[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
ENSURING TIMELY ACCESS:
CHALLENGES IN VA SCHEDULING
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HEARING
BEFORE THE
SUBCOMMITTEE ON TECHNOLOGY
MODERNIZATION
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
__________
THURSDAY, SEPTEMBER 26, 2024
__________
Serial No. 118-85
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
58-232 WASHINGTON : 2026
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COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina MIKE LEVIN, California
MATTHEW M. ROSENDALE, SR., Montana CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa FRANK J. MRVAN, Indiana
GREGORY F. MURPHY, North Carolina SHEILA CHERFILUS-MCCORMICK,
C. SCOTT FRANKLIN, Florida Florida
DERRICK VAN ORDEN, Wisconsin CHRISTOPHER R. DELUZIO,
MORGAN LUTTRELL, Texas Pennsylvania
JUAN CISCOMANI, Arizona MORGAN MCGARVEY, Kentucky
ELIJAH CRANE, Arizona DELIA C. RAMIREZ, Illinois
KEITH SELF, Texas GREG LANDSMAN, Ohio
JENNIFER A. KIGGANS, Virginia NIKKI BUDZINSKI, Illinois
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION
MATTHEW M. ROSENDALE, SR., Montana, Chairman
NANCY MACE, South Carolina SHEILA CHERFILUS-MCCORMICK,
KEITH SELF, Texas Florida, Ranking Member
GREG LANDSMAN, Ohio
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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THURSDAY, SEPTEMBER 26, 2024
Page
OPENING STATEMENTS
The Honorable Matthew M. Rosendale, Sr., Chairman................ 1
The Honorable Sheila Cherfilus-McCormick, Ranking Member......... 2
WITNESSES
Panel I
Ms. Cherri Waters, Executive Director, Health Portfolio, Office
of Information & Technology, U.S. Department of Veterans
Affairs........................................................ 4
Accompanied by:
Ms. Hillary Peabody, Acting Assistant Under Secretary for
Health for Integrated Veteran Care, Veterans Health
Administration, U.S. Department of Veterans Affairs
Mr. Mark Hausman, M.D., Executive Director for Integrated
Access, Veterans Health Administration, U.S. Department
of Veterans Affairs
APPENDIX
Prepared Statements Of Witnesses
Ms. Cherri Waters Prepared Statement............................. 23
Statements For The Record
Questions for the Record Submitted by The Honorable Matthew M.
Rosendale, U.S. House of Representatives, (MT-02).............. 25
U.S. Department of Veterans Affairs Response to Questions for the
Record......................................................... 27
ENSURING TIMELY ACCESS:
CHALLENGES IN VA SCHEDULING
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THURSDAY, SEPTEMBER 26, 2024
Subcommittee on Technology Modernization,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 9:07 a.m., in
room 360, Cannon House Office Building, Hon. Matt Rosendale
(chairman of the subcommittee) presiding.
Present: Representatives Rosendale, and Cherfilus-
McCormick.
OPENING STATEMENT OF MATTHEW M. ROSENDALE, CHAIRMAN
Mr. Rosendale. Good morning. The subcommittee will come to
order. I want to welcome our witnesses to discuss the efforts
to modernize the U.S. Department of Veterans Affairs' (VA)
appointment scheduling process. Ten years after the wait time
scandal, it is still too difficult for veterans to get
appointments in the Veterans Health Administration (VHA) or in
the community. Some members of this committee have been eager
to get into arguments about VHA care versus community care. I
believe veterans should have all the information and the VA
should respect their choices. I was charged with making sure
our veterans get the care that they have earned when they want
it, where they want it, period.
I can tell you, in Montana, community care is an absolute
necessity, but the reality is both systems are still far too
bureaucratic and difficult to navigate. It is also still too
complicated for the VA employees to manage scheduling. These
Information Technology (IT) systems have not been a high
priority, and the projects that are consuming the lion's share
of the IT budget do little to solve the problem. I am glad to
see our witnesses working on the integrated scheduling
solution, the clinical capacity search tool, and the clinic
configuration manager to improve VHA scheduling. I question why
the Department waited so long to start these projects and why
some of them will take so many years to complete, but without a
doubt, the goals are worthy. I expect our witnesses to stay the
course and deliver these systems on schedule and on budget,
which is another big problem that we have had with many of the
IT programs.
Our veterans would have been much better served if the VA
had not abandoned the medical appointment scheduling system,
MASS in 2019. This project had implemented Epic's scheduling
system and patient portal in Columbus, Ohio, and they were
working well. The VA leaders at the time made a special effort
to eliminate it, paving the way for Cerner, a name that we have
had come up in this committee many, many times, not under good
circumstances, to duplicate the work and install an inferior
system. This was a disastrous decision that we are all still
paying for.
I also expect our witnesses to explain how they are going
to fully implement the External Provider Scheduling (EPS)
system, which includes the software of a company called
WellHive. WellHive enables direct scheduling, which means VA
schedulers no longer have to play phone tag for hours to hunt
down open appointments with community care providers. Instead,
they can see each participating community care provider's
scheduling availability in real time on one screen. They can
schedule the veteran's desired appointment with one call.
WellHive's software has proven successful in the medical
centers that have been permitted to use it. According to VA's
own statistics, it has accelerated the overall community care
referral and scheduling process from 26.6 to 17 days. The
status quo phone tag method takes days or weeks and many phone
calls before a veteran can get scheduled. I know many veterans
who are watching this can certainly relate to this problem.
According to the VA's website, WellHive enables staff to
schedule appointments in under 6 minutes. The medical center
employees have given it rave reviews during the committee
staff's oversight visits. It seems to be working, yet we
continue to see VA make confusing decisions that hold the
project back. Early on, there were caps on how many schedulers
at each medical center could use WellHive. More recently, the
company has complained that its efforts to sign up new
healthcare providers are restricted. Now VA tells us that
WellHive's system will be turned off in four medical centers
where it was already implemented, and the planned rollout in
Fiscal Year 2025 will be dramatically scaled back.
I am well aware of the VHA budget shortfall. I think the
House made the right decision yesterday to get a complete
explanation of the shortfall rather than to hand over a $12
billion supplemental appropriation right away. I have no doubt
that Congress will get to the bottom of the situation and
prevent any veterans' care from being disrupted. That being
said, it would be incredibly short sighted to cause lasting
damage to this project with budget cuts that will quickly
disappear everywhere else. I have serious concerns that the
current leaders of the Department of Veterans Affairs might be
intentionally undermining this project and making veterans'
health care slower and more difficult out of political
hostility to community care. I hope that is not the case.
Today we are going to dig into these decisions and the
thinking behind them because veterans' appointment scheduling
is too important, and the status quo is too broken to let any
of the projects we are discussing today slip into failure or
neglect. With that, I will yield time to Ranking Member Sheila
Cherfilus-McCormick for her opening statement.
