Veterans Affairs: Subcommittee Post-Hearing Questions Concerning 
the Department's Information Technology Management (05-NOV-02,	 
GAO-03-261R).							 
                                                                 
The Department of Veterans Affairs' (VA) has made progress in	 
improving its overall management of information technology,	 
including centralization of information technology functions,	 
programs, and funding under the department-level chief		 
information officer (CIO). The department has also made progress 
in developing an enterprise architecture, improving information  
security, and managing important information systems initiatives 
being pursued by the Veterans Benefits Administration (VBA) and  
the Veterans Health Administration (VHA). GAO reviewed (1)	 
whether VA's proposed business and enabling functions provide the
management tools necessary to start the process for implementing 
VA's enterprise architecture; (2) how veterans have benefited	 
from the VETSNET Program; (3) what must be done to assure	 
successful implementation of the Federal Health Information	 
Exchange (FHIE); and (4) whether VA can realistically implement  
HealtheVet-Vista by the end of 2005. GAO found that the Federal  
CIO's Council's guidance on enterprise architecture advises	 
organizations to develop a set of controls to help them 	 
successfully manage the process of creating, changing, and using 
an enterprise architecture. Although the enterprise business	 
functions and key enabling functions are essential components of 
the architecture that VA is developing, they cannot be considered
a primary tool for managing the enterprise architecture effort.  
Although VBA has spent more than $40 million since 1996 on	 
developing the VETSNET compensation and pension replacement,	 
veterans have not received measurable benefits from this	 
initiative. Successful implementation of FHIE will largely depend
on the extent to which consistent and effective project 	 
management and oversight exists to guide the initiative. Beyond  
FHIE, VA and the Department of Defense (DOD) have envisioned a	 
long-term strategy--HealthePeople--involving the two-way exchange
of patient health care information. This exchange is expected to 
depend on the successful interoperability, and resultant sharing 
of secure health care data, between DOD's Composite Health Care  
System II and VA's HealtheVet VISTA, both of which continue under
development.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-03-261R					        
    ACCNO:   A05486						        
  TITLE:     Veterans Affairs: Subcommittee Post-Hearing Questions    
Concerning the Department's Information Technology Management	 
     DATE:   11/05/2002 
  SUBJECT:   Computer security					 
	     Information resources management			 
	     Information technology				 
	     Medical information systems			 
	     Systems compatibility				 
	     DOD Composite Health Care System			 
	     DOD/IHS/VA Government Computer-Based		 
	     Patient Record Project				 
                                                                 
	     Federal Health Information Exchange		 
	     Program						 
                                                                 

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GAO-03-261R

GAO- 03- 261R Post- Hearing Questions on VA IT United States General
Accounting Office Washington, DC 20548

November 5, 2002 The Honorable Steve Buyer Chairman, Subcommittee on
Oversight and Investigations Committee on Veterans* Affairs House of
Representatives Subject: Veterans Affairs: Subcommittee Post- Hearing
Questions Concerning the

Department*s Information Technology Management

This letter responds to your October 10, 2002, request that we provide
answers to questions relating to our testimony of September 26, 2002. 1 At
that hearing, we discussed the Department of Veterans Affairs* (VA)
progress in improving its overall management of information technology,
including the centralization of information technology functions,
programs, and funding under the department- level chief information
officer (CIO). We also discussed the department*s progress since last
March in developing an enterprise architecture, improving information
security, and managing important information systems initiatives being
pursued by the Veterans Benefits Administration (VBA) and the Veterans
Health Administration (VHA). Your questions, along with our responses,
follow.

1. On page 19, the GAO testimony stated that VA must also still develop a
program management plan to delineate how it will develop, use, and
maintain the enterprise architecture. GAO stated that such a plan is
integral to providing definitive guidance for effective management of the
enterprise architecture program. According to Dr. Gauss, VA has developed
and will implement version 1.0 of the One- VA Enterprise Architecture,
which establishes ten enterprise business functions and seven key enabling
functions. Does GAO agree that these business and enabling functions
provide the management tools necessary to start the process for
implementing VA*s enterprise architecture?

