.
Senator Brown of Massachusetts. All right. Well, maybe we
can talk about that offline and figure out a way to help you
get to where you need to be.
There is obviously an initiative by DOD to find a way to
save $100 billion. What are you doing to try to save money, as
well, because the money tree is getting smaller.
Mr. Baker. I agree. I have been focused since I arrived at
VA on making certain that the dollars we spend are spent on
things that are going to benefit veterans, that we are not
wasting the dollars. We requested no increase from fiscal year
2010 to fiscal year 2011. We will request no--I am sorry, I am
not allowed to talk about the President's budget, but I would
not anticipate the VA requesting an IT increase going into
2012, as well. My focus is on how we get more out of the
dollars that we have. We have to deliver more things for the
veterans, and I want to be careful to make certain that we are
not cutting back in areas that we should not be cutting back,
specifically to Senator Burr's comment about the maintenance
and the operations and the infrastructure. But my main focus is
on making certain that when we spend a dollar, we have got real
return for that dollar inside VA.
Senator Brown of Massachusetts. That is appreciated. As a
30-year, almost 31-year Guardsman, if somebody is in the Guard
and they deploy, then get home and decide they want to get out
of the military, what assurances can you provide that his
medical records from deployment and home station will be
transferred to the VA CBOCs 3, 4, or 5 years down the line?
Mr. Baker. From my understanding of that system, that is a
great question.
Senator Brown of Massachusetts. That is why I asked it.
[Laughter.]
Mr. Baker. Anything that is electronically generated inside
the DOD comes to the VA through a system called the Federal
Health Information Exchange. There is a lot of electronic
information. I do not know the DOD system well enough to know
how much of that Guard's information comes over in that system
and how much of it does not come into that for the VA to see. I
will be happy to get an answer on that one so that we both get
a little bit better educated on what does occur and what does
not occur.
Senator Brown of Massachusetts. Well, I think it is
important because you have a tremendous amount of Guardsmen who
are serving in the One Army concept, doing their time, getting
out, and getting the appropriate care and treatment. If the
records are not complete, it is a waste of time and money for a
whole host of reasons, so thank you. If you could maybe get
back to me; just call the office. You do not need to send
anything. Just pick up the phone. It is a ``keep it simple,
stupid'' type of thing.
Mr. Baker. OK.
Senator Brown of Massachusetts. OK?
Mr. Baker. I appreciate it. Thank you.
Senator Brown of Massachusetts. Thank you, sir. I
appreciate it. Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Brown.
Senator Brown of Massachusetts. I did not mean to say that
you are stupid. It is the KISS theory, just so----
Mr. Baker. I love the KISS theory.
Senator Brown of Massachusetts [continuing]. I am not
misquoted. I think you are doing a very thorough job. So I just
want to make sure----
[Laughter.]
Mr. Baker. I took it as intended, sir. Thank you.
Senator Brown of Massachusetts. OK. Thank you.
Chairman Akaka. Thank you very much, Senator Brown.
Mr. Baker, with the failure of CoreFLS, the Committee
learned that the contractor was still paid a bonus due to
contractual obligations. Are bonuses being used to encourage
contractor performance, and how are they structured?
Mr. Baker. To answer the first question, I am certain that
there still are incentives in our contracts to encourage the
contractor to do what we want them to do. My experience from
both the private and the government sector sides are that there
are frequently cost-plus-incentive fee contracts, and I expect
that we would use those where appropriate.
The issue that you frequently see is when a contractor does
exactly or close to exactly what the contract asks them to do
and the project still fails for either reasons that they did
not even contribute to or reasons that were not contemplated in
the contract, and I think the government has fairly
traditionally continued to pay those incentive fees when
contractually required in those.
It is an interesting dilemma, because, if you will, the
environment that a program exists in is multiple contractors,
lots of different government offices, and as we have all seen,
pinning the blame on who caused the failure inside the
government programs is almost impossible. There are so many
people involved, so many people insulate themselves from taking
charge, that it is perfectly feasible for the contractor to
say, I did what I told you I would do. I earned my incentive
payment. Please pay me. Do I like it? No, but it is part of the
contractual process.
Chairman Akaka. For our other witnesses, do you have any
thoughts on bonuses built into these IT contracts? Mr.
Munnecke?
Mr. Munnecke. Well, as a VA employee who was demoted for my
work with VistA, I think there is a lot to be said for aligning
incentives to support innovation. I would like to focus on
innovation and giving bonuses for innovation. I guess I would
like to see innovation tracked as well as costs and budget.
Chairman Akaka. Ms. Finn, with regard to the recent IG
report on the G.I. Bill, why is it so important to have an
independent milestone review in place, and also, does VA's
solution fit the bill?