OPENING STATEMENT OF SHEILA CHERFILUS-MCCORMICK, RANKING MEMBER
Ms. Cherfilus-McCormick. Thank you so much, Mr. Chairman,
and thank you so much to our witnesses for being here today.
This subcommittee has spent a lot of time discussing VA's
transition to its new Oracle Electronic Health Record (EHR).
Lost in the conversation has been the Veterans Health
Administration's critical need for a new appointment scheduling
solution. Appointment scheduling is the foundation of veteran
access to care, the current process and the system that support
it. Weeks or months to the time that the veterans wait for
their critical medical appointments. This should not be the
case. Instead, we should be creating solutions that provide
better visibility to care. Whether it is sought at VA or in the
community, veterans deserve as much.
For more than 20 years, VA has attempted to modernize or
replace its scheduling IT system. It has been decades of
modernization efforts with little to no success. In fact, most
of the efforts have been abandoned. In just the last 10 years,
we have seen four partial efforts to create this functionality
for veterans, all of which have suffered from the same feeling
as most of VA's IT modernization struggles--poor requirements
development. In 2014, VA updated Veterans Health Information
Systems and Technology Architecture (VISTA) legacy by
developing a graphical user interface, or GUI, and automated
some of the scheduling rules. The project, dubbed VistA
scheduling enhancement (VSE) for VSA, did not address data
quality issues and did not bring VA much closer to the then
current state of healthcare information systems, effectively
putting lipstick on a pig.
In 2015, VA has changed directions and contracted for 624
million to implement a commercial off the shelf or COTS
scheduling system the medical appointment scheduling system
MASS, which has later downgraded to a pilot. By all reports,
including VA's own assessment, that pilot was a huge success.
VA found increasing scheduling system efficiencies, improved
timely access to services for veterans, increased productivity,
and a substantial decrease in overtime. However, 8 months after
the implementation of MASS and the signing of a contract with
Cerner, now Oracle Health, VA halted the pilot.
In 2019, VA shifted again, announcing plans to implement
the scheduling solution that it had purchased as part of the
Cerner contract, known as the centralized scheduling solution,
or CSS, but on a separate and accelerated deployment schedule
from the rest of the electronic health record. The plan at the
time was to have the Cerner application deployed by 2023. This
plan, similar to VSE and MASS, was also abandoned. Instead, VA
has spent the past 5 years developing its own software. The
integrated scheduling solution, or ISS, a system that is
currently being scheduled, will now take as long or even longer
than planned CSS timelines and is being developed and deployed
only to eventually be replaced by CSS anyway.
I still do not understand the logic behind this. It seems
like a waste of time, energy, taxpayer money to be spent 5
years developing something that would presumably be replaced in
the next 10 years, especially when called systems have already
been tested and integrated at VA, with some success. Further,
despite these efforts, the ISS is still unable to compare
direct care schedules to availability in the community,
something it desperately needs as community care referrals
continue to rise. The exploiting community care cost is having
dire impacts on VA's budget, especially as community care is
more expensive than VA direct care. If we do not find a way to
balance it, there may not be a VA for future generations of
veterans. While community care is valuable resource for
ensuring that veterans have access to the care they need, VA
lacks the ability to prove that veterans could be seen faster
in community care than they can at VA.
In fact, in a broader swath in the country, VA's access is
better than that of the community. Central to the oversight of
this committee provides is ensuring that veterans, whether they
are seen as VA or in the community, have access to health care
that is both timely and high quality. Without visibility into
the community, we are not able to make these quality assurances
for veterans as they deserve. I urge VA to implement a solution
that allows for apples-to-apples comparisons between VA care
and community care. Veterans should be able to make decisions
about their healthcare with the full breadth of information
available. Thank you to our witnesses and I yield back.
Mr. Rosendale. Thank you very much, Ranking Member Sheila
Cherfilus-McCormick. I will now introduce the witnesses on our
first and only panel.
First, from the Department of Veterans Affairs, we have Ms.
Cherri Waters, Executive Director for the health portfolio in
the Office of Information and Technology (OIT). Welcome back,
Ms. Waters. From the Veterans Health Administration, we have
Ms. Hillary Peabody, the Acting Assistant Under Secretary for
Health for Integrated Veteran Care (IVC). Finally, we have Dr.
Mark Hausman, the Executive Director for the Access
Transformation in the Office of Integrated Veteran Care. If you
all could please rise and raise your right hands.
Do you solemnly swear, under penalty of perjury, that the
testimony you are about to provide is the truth, the whole
truth and nothing but the truth? Thank you very much and let
the record reflect that all witnesses have answered in the
affirmative.
[Witnesses sworn.]
Mr. Rosendale. Ms. Waters, you are now recognized for 5
minutes to deliver the opening statement on behalf of the VA.
STATEMENT OF CHERRI WATERS
Ms. Waters. Good morning. Chairman Rosendale, Ranking
Member Cherfilus-McCormick and distinguished members of the
subcommittee thank you for the opportunity to testify on the
Office of Information and Technology and Veteran Health
Administration's efforts to modernize the Department of
Veterans Affairs scheduling systems. I am accompanied by my
colleagues from VHA, Ms. Hillary Peabody, Acting Assistant
Under Secretary for Integrated Veteran Care, and Dr. Mark
Hausman, Executive Director for Access Transformation, IVC. I
am honored to highlight the collaborative efforts that are
transforming the future of veteran care.
VA's enterprise scheduling modernization effort, a joint
endeavor between VHA and OIT, is a testament to our commitment
to streamline and enhance VA scheduling systems. To provide the
best outcomes for veterans, VA must invest in modern scheduling
tools that offer near term benefits and ultimately facilitate a
long-term scheduling solution. The introduction of new
functionalities through VA's modernization efforts is a
significant step toward improving access to care for veterans.
The ability to schedule both virtual and in person
appointments, consolidate scheduling functions, and implement
provider-based scheduling is pivotal in aligning VA scheduling
systems with industry standards. These enhancements are
designed to provide greater flexibility and efficiency in
scheduling appointments, ultimately connecting veterans with
the best available resources for their needs.
One of the key tools driving this effort is the Integrated
Scheduling Solution, ISS, which represents a significant
improvement from our legacy system VistA scheduling enhancement
graphical user interface, or VSE GUI. ISS streamlines the
scheduling process, offering a more integrated and intuitive
platform for VA staff to schedule various appointment types
across multiple sites of care. Transitioning users from VSE GUI
to ISS is in progress and is expected to be fully completed by
February 2025, representing a significant milestone in our
journey toward a more cohesive scheduling system. We have
already received significant staff praise during the initial
testing and implementation. The Clinic Capacity Search Tool,
CCST, and the Clinic Configuration Manager, CCM, are enhancing
the scheduling experience for veterans by providing quicker
access to care, reducing discrepancies and increasing
efficiency.