The Federal CIO Council*s guidance on enterprise architecture 2 advises
organizations to develop a set of controls to help them successfully
manage the process of creating, changing, and using an enterprise
architecture. These controls are intended to promote sound management of
the enterprise architecture project through the use of plans, products,
and requirements, including the program management plan that we referred
to in our testimony. In particular, a program management plan would
articulate critical factors guiding work on the architecture, including a
work breakdown structure detailing the tasks and subtasks

1 U. S. General Accounting Office, VA Information Technology: Management
Making Important Progress in Addressing Key Challenges, GAO- 02- 1054T
(Washington, D. C.: Sept. 26, 2002). 2 Chief Information Officer Council,
A Practical Guide to Federal Enterprise Architecture, Version 1.0
(Washington, D. C.: February 2001).

GAO- 03- 261R Post- Hearing Questions on VA IT Page 2 necessary to
acquire, develop, and maintain the architecture; resource estimates for
funding,

staffing, training, workspace requirements, and equipment needs; and a
roadmap for the initiation and completion of key project tasks. As our
testimony noted, VA lacked such a management plan to support its
enterprise architecture effort.

While the enterprise business functions and key enabling functions are
essential components of the architecture that VA is developing, they
cannot be considered a primary tool for managing the enterprise
architecture effort. Rather, these business and enabling functions are the
products of VA*s efforts to develop the baseline, or *as- is,* and
identify the target, or *tobe,* components of its enterprise architecture.
Specifically, enterprise business functions are externally focused
functions involving direct interactions with veterans across the
enterprise, such as providing medical care benefits, vocational
rehabilitation, and employment benefits. Key enabling functions are those
necessary to support the enterprise business functions, such as
eligibility and registration, and enable smooth operation of the overall
enterprise both internally and externally. As the CIO Council*s guidance
notes, one of the initial steps in developing an enterprise

architecture is describing the enterprise as it currently exists,
including business functions and information flows. By identifying the
business and enabling functions, VA has set the stage for moving toward
and measuring progress against its target architecture. Nonetheless, while
these functions represent an important accomplishment in VA*s development
of its enterprise architecture, they do not satisfy the department*s need
for a program management plan to help provide a sound foundation for
managing the development, implementation, and use of the architecture.

2. Concerning VETSNET, GAO testified that *after six years the VA still
has significant work to accomplish, and could be several years from fully
implementing the system.* In GAO*s opinion, how have veterans benefited
from this program, considering the significant capital that has been
dedicated to this program?

Although VBA has spent more than $40 million on developing the VETSNET
compensation and pension replacement system since 1996, veterans have not
yet received measurable benefits from this initiative. At the time of our
testimony, VBA was using its new software products to deliver benefits
payments to only 9 of the more than 3 million compensation and

pension benefits recipients on its rolls. 3 Benefits payments to all other
recipients continued to be made via the department*s aging Benefits
Delivery Network. Moreover, subsequent to our testimony, VBA officials
told us that at the beginning of this month they intended to convert the
processing of the nine benefits payments being made with the new software
to the Benefits Delivery Network. An official explained that the February
2001 pilot test using the new VETSNET software had in essence been a proof
of concept exercise to demonstrate

3 As part of a pilot test in February 2001, VBA began processing ten
original benefits claims using its new software. However, according to
VBA, one of the ten veterans subsequently moved outside of the area
covered by the pilot test and now receives his payments via the Benefits
Delivery Network.