Ms. Finn. We believe the independent review is important
because it helps people making decisions, like Mr. Baker, have
a solid understanding of what is going on, separate from just
the program managers' or the project managers' assertion of how
things are going. It gets down to the facts of what is
happening, where the costs are, how much things have cost, and
what the progress really is.
The response from the Department was that although this has
not been accomplished yet through the PMAS oversight process,
it is planned to be and will be part of future PMAS. That is a
solution. We are still waiting to see how that works out. We
are currently working on an audit of the PMAS system to take a
closer look at the controls and the processes being used to
oversee system developments. So, hopefully when we finish that,
we will have better insight as to how well PMAS can fit the
independent review portion.
Chairman Akaka. For the other witnesses, should these
independent reviews be done on some of the other large-scale
projects, as well?
Mr. Baker. Senator, I will just point out that one of our
main philosophies is that we are looking to the customer to
tell us whether they are getting what they are expecting from
us, and that is an integral part of PMAS.
We have, I believe, an exceedingly good relationship with
our IG folks on the technical side. We get very good
constructive criticisms from them. It is extremely useful. I
believe you will find, in general, with the recommendations
they make to us these days, we are going to concur. We can take
all the help we can get in making this work well. I appreciate
the work that Ms. Finn and Mr. Carbone and their folks do for
us. It helps.
Chairman Akaka. Any others? Well, my time has expired.
Senator Burr?
Senator Burr. I got to thinking as Senator Brown held up
his iPad. My last trip to Mid-Valley Hospital, as I saw kids
come in from Landstuhl, I think all of them had their medical
records taped to their belly. That is why I made the comment I
did about DOD. I am sure there are some areas that do work. But
I am also struck by the fact that I think three of our
witnesses brought their iPads with them. I think that gives us
a great indication as to how much most of you, if not all of
you, look at the new technologies available that change the way
you personally communicate. So I think the challenge, Mr.
Baker, is to change the culture, not just at VA, I would say
throughout government, though it may be a bridge too far.
My hope is that like we see business collaboration with
academia that did not exist 20 years ago, we now see business
collaboration with academia is an absolutely crucial component
to where business chooses to invest capital because it is
essential to their long-term viability of the business.
Again, my hope is that VA will collaborate with the private
sector, not just from a contractual standpoint, but from a
strategic and tactical standpoint with business, because when
we both get on the same page, when we both agree with the
platforms, when the highway goes to the same end place--you may
have different exits on yours, the private sector may have
different exits, but where you stop and where you end have to
be one and the same. I think we will find that we can leverage
things that we are currently not leveraging in our efforts.
Let me ask you about skilled staff. I think IT projects are
a lot about staffing, and I would ask you, what is your
assessment of the professional competence of the program
managers within the office who manage these expensive and
critical IT programs?
Mr. Baker. Senator, one of the reasons that we have cut
back on the number of projects that we are doing is because we
do not have a sufficient amount of project management skills to
run the number of projects that our customers would like us to
compete. One of the primary premises of the Program Management
Accountability System is we are not going to ask a project
manager to start a project when he or she already knows it is
going to fail. Those project management skills have proven to
be where we are weakest, where we have the most trouble hiring,
and where we compete most directly head-to-head on dollars with
the private sector. A great project manager is worth every
penny he or she is paid in what they save you in what they do
in delivering a project.
Senator Burr. Do you have all the tools you need to improve
the competency and the performance of your program managers?
Mr. Baker. I would never say we have all the tools we need.
We are doing a lot of training. We are doing a lot of hiring.
But we need more than 100 good project managers at the VA right
now. We are able to hire one or two at a time. It is difficult.
Everybody needs them. And while we have a mission that I
believe is more communicable than anybody else's, great project
managers are in high demand in the private sector and in
government.
Senator Burr. We currently have an RFP with IBM for the
Agent Orange claims. What is the amount of that relationship
with IBM for that project?
Mr. Baker. I believe that is a firm fixed price at about $9
million.
Senator Burr. OK. The first 45-day mark, they missed.
Mr. Baker. That is correct.
Senator Burr. You then issued a second, a back-up RFP.
Mr. Baker. Correct.
Senator Burr. What is the reason IBM missed it?
Mr. Baker. From our perspective, I do not believe they
understood--just being blunt--they did not understand it was
not ``business as usual'' in the government, that we were
absolutely committed to making the 45-day mark from the VA's
standpoint. Anecdotally--I will talk about this because I have
read it in the press--I believe that they were probably
surprised on day 46 that a Cabinet Secretary called the CEO and
said, ``I am concerned.'' That is not government as usual.
Senator Burr. I agree.