CCST currently allows VA staff to quickly search and view
telehealth appointments across multiple facilities. Starting in
January 2025, we will begin rolling out enhancements to CCST
that will enable staff to view appointments for both telehealth
and in person visits. Furthermore, we are working on
enhancements to CCM for managing the provider's appointment
availability. These enhancements will enable the implementation
of provider-based scheduling across VA, providing a unified
view of provider availability and significantly streamlining
the scheduling process. In support of community care, the
External Provider Scheduling platform simplifies the process of
connecting veterans with community care providers. EPS enables
VA staff to directly schedule community care appointments
electronically, enhancing coordination and ensuring timely
access to care.
As we look toward the future, our focus remains on
improving timeliness, ensuring veterans receive the best
available resources, and enhancing coordination between VA and
community care providers. These efforts will ultimately
converge under the ISS platform, which will integrate multiple
scheduling tools into a single, streamlined experience across
the enterprise. This will provide veterans with faster access
to care, whether through VA facilities or community providers,
while simultaneously reducing the administrative burden on VA
staff.
Chairman Rosendale, Ranking Member Sheila Cherfilus-
McCormick, and members of the subcommittee, thank you for the
opportunity to appear today. We are proud of the progress we
have made and remain committed to continuing this journey of
improvement for the benefit of our veterans and the dedicated
staff who serve them. This concludes my testimony, and I look
forward to answering your questions.
[The Prepared Statement Of Cherri Waters Appears In The
Appendix]
Mr. Rosendale. Thank you, Ms. Waters the written statement
of Ms. Waters will be entered into the hearing record. We are
now going to proceed to questioning and I will recognize myself
for 5 minutes. Ms. Waters, how is the clinical capacity search
tool going to make the appointment scheduling process easier
and better?
Ms. Waters. Thank you for that question, Chairman. The
clinical capacity search tool will allow a staff scheduler to
be able to see available appointments across multiple sites in
a single unified view. Currently, this is available to see all
telehealth appointments. As I mentioned in my opening
testimony, in January 2025, we are rolling out the next
enhancement to CCST, which will allow you to see schedules
across multiple sites.
Mr. Rosendale. What are CCST's capabilities today, and when
do you expect the system to be fully functional? Fully
functional is a term that I have been using since the day I
arrived in Washington, and we have not had it, experienced it
anywhere in anything. That is the big part of this.
Ms. Waters. I appreciate the question. It is very difficult
when we talk about IT tools to talk about what is fully
functional. One of the things that we do is we look----
Mr. Rosendale. Where all of the features that are being
promised by the vendor are fully functional. They are working,
they are available, they are ready.
Ms. Waters. As I mentioned, the current state of CCST
allows you to see available telehealth appointments across the
enterprise. In January 2025, we are rolling out the next
enhancement, which will allow us to see available in person
appointments in that same unified view.
Mr. Rosendale. Will all the features then be functioning?
Ms. Waters. Again with IT systems it is always our hope
that we are continuously making incremental improvements, and
we will be working with our partners in IVC.
Mr. Rosendale. I will take that as a no. All of the
features will not be fully functional in January 2025?
Ms. Waters. All of the features that we have defined today
will be available in January 2025. That is correct. We are
always looking for opportunities to enhance and improve things.
Mr. Rosendale. You just began rolling out the integrated
scheduling solution this month. Will it improve the scheduling
process and what are its initial capabilities?
Ms. Waters. Yes, so ISS is going to vastly improve the
ability to schedule appointments. ISS is initially designed as
a replacement for VSE GUI, but we are already seeing incredible
improvements with this tool. Examples of this include the fact
that it is designed to be in a web browser, so it is got a much
more modern user interface. It is not dependent on a desktop
application, so it runs faster for the scheduler to be able to
utilize, and it allows them to then move from one VistA system
into another VistA system to schedule appointments without re-
authenticating. It makes that experience much better for the
user. The redesign of the system also makes it much easier for
us to do enhancements to the system because it is no longer
dependent on a desktop application that will sit on 600,000
desktops. We are not beholden to that as we want to do
incremental enhancements and do improvements to the project.
Mr. Rosendale. What will its full capabilities look like
and when will those be implemented throughout VHA?
Ms. Waters. Again, with IT systems, we are hoping to always
build requirements and do enhancements to it. Right now, on our
roadmap for ISS, not only do we have the ability to schedule
across multiple facilities, we will be working to integrate the
view from the CCST tool and to work on the ability to schedule
external provider appointments or through EPS through the ISS
platform.
Mr. Rosendale. When do you expect all of this to be
implemented throughout VHA?
Ms. Waters. I do not have that date at this point. We are
still working on the requirements that we need to refine that
date, but I am happy to come back and brief you on that.
Mr. Rosendale. Thank you. Thank you very much. Ms. Waters,
why are these two systems, CCST and ISS, being developed
separately, and what will it entail to eventually combine them?
Ms. Waters. They are being developed separately at this
point, it allowed us to do a much more rapid glide path to
build those tools out. They use the same back-end
infrastructure and architecture and refer back to the back end
EAS system. It was simply for ease of convenience and the
ability to rapidly deploy them that we did them separately with
the full intention to combine them in the future.
Mr. Rosendale. Okay, thank you very much. I will yield
back. I now recognize Ranking Member Sheila Cherfilus-McCormick
for 5 minutes of questioning.
Ms. Cherfilus-McCormick. Thank you, Mr. Chairman. Ms.
Peabody. At this subcommittee's last hearing on VA's patient
scheduling IT system, the witnesses discussed VA's plan to
separate CSS from the rest of the Cerner suite of applications
and deploying in ahead of the rest of the EHR. That plan was
abandoned during the pandemic, and I am still unclear as to
why. What is the VA's logic for choosing to develop another
homegrown solution versus deploying the tool that the
department had already purchased?
Ms. Peabody. Thank you for that question, Ranking Member. I
am actually going to hand that one to Dr. Hausman.
Dr. Hausman. Thank you, Ranking Member. Yes, in Columbus,
the central scheduling solution, or Cerner based scheduling
solution, was implemented in August 2020, and following that
implementation an evaluation was performed. Ultimately, the
decision based on the evaluation was that while this can work
layered on a VistA electronic health record, the cost and the
disruption to clinical operations outweighed the value gained
by moving forward with this strategy. Specifically, in order to
implement the scheduling solution thousands of clinics had to
be rebuilt and reconfigured in a way that is compatible with
Cerner, which puts capacity limitations and access limitations
on the medical center for weeks to months to get this done.
One other point is there is an incremental cost with
licensing with this, so there would be additional expense to
license the scheduling product across the enterprise. In
summary, the thought was instead of having two disruptive
events implementing scheduling, Cerner scheduling, and then
later implementing the Cerner EHR, it made more sense to
implement both at the same time.
Ms. Cherfilus-McCormick. Are you not doing the clinic
rebuild for ISS?
Dr. Hausman. We are not. ISS is currently, as of this
month, being deployed in its initial phases, and that
deployment is going to run over the next 5 months. We are able
to seamlessly integrate this version of ISS with all existing
VistA clinics.
Ms. Cherfilus-McCormick. What would the cost difference be
between the, what would the cost difference have been before
been for VA to deploy CSS versus the development of ISS?
Dr. Hausman. I do not have those figures. That is something
we can take back and get you an answer.
Ms. Cherfilus-McCormick. What was the decision-making
process for this strategy and who ultimately made that
decision?
Dr. Hausman. I think that is another question we will need
to take back to get you the right answer.
Ms. Cherfilus-McCormick. Ms. Waters, VA has a long history
of IT. Modernization efforts suffering from the lack of
effective project management and requirements development does
not meet the VA's needs. How does the planning for a Cerner
scheduling solution deployment differ from what has been going
on in the past?
Ms. Waters. I am not sure, and let me please clarify. Are
you speaking to the Cerner scheduling deployment or the
integrated ISS scheduling deployment?
Ms. Cherfilus-McCormick. ISS.
Ms. Waters. Thank you for that clarification and thank you
for the question. One of the things that we are trying to do
with ISS is adopt an incremental approach. That is again, goes
back to that answer of fully deployed versus deploying a tool
and then making enhancements to it. We firmly believe that when
we do an incremental approach the way that we are doing, you
will see a quicker rollout and adoption across the enterprise
that then allows us to move the organization with each
enhancement that we deploy.
Ms. Cherfilus-McCormick. How does the VA plan to avoid or
mitigate the risk of outcomes similar to the past failed IT
projects?
Ms. Waters. What I can say is that we are working very
diligently in a collaborative effort in IT with VHA to work
together. With any one of these implementations, it really
requires movement in both people, process and technology. If
you only move one of those things, you are likely to suffer
failures.
Ms. Cherfilus-McCormick. There is no plan? My time is
running out, so there is no plan?
Ms. Waters. I guess I am not sure that I understand your
question.
Ms. Cherfilus-McCormick. You do not have a plan to avoid
and mitigate the past failures?
Ms. Waters. Our plan to mitigate the past failures is to
ensure that we are working in a collaborative format, doing
incremental improvements so that we can ensure success at every
step along the way. I think we are demonstrating that with our
current rollouts.
Ms. Cherfilus-McCormick. You have made an assessment of all
the failures and now have committed to avoiding that?
Ms. Waters. I cannot speak for what happened before me, so
I cannot say that we have done an assessment of all the
failures. Certainly, we do have an understanding of why we have
stepped away from other solutions.
Ms. Cherfilus-McCormick. Thank you. I yield back.
Mr. Rosendale. Thank you very much. Ms. Waters, we just
touched on, and Dr. Hausman just touched on, the MASS medical
appointment scheduling system Ranking Member was asking about.
I do want to make sure that we get the information on the
record about what the thought process was and who was
responsible for the decision to end that system. That is very
important. We will be looking for that information to come back
to us. Dr. Hausman, could you briefly describe the steps the VA
schedulers go through to schedule veterans' community care
appointments without WellHive?
Dr. Hausman. Yes, Mr. Chairman. It starts with a referral
or a request for care, and from there we have referral
coordination teams that evaluate that request to determine if a
veteran is community care eligible based on access standards.
Once eligibility is determined, a veteran is offered community
care, the best community care option we can find, as well as
the best VA option that we have. If a veteran opts into
community care, then we begin the process of collecting
preferences. Where geographically would you like to see your
provider? What days and times tend to work best for you? Those
types of things.
From that point, we begin the process of telephoning. We
need to reach community provider offices to determine if they
have available appointments, when those appointments are
available. We, of course, target that search based on the
preferences the veteran gives us. That really can be one of the
areas for delay in getting veterans appointed to the community
is the need to have synchronous communication through a
telephone, and that could take some time.
Mr. Rosendale. If anybody was trying to create a flowchart
just now on that process, it did not really look good. Okay.
From my standpoint, because there is a long, long path before
the veteran actually gets that care. Okay. Where we need to get
a more direct path, if you will. How long does this process
take with and without WellHive?
Dr. Hausman. This last quarter, quarter three of this
current fiscal year, we are scheduling veterans from the moment
in time care is requested to when they are first appointed in
the community in just over 21 days. If you look at a head-to-
head comparison of scheduling veterans to like care using our
traditional process versus WellHive, it is about a 26 day with
a traditional process versus 17 days with WellHive. That is the
difference. Substantial time savings and improvement in
timeliness with using the EPS solution.
Mr. Rosendale. Okay. On average, how many community care
appointments are VA staff able to schedule per day using
WellHive versus the current system?
Dr. Hausman. Using the WellHive software, a trained, season
scheduler can schedule upwards of 20, maybe 25 appointments per
day.
Mr. Rosendale. Without?
Dr. Hausman. About eight appointments.
Mr. Rosendale. About eight. Okay, what are the VA
schedulers saying about WellHive, either in surveys or
anecdotally? What kind feedback are you getting?
Dr. Hausman. You know, the feedback for those that have
used the system, which is now numbers in the hundreds, has been
uniformly positive. I think the greatest challenge is having
appointments available in this system. In other words----
Mr. Rosendale. If slots open, availability.
Dr. Hausman. In the right specialties for the right type of
care. That is correct.
Mr. Rosendale. Okay. Okay. Please explain what File Entry
Date (FED) to first appointment means.
Dr. Hausman. File entry date is the moment in time when
care is requested by a veteran, or in the event of a primary
care provider and a veteran generating a referral for specialty
care. It is that moment in time that referral is generated.
That is file entry date. First appointment is the moment in
time when the appointment for that care is scheduled.
Mr. Rosendale. Okay. One of the things that I have seen in
the past is that the first appointment date sometimes gets
skewed because it gets canceled, and then the initial
appointment for the veteran gets transferred out and
transferred out, sometimes several times, so that their true
first appointment may not be for many months after that. I
would really like to see if there is some way that we can get
more of an accurate reflection of those times as well.
Not just the first appointment date, when it is set, but
when it is actually experienced, if you will. Okay. When it
takes place, so that we can see the true timeframe between when
they contact and when they are getting that. That initial care
for healthcare. Okay, I am close enough. I will go ahead and
yield time to the Ranking Member.
Ms. Cherfilus-McCormick. Thank you. Ms. Waters. I cannot
help but recall your response of not knowing what happened
before you were there. It just makes me feel like if we do not
understand the mistakes we did in the past, then we are capable
of repeating it. The committee really wants to make sure that
implementation going forward is not repeating the mistakes of
the past. You know, hopefully we can get back and you guys can
actually take a real good assessment of that, and we can make
sure that we are not repeating that.
My next question is also for Ms. Peabody. What is the OIT's
role in the ISS role in the ISS project?