Mr. Baker. We must process Agent Orange claims when they
come in and demonstrate that we can do that effectively and
that we can involve the private sector in doing that. I believe
with the path IBM is on right now, they will succeed. I can
assure you they got the message, and they have responded like
you would expect from one of our Nation's leading technology
companies.
We also, however, recognize that in this case, a reasonable
probability of success may not be enough. We may need to have a
back-up system that if for any reason they were not to deliver,
we would have an alternative. We have not yet, to my knowledge,
let that second RFP, but I believe that the motions that we
made that were seen in the public probably are interpreted the
right way, which is we are going to deliver this system.
Senator Burr. We both know we do not have any choice.
Mr. Baker. That is right.
Senator Burr. If we do not, we will have an implosion of
our claims processing, and I dare say we are close to that
today anyway, and we both know that.
The Chairman is being awfully accommodating to me. Let me
move to Mr. Tullman just real quick, because Allscripts has an
extensive experience in electronic health services in the
private sector, and I think you even commented in your
testimony that you had processed, I think, 3.5 million or 3.5
trillion claims?
Mr. Tullman. Million.
Senator Burr. Million. Well, we are in Washington, so----
[Laughter.]
Senator Burr. I wondered if you could talk just a little
bit about the partnerships Delta Health Alliance and the
University of Massachusetts have and what lessons you learned
from that which might assist the VA and DOD efforts in their
quest for a seamless electronic medical records system.
Mr. Tullman. I would start off by saying that clearly the
challenge that the VA has is a larger one than those that we
will talk about with Delta Health Alliance or with University
of Massachusetts. That said, the general principle was we were
not going to put the patient between the interest of various
bureaucracies that might be involved, and those could be--in
both cases, we are talking about a variety of competitors
actually exchanging information based on standards published by
the government and, in fact, exceeding those standards. So what
we have set up is an information exchange, private information
exchanges that are secure. We have asked that each of the
entities put aside the competitive aspects of what they do and
look at the patient.
So I think the biggest message there was we went in with an
objective that said, we have to exchange basic information
across these systems. We have not always been able to use
standard technology, so there we have applied new technologies
from innovative companies like dbMotion, which allows us to
essentially do semantic interoperability, which is allowing
French, German, English all to connect into one virtual patient
record.
So net/net, I think it has been both a technology
accomplishment, and also one, as was mentioned earlier, that
has to do with the politics of what goes on, because large
academic medical centers in a variety of other community-based
organizations do not always want to--it is not a natural act to
communicate, but it has to be in health care. It is too
important a problem. And as you mentioned, we cannot have
especially our young service men and women not have full access
to the information to allow our physicians to make better
decisions.
So we have taken both a technology approach and also a
political approach in terms of managing that and I think that
is the same approach that we will need to take in the
government.
Senator Burr. Thank you, Mr. Chairman.
Chairman Akaka. Thank you very much, Senator Burr.
Mr. Baker, two points about VA's pharmacy program. First,
medication safety is a priority for VA. Second, VA's pharmacy
program is renowned for its delivery system. Many pharmacy IT
solutions are critical, so I have two questions. What is the
status of the pharmacy reengineering project, and has there
been any decision to cut funding for this project? And second,
are you confident that the development for such a program is
now on the right course?
Mr. Baker. Senator, let me answer the second question
first. Yes, I do. Pharmacy reengineering was one of the 45
projects we originally paused. I have frequently said that if
you laid the schedule for Replacement Scheduling next to the
one for Pharmacy and took the names off, you would not have
been able to tell the difference.
Pharmacy, as you point out, is critical to us. What this
application does is enhance our ability to detect drug
interactions and avoid adverse impact from those drug
interactions by using, frankly--by giving us access to private
sector technology that now exceeds what we were able to develop
inside the VA.
We right-sized that project and basically forced it to
start delivering in one hospital. The Charleston, SC, hospital,
is, I believe, the one where it is operational. It is either
now or soon to be at more hospitals, basically following the
same thing that Mr. Munnecke and the VistA developers did in
the early days. Develop it in one, move it to more to prove out
what it does, and then distribute it throughout the
organization.
From a funding standpoint, I would tell you that I believe
we have right-sized the program. I know that we spent $10
million less on it in 2010 than we had planned, but we
delivered functionality to the schedule we established there. I
would tell you that my belief as a computer scientist is that
we could easily have spent that $10 million and gotten nothing
more than we got out of the programs. I do believe we right-
sized it.
I do not have the numbers for 2011 for that program right
off the top of my head, but I believe we have the dollars
allocated for it to move ahead on a path that will continue its
success.
Chairman Akaka. Mr. Baker, with respect to the lifetime
electronic record, what discussions have taken place among
members of the Joint Executive Council about the goal of the
single or shared program that handles DOD and VA electronic
medical records?