Ms. Peabody. Thank you for that question. I will start and
then I will ask Dr. Hausman to add on, because really, it is
his team and Ms. Waters teams that have been working in the
trenches together on this. OIT has been a really valuable
partner for us in VHA. Dr. Hausman's worked very closely in
partnership with our colleagues in OIT to actually stand up a
very unique governance structure where we have a working group
that includes our OIT counterparts and key VHA stakeholders,
and they are working hand in hand to develop that scheduling
roadmap.
OIT's role, coming back to your question, is really to take
the business requirements that VHA puts forward and help us
design the solution and then be able to fund that. Anything to
add, Dr. Hausman?
Dr. Hausman. Thanks, Ms. Peabody. That is correct. A strong
partnership between VHA and OIT on this project is critical. I
believe we have a strong partnership in place. We set the
requirements, we set the priorities. We do the testing of the
initial versions of the product, the user acceptance testing.
We also do the training, deployment, change management. OIT
takes our requirements and our prioritizations and develops
these products or enhances the products. Also, those
prioritizations and requirements inform the roadmap for the
timing for some of these bigger milestones that we are working
toward.
Ms. Cherfilus-McCormick. Is OIT's is role prominent enough
to support solid project management and to help prevent. Oh,
Ms. Waters, is OIT's role prominent enough to support solid
project management and to help prevent previous mistakes?
Ms. Waters. Thank you for that question. Please also let me
clarify that my answer when I reflected that I personally was
not aware of some of those challenges and decisions that were
made in the past, rest assured that there are strong teams
behind me in OIT that are very aware of them and are taking
them into account. I probably misspoke when I said I was not
aware of them.
Let me also share that on this initiative, it is critical
that we have strong PM's available and working with the team,
and we have teams that are working day in and day out with Dr.
Hausman and his team that are dedicated to making this effort a
success.
Ms. Cherfilus-McCormick. How is the requirements
development for this project different from VA's previous
struggles to modernize patient scheduling applications?
Ms. Waters. Again, with this adoption that we are doing, we
are doing it in a collaborative, shoulder to shoulder format,
day in and day out, working with our partners to ensure that we
are doing it together.
Ms. Cherfilus-McCormick. Wonderful. Ms. Waters, you are
leading your teams, correct?
Ms. Waters. That is correct.
Ms. Cherfilus-McCormick. As a leader of your teams, do you
feel like you should be aware and do that analysis for your own
knowledge to lead your team?
Ms. Waters. Yes, of course. I also trust my teams and the
leaders that I have on my teams.
Ms. Cherfilus-McCormick. Thank you, Ms. Peabody. I
understand that VA is rethinking a strategy for the external
provider scheduling project that you are looking at, pairing
back the number of sites using the EPS tool. What is the VA's
goal in this reformatting effort?
Ms. Peabody. Thank you for that question. Our goal is
really to take the lessons that we have learned from the first
two phases of the rollout this year and refocus our strategy to
secure more success. One of the biggest challenges that we have
had in rolling this out is getting enough providers enrolled on
the platform so that the scheduler, when they log into the EPS
system, they can actually find a provider and they are not
having to then revert back to the standard processes of looking
for a provider elsewhere.
Ms. Cherfilus-McCormick. How many facilities are using EPS?
Ms. Peabody. I will tag that to Dr. Hausman.
Dr. Hausman. 16 facilities are currently live on EPS.
Ms. Cherfilus-McCormick. All right, thank you. I yield
back.
Mr. Rosendale. Thank you, Dr. Hausman. I want to go back to
the file entry date, first appointment issue again. With all of
this advances in technology and improvements that we are
making, is it true that the goal was recently changed from
seven to 14 days to actually extend it out?
Dr. Hausman. For community care appointments? I know there
was discussion on changing that goal. I am not sure if that
decision has yet been made.
Mr. Rosendale. If we are having improvements, Ms. Waters,
and things are flowing better and we are making all these
investments in the technology, that just seems counterintuitive
to me that if it is working well, if we are making
improvements, that we would be setting the goal out longer,
doubling it, literally doubling it from seven to 14 days. Have
you seen that information? Are you telling me that you have not
seen and participated in discussions in that regard?
Dr. Hausman. I will defer to Ms. Peabody to answer that,
sir.
Ms. Peabody. Thank you for that question. I want to clarify
that these metrics, when we are talking about FED to first
scheduled, that is what we call internal schedule timeliness.
It is very different from wait times. Now, both of those
measures are important for us to track and monitor within VHA,
and we set goals around that schedule timeliness because that
is really our measure for our schedulers within VHA to be able
to do the piece of this that is their responsibility.
We have been exploring changing what are those goals. We
had some very strong feedback and a report from the U.S.
Government Accountability Office (GAO) several years ago, and
we have had an open recommendation to relook at that schedule
timeliness metric and to reconsider it to something that is
more realistic for our facilities. We have undertaken through
our access committee, a look at different options for that we
have recently just brought up through the VHA governance
structure.
Mr. Rosendale. Okay, so Ms. Peabody, you have seen this
recommendation then, or consideration from the seven to 14
days?
Ms. Peabody. Yes.
Mr. Rosendale. Okay. Again, counterintuitive to everybody
that is sitting in this room. If we are making improvements, if
we are making investments and everybody is telling us that we
are making these strides toward a smoother system, why would we
not be taking the goal and pushing it the other direction? This
just does not make sense to me that we are talking about
extending it, doubling it from seven to 14 days.
Ms. Peabody. Thank you for that question. I would add there
are some nuances and we can take it back for the record to get
you the specifics of what we are looking at changing in that
metric.
Mr. Rosendale. Why has it changed? Whether it is Dr.
Hausman or Ms. Peabody, why would they change this number
again, if we are making improvements?
Ms. Peabody. We have looked at different options for
changing that measure in several different ways to measure
that. What is most important is that for any urgent consults,
our measure continues to be that those need to be scheduled
within 2 days. I looked at that measure this morning, and we
are sitting at 100 percent of those. For those non urgent
consults, we do want to allow our schedulers enough time to be
able to make contact with the community provider and with the
veteran to schedule that. We have----
Mr. Rosendale. Okay, working on my time here. I just do not
understand. Okay. As a person who has always had his
compensation based on performance, how in the world you can
never expect better performance if you set the goal lower. That
just is, again, it is counterintuitive. If you take the goal
and you make it lower, that matrix. You are never going to
improve the situation. If you set goals that are less than what
you have now, standards that are lower than you have now, how
are you ever going to make an improvement? It just does not
work. You have a section touting external provider scheduling,
aka WellHive, on your community care network page, on your
information website for providers. Does the department endorse
this system and encourage community care providers to sign up
and use it?
Ms. Peabody. We do encourage community care providers to
sign up for our external provider scheduling platform.
Mr. Rosendale. Okay, what is the process to solicit and
recruit providers into external provider scheduling, Ms.
Peabody?
Ms. Peabody. If I could, I would like to hand that to Dr.
Hausman.
Dr. Hausman. Thank you, Mr. Chairman. The process begins
with selecting from our community care provider network of 1.3
million the highest potential providers with whom to engage,
and engaging with them to explain the program, explain the
value of the program, the importance of this program, the
vision. Then from there discuss, make sure we get with the
right decision-makers and discuss the process. How does a
community provider system participate in this? We get into the
technical requirements and then from there, if we have an
agreement, we do the process of onboarding, which actually is
the technical integration of their schedules into our WellHive
user interface.
Mr. Rosendale. My time is expired. Ranking Member, I yield
5 minutes for questions.
Ms. Cherfilus-McCormick. Thank you Mr. Chairman. Ms.
Peabody, what do you believe is limiting provider enrollment in
EPA in EPS?
Ms. Peabody. The thank you for that question, as Dr.
Hausman was just articulating, the longer piece of the
onboarding is actually that technical integration, and there is
a fair bit of work on the provider. The provider has to have
the ability to actually know their appointment availability and
to be able to pass that into our system and be able to do that
technical integration with our team that can be very lengthy
and a significant investment of time for them.
At this time, we have not put in place any types of
incentives or run this through our community care network
contract. We have done a significant amount of market research
actually through our CCN next generation contract recompete
efforts to gather some market research on how do we actually
incentivize providers to do that. We have received a good
amount of feedback on what that would look like. As we look
further on down the road, how we will make this successful, we
know that we are going to have to have some sort of carrot, if
you will, for providers.
Ms. Cherfilus-McCormick. Also, when we took a look at it,
South Carolina was successful, whereas Orlando really
struggled. One of the different factors we saw was that the
staff and the providers were more involved, and so really
supporting the system made a huge difference. We did not see
that in Orlando. Is the VHA properly supporting their
enrollment efforts?
Ms. Peabody. Yes, we have made this a priority, and in
fact, this has been an initiative that myself and Dr. Hausman
have briefed several times to our governance board, which is
VHA's highest governing body. We have got full support behind
this. It is just important that we really step back and take
some of those lessons we have learned over the last several
months and pivot a little bit in that approach, because we need
to do that to make it successful.
Ms. Cherfilus-McCormick. The lessons that you learned from
doing the analysis of these two sites, that has not been done
yet, the analysis?
Ms. Peabody. Yes, that has been done, and our refocused
strategy is a direct result of that analysis.
Ms. Cherfilus-McCormick. Can you tell us some of the pieces
that you are plugging in to make sure that they are actually,
that other clinics do not have this kind of struggle?
Ms. Peabody. I will start and then I will ask Dr. Hausman
to help fill in any gaps here since he has been leading this
effort. The biggest thing that we have learned is that when we
try to do this big bang approach across the entire system, it
is a pretty significant level of effort for us to do that
provider outreach and start integrating each of those
providers. When we initially took this approach of let us just
do it everywhere at the same time, we found that we got several
providers here and there, and it was sort of a smattering. When
the scheduler logs into the system, if there is only a handful
or a few handfuls of providers, they are having to go back and
forth between systems, and it is impacting the trust that they
have in the data that is in that system. We feel taking that
focused approach so that we can really, really do it well at a
few sites and then be able to expand from there, that is going
to be more successful.
Ms. Cherfilus-McCormick. Thank you. Also, is VA planning on
pulling the tools from any facilities?
Ms. Peabody. Yes.
Ms. Cherfilus-McCormick. What is the long-term plan for
EPS?
Ms. Peabody. Dr. Hausman, do you want to address that?
Dr. Hausman. Yes, I am happy to. Thank you. We do see EPS
as the enterprise solution for community care scheduling. At
the end of the 2025 fiscal year, we intend to have EPS live in
approximately one third of our VA medical centers. That is
about 50 sites across the enterprise in focused regions. We
anticipate being successful. What I mean by that is attracting
and enlisting the participation of a large number of larger,
higher volume community care providers into this program over
the next year and then booking more appointments through EPS.
Specifically, we are looking at least a tenfold increase in
provider participation as well as appointments booked compared
to what we are looking at this year. That is how we define
success for next year. Now beyond 2025, we intend to continue
to roll this out across the enterprise to the other medical
centers and other Veterans Integrated Service Networks (VISN)
that are not part of the 25 plan.
Ms. Cherfilus-McCormick. Thank you. I yield back.
Mr. Rosendale. Thank you very much. Ms. Peabody, what is
the process to solicit and recruit providers into the external
provider scheduling?
Ms. Peabody. Thank you for that question, Chairman. We have
both a team within Dr. Hausman's team as well as a vendor that
we have been using to support some of those onboarding efforts.
We take several steps in this process. One, our team has been
traveling to conferences, doing webinars, posting in our
newsletters just to get the word out. Then the provider that is
interested can reach out to us and our team will start that
process of onboarding and walk them through that.
Mr. Rosendale. When you were talking earlier about focusing
your attention instead of trying to do just what I will call a
shotgun approach and cover the whole country focusing in, and
we are going to use a rifle and a scope and we are going to
zero in on some areas and concentrate the effort to try and get
those providers. That is starting to make a little bit of sense
to me. Is that why there is such a discrepancy in the number of
participating providers in WellHive, in, say, South Carolina,
which has numerous, and Montana, which has a couple of dozen.
Ms. Peabody. Thank you for that question. Yes, I would
agree with that assessment. I think in some areas, if we are
able to get the affiliate or one or two of the large hospital
systems, this works really well in more urban areas where you
have one hospital system, you can bring that whole system in.
It has been really successful. In areas like Montana, it is a
little more sparse.
Mr. Rosendale. It is rural. That is exactly right. What is
the thought process or how are you identifying where to focus
those resources, okay. To go in and recruit and get these
providers listed? You know, what does that list look like and
what is the criteria that you are using?
Ms. Peabody. Yes, so I will start and Dr. Hausman will
definitely help make sure I do not miss anything here. We
started actually by sitting down with our CCN contractors and
getting some feedback from them because it is their network of
providers predominantly, and so they know which providers are
most likely to be open to doing this. The team actually focused
which VISNs and medical centers where, you know, we would go
next around some of that feedback. We also gathered that just
from our own experience. We have to consider just where is
their appetite to do this. This is very leading edge kind of
stuff. The private sector, you do not see a whole lot of this.
We are starting to get there with more providers being willing
to open up their clinic grids and do the work to integrate into
some of these.
Mr. Rosendale. I have to stop you. The one concern that I
have is that what is the input from the actual patient? What is
the input from the veterans themselves? If we start basing too
much of our information on these large providers, forgive me
for using the term, but there is a medical industrial complex
out there. They will try to completely dominate the services.
As a former commissioner of securities and insurance, I can
tell you that every single study that has ever been put out
shows that the bigger the organization is, the bigger the
administration is, the bigger the corporation, the medical
corporation is, that the lower the quality of care is and the
higher the cost is. I need to hear something that says we are
talking to those veterans, especially in the rural communities
like Montana, that maybe are not going to have access to a
large facility, that we have a team that understands this and
is going to go out and recruit and sign up physicians that the
veterans want to access.