Mr. Baker. Senator, I would tell you there are extensive
discussions occurring almost every day on that topic between
DOD and VA. I know that Deputy Secretary Gould, who is the VA
Co-Chair along with Deputy Secretary Lynn of the DOD, has had
discussions on that topic. We clearly would like to achieve
that if possible, but there are mission differences between the
DOD and the VA. The DOD right now is working on their
electronic health record way ahead and I know that our future
path for VistA is one of the options that they still consider
to be a possibility. We certainly consider working with the DOD
on a single record system to be something that we would like to
do and we would like to figure out a way to do. But clearly,
both of us must accomplish our missions as the primary goal.
Chairman Akaka. Mr. Meagher, we have discussed a bit
already about project management, but project management is a
key to successful projects. What changes in IT project
management have you seen within VA? Are these the right
changes? Are more changes needed?
Mr. Meagher. Well, sir, I think the primary difference can
be summed up in leadership and accountability. I think the
substantiation of the PMAS system that Mr. Baker brought to the
Department and the formalization of some of the rules of the
road, these are things that are commonly understood to lead to
success. So when you say you bring these things, you break the
projects up into more manageable pieces. You make sure that
there is a program manager and a business owner associated from
the very beginning. You make sure the funding is adequate to
the task. You make sure the milestones are reasonable and that
they deliver results in our lifetimes so that the technology
does not change while they are on a 3-5-year plan. You are
familiar with how quickly technology does change.
So if you break these into 3- and 6-month increments, you
make sure you have got the right people, you hold those people
accountable, and you make--there is the old saying that ``what
gets measured gets managed''--so you have meaningful measures
built in from the very beginning. Everyone understands. I think
the example that you were discussing earlier about IBM, all of
a sudden, everyone understands that the VA is serious now. They
are not just mouthing platitudes. There will be consequences if
you do not deliver according to the agreed-upon schedule.
Those leadership changes, and then the actual programmatic
mechanics of it that have been put in place, I think have
dramatically changed how VA is now capable of delivering. I
think, as Roger said, you will not see any big failure coming
out of the VA if they stick to the path they are on today. It
will not be possible. If there is going to be any failure, it
will be where they are taking risks, where they are trying
innovative things. If it comes to pass that this is not within
the capabilities or the realm of possibilities given current
circumstances, you shut them down before they become too big to
fail.
So I think the leadership and the focus on personal
accountability, where a program manager knows they will be held
accountable, their career will be affected if they do not
deliver on time and on budget--I think is the biggest change--
and having measured my time at the VA against what has happened
in the last 18 months, I can only applaud the changes that have
been made.
Chairman Akaka. For the other witnesses, what can you share
with us about VA's project management?
Ms. Finn. I will speak from a bit larger perspective. In
project management, one of the things I see as positive is that
when we work now within the Department, we are not arguing with
OI&T or Mr. Baker and his staff about whether or not an issue
exists based on the facts that we find. Sometimes we are
discussing how best to address it, but we do not have
resistance. So that kind of acceptance of input and information
is critical to doing good project management.
Chairman Akaka. Mr. Baker, on a scale of one to ten, what
degree of confidence do you have that VA will make the December
31 deadline for the G.I. Bill Long Term Solution and what
contingency plans are there should that deadline not be met?
Mr. Baker. Senator, as you can imagine, we watch that one
closely. I give at least a nine that we will make a delivery by
December 31. The key question there is the inclusion of the
financial payments interface in that delivery, and I would tell
you that I have good confidence in that. Call that a seven-and-
a-half to an eight. I am an experienced software developer. It
is not going above nine until the customers are using it, as
far as I am concerned. There are so many moving parts in any
software development project of this scale that lots of things
can go wrong. But I believe we have a good degree of confidence
in what we have seen, in our ability to deliver in that area,
and the realism of the project at this point.
Chairman Akaka. In closing, I again want to thank all of
our witnesses for appearing today. As Chairman, it is my
responsibility to make certain that this Committee fulfills its
obligation to conduct oversight of the Department of Veterans
Affairs. How VA conducts its IT development impacts nearly
every program and benefit veterans enjoy today. With the
appropriate technology, management, and attention, I remain
hopeful that VA will continue to be a leader and innovator in
the area of health technology.
I thank you all for participating today. I would also like
to acknowledge three VA leadership participants, Sylvia
Tennent, Trenna Carter, and Timothy Graham, in the room today.
I hope that the skills you have developed will aid you during
your career at VA, especially those that will assist in
improving VA's IT program.
The hearing is now adjourned.
[Whereupon, at 11:12 a.m., the Committee was adjourned.]