Ms. Peabody. Thank you for that question, Chairman. Yes,
absolutely. In fact, our team did, I am sure you are very
familiar with Veterans Signals (VSignals). That is how we get
the most, a big portion of our feedback from veterans. We
actually rolled out a VSignal specifically for EPS, and we got
some really, really impressive results. We are continuing to
get that feedback from veterans as well.
Mr. Rosendale. Again, what would it look like to have a
team if we are going to go out, and I understand we have the
electronics and everything, but to actually have a team to go
out and start trying to go around to these areas that not
necessarily are urban, the very rural areas and start getting
some, some providers to sign up.
Ms. Peabody. Thank you for that question. We do have that
in place today, and that is that separate vendor contract that
is supporting us with going out and doing that onboarding. Then
we are also looking at options perhaps in the future to be able
to leverage our CCN contractors to help us with that.
Mr. Rosendale. Okay, thank you. I yield back and recognize
the Ranking Member.
Ms. Cherfilus-McCormick. Thank you, Ms. Peabody. As I said
in my opening, I am convinced that VA must address the lack of
a fully integrated scheduling solution. We are extremely
concerned by the exploding community care costs. I am
particularly concerned that much of the cost may be
unnecessary, but VA cannot prove that, as they cannot compare
access in apples-to-apples manner. What is the VA's plan to
address this shortcoming?
Ms. Peabody. Thank you for that question. VA is committed
to making sure that the care that our veterans are getting in
the community is clinically appropriate and that they are
getting that care at the right time and place. Since I stepped
into this role as the Acting Assistant Under Secretary for
Health for Integrated Veteran Care in February, I actually
spent some time resetting what our mission statement is and
what our three priorities are as an office. One of those three
priorities is ensuring that when our veterans do go out to the
community, that the care that they are getting is high value
care. We would be happy to do a briefing on several of the
initiatives that we are doing, but that includes making sure
that we have a high performing provider network, and we are
able to see where the providers that are in our network are
actually highest performing and have the best quality measures
and be able to give that information to our veterans. That also
includes doing a more robust utilization management program in
the future.
Ms. Cherfilus-McCormick. Thank you. The vendor who supports
the EPS, the project has this capability. It was part of the
pilot program. Why did the VA choose to shut it down?
Ms. Peabody. Thank you for that question. VHA has not
chosen to shut down. In fact, based on the pilot, we did a, we
gathered market research from industry to identify options for
how we could procure a similar solution in the future and then
moved forward with an acquisition plan to do that, which
resulted in actually having the same vendor from that pilot.
Ms. Cherfilus-McCormick. It seems to me that the VA is
making short sighted decisions that are focusing veterans to
continue waiting. Is there anything that you would recommend
this committee do to help and support, make sure that there are
not any feelings and that this is actually sufficient moving
forward?
Ms. Peabody. Thank you for that question. We appreciate
your continued support for efforts like this one and for
continuing to hold us accountable for ensuring that our
veterans get the care that they have earned and deserve.
Ms. Cherfilus-McCormick. Thank you. I yield back.
Mr. Rosendale. Thank you very much. Ms. Peabody, I
understand your office has decided to make cuts to the external
provider scheduling. We are going to get into the reasoning in
a moment, but I want to understand what the cuts actually
entail first. Is it correct that the VA medical centers in West
Haven, Connecticut, Hudson Valley, New York, and Ann Arbor and
Iron Mountain, Michigan currently have WellHive activated and
that it will be turned off?
Ms. Peabody. Thank you for that question. I definitely want
to ask Dr. Hausman to make sure I get this right.
Dr. Hausman. That is correct.
Mr. Rosendale. Okay. Dr. Hausman, I really do not
understand this because when we were just talking about the
final entry date to first appointment and the time that it is
reducing, that it is making these improvements, why would this
be being turned off?
Dr. Hausman. We are active at 16 medical centers. We will
continue to be active in 12 of those 16 medical centers moving
into the next fiscal year, plus adding five additional entire
VISNs into the mix. This was a decision made by our VHA
governance board. I think the decision was around solving the
issue of having acquired licenses this year that we simply
cannot use because we do not have adequate number of community
care providers yet participating in this program.
The strategy that we are putting forward and we are going
to be working toward next year will allow us to focus on key
areas or markets that we think are highest potential for a lot
of the considerations that Ms. Peabody already mentioned with
this revised strategy, there are four medical centers, two in
Michigan and the other two that you mentioned that will be
paused for this next year.
Mr. Rosendale. Dr. Hausman, Iron Mountain, Michigan has
very few community care providers signed up, but Hudson Valley,
New York already has hundreds. Why did you decide to turn off
both of these facilities? What message does that send to
providers that WellHive already has in New York and the
providers you are hoping to recruit in Michigan?
Dr. Hausman. Well, we hope the message will be that we
believe in this program, and we are going to be back to
building and activating this program in these areas very soon.
In the instance of Hudson Valley, while we do have around 300,
almost 300 providers that are on board, this was the first area
that we built out, and we did not focus in the way that we
should have in terms of engaging providers that do higher
volume of care, more veteran care, higher quality care. We
built this out in a way that we learned from. Strategically, we
are going to be focusing on working with providers that do
higher volume of care, that are known to do high quality care,
and that also have a good relationship, that we have a good
relationship with, for example, academic affiliates.
Mr. Rosendale. Again, I just, to me, as a consumer, I hear
somebody shutting down after they have opened up a system, a
facility, whatever, and they are telling me how great it is,
but yet they come in and say, but you are not going to have it
available to you. We are going to go out and try and sell. I do
not see how that is going to help efforts going forward to get
other providers to sign up. I just do not.
I think it is a very, very poor marketing concept. Are you
concerned that when you decide to turn, WellHive on again in
Connecticut, New York and Michigan, the providers will be
frustrated and suspicious about working with VA?
Dr. Hausman. We appreciate that those sentiments may exist
as we go to reactivate. I do believe that the messaging that we
put forward, the communications that we are going to be putting
forward to these community partners now, is going to be very
important in how we message this decision and why we are doing
this, and also the idea that we will be coming back likely in
the beginning of `26. There is definitely some communication
that will be taking place that will hopefully keep the
relationship with these providers strong and keep them
interested in participating in the future.
Mr. Rosendale. Even again, the future providers that you
are trying to sign up, when they look and see that you are
basically pulling the rug on the other providers, I cannot
believe that it is going to give them a level of faith in
participating. I mean, can you understand that?
Dr. Hausman. I do understand that concern.
Mr. Rosendale. How much is the cut to the external provider
scheduling project? You told the committee staff that $20
million during a meeting, is that correct?
Dr. Hausman. That is approximately our budget for this
program in `25.
Mr. Rosendale. The system that seems to be working that is
helping us schedule a better, that is providing better
healthcare, is the place that we are going to have a $20
million cut?
Dr. Hausman. Approximately.
Mr. Rosendale. Ms. Peabody, was this cut your decision? If
you did not make that decision, who did?
Ms. Peabody. Thank you for that question. Our VHA
governance board made that decision unanimous to take on----
Mr. Rosendale. Did you make it as a recommendation to them
or did they come up with this, amongst their collaboration and
their work?
Ms. Peabody. That was IVC's recommendation. Yes.
Mr. Rosendale. That was your recommendation?
Ms. Peabody. Yes, sir, that was my recommendation based on
the inputs from Dr. Hausman and his team.
Mr. Rosendale. Okay. I will now yield 5 minutes. I think
that that puts a pin on it. Then I am good. Okay. I would
recognize the Ranking Member for any closing remarks that you
may have. Do not have any. Okay. No closing remarks. Okay. I
want to thank our witnesses for joining us today. VA scheduling
process and technology directly affect veterans' healthcare.
Obviously. Outdated, dysfunctional systems increase veterans
wait times and may discourage them from getting care from the
VA altogether.
We have to remember that most veterans also have Medicare
or private insurance. As the billboards say, the Department of
Veterans Affairs want veterans to choose VA. That means getting
an appointment has to be user friendly. This morning, we have
heard about some real accomplishments in internal scheduling
and direct scheduling that are improving veterans experiences.
We also know that the VA has a troubling history of
snatching defeat from the jaws of victory when it comes to
technology projects. I urge the committee to continue rigorous
oversight in the next Congress to prevent that from happening
again. I ask unanimous consent that all members have five
legislative days to revise and extend their remarks and include
extraneous material. Without objection. So, ordered. This
hearing is adjourned.
[Whereupon, at 10:09 a.m., the subcommittee was adjourned.]
=======================================================================
A P P E N D I X
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Prepared Statements of Witnesses
----------
Prepared Statement of Cherri Waters
Good morning, Chairman Rosendale, Ranking Member Cherfilus-
McCormick, and distinguished Members of the Subcommittee. Thank you for
the opportunity to testify on the Office of Information and
Technology's (OIT) and Veterans Health Administration's (VHA) efforts
to modernize the Department of Veterans Affairs' (VA's) scheduling
systems. I am accompanied by my colleagues from VHA, Ms. Hillary
Peabody, Acting Assistant Under Secretary for Health for Integrated
Veteran Care (IVC), and Dr. Mark Hausman, Executive Director, Access
Transformation, IVC.
Enterprise Scheduling Modernization: A Collaborative Effort
VHA and OIT are working together on the Enterprise Scheduling
Modernization effort, which aims to streamline and enhance VA
scheduling systems. The modernization of our scheduling tools is
essential for ensuring Veterans receive the best and most timely care
while simplifying processes for Veterans and VA staff. By consolidating
and upgrading our scheduling systems, we are laying the foundation for
a seamless, more efficient, and more Veteran-centered health care
system.
VA's Enterprise Scheduling Modernization efforts introduce new
functionalities designed to improve access to care for Veterans. These
include the ability to schedule virtual and in-person appointments
across VA facilities, consolidating multiple scheduling functions into
a unified platform, and provider-based scheduling that integrates
various appointment types into a single scheduling application. Our
modernization efforts are crucial in bringing VA scheduling systems up
to industry standards, enabling us to schedule any type of appointment
with greater flexibility and efficiency. Our ultimate goal for these
scheduling improvements is to connect Veterans with the best available
resources for the most convenient and most appropriate care. To provide
the best health outcomes for Veterans, VA must invest in modern
scheduling tools that have near-term benefits and ultimately
facilitates a long-term scheduling solution.
Key Scheduling Tools and Benefits
Integrated Scheduling Solution
The Integrated Scheduling Solution (ISS) is a staff-facing, web-
based application currently used for scheduling Veteran appointments
that ultimately consolidates functionalities from multiple scheduling
applications into a single enterprise scheduling solution for care in
VA health care facilities. ISS represents a significant leap forward
from our legacy system, VistA Scheduling Enhancement Graphical User
Interface (VSE GUI) by offering a more integrated, intuitive, and
efficient scheduling process. We began the enterprise-wide rollout of
ISS September 2024, and full implementation is expected by February
2025. Enhancements, including additional appointment types and
telehealth capabilities are underway, and we anticipate retiring VSE
GUI by June 2025. Ultimately, ISS will be the future single scheduling
system that will house all scheduling tools and functionalities; this
will allow VA staff to schedule appointments in a single platform
across multiple sites of care.
Clinic Capacity Search Tool
The Clinic Capacity Search Tool (CCST) is a simplified web
application providing the ability to search and view all available
appointments for requested service and modality across multiple
facilities. Currently, CCST enables the scheduling of telehealth
appointments, providing Veterans with quicker access to care and a
broader range of available options. We are enhancing CCST to include
additional in-person clinical resources, and we are scheduled to begin
rolling out of these new features in January 2025.
Clinic Configuration Manager
The Clinic Configuration Manager (CCM) is a web-based tool VHA
administrative staff use to provide a standardized approach to managing
availability with providers anywhere in VA. Fully implemented in March
2024, CCM reduces discrepancies, increases efficiency and improves
scheduling.
Community Care Scheduling: External Provider Scheduling (EPS) Platform
External Provider Scheduling (EPS) is a technology platform that
will be able to improve the process of scheduling Veterans with
community care providers by supplying information on care availability
and allowing VA staff to schedule Veterans directly into available
community care provider appointment slots through a singular user
interface. EPS connects VA and community care providers to streamline
care navigation and coordination activities. EPS offers information on
who, where, and when community care providers and services are
available to support informed Veteran decision-making.
Moving Forward
VA's scheduling modernization efforts aim to improve timeliness
between a Veteran's request for care and the scheduling of their
appointment, ensure Veterans receive the best available resources, and
enhance coordination and information sharing between VA and community
care providers. Our multiple scheduling efforts strengthen the
collaboration between VA, Veterans, and community care providers and
will ultimately unite under our ISS platform. ISS will integrate these
tools and processes to create a streamlined scheduling experience
across the enterprise, which will lead to faster, more flexible care
for Veterans. Our efforts enable VA staff to increase efficiency,
reduce administrative burdens, and improve care delivery for Veterans
in a sustainable and effective manner. Veterans will experience
enhanced access to the best care more quickly, whether within VA or
through community providers.
Conclusion
Chairman Rosendale, Ranking Member Cherfilus-McCormick, and Members
of the Subcommittee, thank you for the opportunity to appear today.
VA's modernization efforts are transforming the way we deliver care to
Veterans and support VA staff and providers. We are proud of the
progress we have made and remain committed to continuing this journey
of improvement for the benefit of our Veterans and the dedicated staff
who serve them. This concludes my testimony, and I look forward to
answering your questions.
Statements for the Record
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Questions for the Record Submitted by Matthew M. Rosendale
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U.S. Department of Veterans Affairs Response to Questions for the
Record
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