GAO- 03- 261R Post- Hearing Questions on VA IT Page 3 that the software
could deliver benefits payments. He stated that this exercise has now been

completed. VBA still has numerous tasks to accomplish before its software
applications comprising the compensation and pension replacement system
can be fully implemented and capitalized upon. As our testimony noted, all
but one of the six software applications constituting the new system 4
still need to be fully deployed or developed. Specifically, two
applications*

Share, which is used to establish a claim, and Modern Award Processing-
Development, which is used to help develop a claim* still need to be
implemented in the majority of VBA*s 57 regional offices. 5 In addition,
three applications continue to require development

and, according to VBA officials, are not expected to be fully deployed
until December 2004. At that time, Award Processing will be expected to
record award decisions; generate, authorize, and validate on- line awards;
and interface with a correspondence application to develop notification
letters to veterans. The Finance and Accounting System will be expected to
perform accounting and benefits payments functions and interface with the

Department of the Treasury. Beyond these applications that VBA must still
deploy and/ or develop, it faces the more immediate task of ensuring that
the one application already deployed* Rating Board Automation 2000* is
utilized to its full potential. When implemented in November 2000, this
application was expected to assist veterans service representatives in
rating benefits claims. However, according to a VBA official, some
regional offices indicated that rather than improve service delivery, use
of the software tool actually resulted in longer processing times. Given
the department*s backlog of compensation and pension benefits claims, the
undersecretary for benefits subsequently suspended the requirement for
regional offices to

use the software until its backlog had been reduced. At the time of our
testimony, VBA did not plan to require its regional offices to fully
utilize this software until July 2003.

3. Since VA has been given the lead in making the renamed Federal Health
Information Exchange (FHIE) a reality, what must be done to assure
successful implementation? Successful implementation of FHIE will largely
depend on the extent to which consistent and

effective project management and oversight exists to guide the initiative.
In April 2001, 6 we recommended that the participating agencies* VA, the
Department of Defense (DOD), and

4 The six software applications constituting the replacement system are
Share, Modern Award Processing* Development, Rating Board Automation 2000,
Award Processing, Finance and Accounting System, and Correspondence.

5 Among the 57 regional offices that are expected to benefit from the
replacement system, only 6 currently use Share to establish a claim; only
2 offices (Salt Lake and Little Rock) have pilot- tested and currently use
Modern Award Processing* Development to assist in developing most
compensation claims.

6 U. S. General Accounting Office, Computer- Based Patient Records: Better
Planning and Oversight by VA, DOD, and IHS Would Enhance Data Sharing,
GAO- 01- 459 (Washington, D. C.: Apr. 30, 2001).

GAO- 03- 261R Post- Hearing Questions on VA IT Page 4 the Indian Health
Service* take various actions to strengthen the management and oversight

of the government computer- based patient record (GCPR) project (the
predecessor strategy). These steps included (1) designating a lead entity
with final decision- making authority and (2) creating comprehensive and
coordinated plans that included an agreed- upon mission and clear goals,
objectives, and performance measures to ensure that the agencies could
share comprehensive, meaningful, accurate, and secure patient health care
data. We reiterated the need for VA to implement these recommendations in
our June 2002 report, 7 and also made additional recommendations that the
participating agencies (1) revisit the original goals and objectives of
the GCPR initiative to determine if they remained valid and, where
necessary, revise the goals and objectives to be aligned with the current
strategy and direction of the project; and (2) commit the executive
support necessary for adequately managing the project and ensure that
sound project management principles are followed in carrying out the
initiative. VA concurred with these recommendations.

The actions that VA and DOD took in response to the recommendations
resulted in a revised strategy whereby patient data would be exchanged and
a common health information infrastructure and architecture comprised of
standardized data, communications, security, and high- performance health
information systems would be developed. VA and DOD intend to accomplish
this with two initiatives. The first, FHIE, is focused on DOD providing
information to VA clinicians. A second initiative, referred to as
HealthePeople (Federal), is intended to allow the two- way exchange of
clinical information, with an emphasis on

establishing a common health information infrastructure and architecture.
VA and DOD have stated that they plan to complete this initiative by the
end of 2005.

Along with designating VA as the lead agency for FHIE, VA and DOD took
actions to improve project management that should continue to help guide
this initiative to a successful outcome. For example,

goals and objectives have been revised and aligned with the new FHIE
strategy;

a permanent project manager has been assigned to the initiative, and he is
using project management software to facilitate the monitoring of assigned
tasks;

executive- level reviews are being conducted for systems development and
deployment approval;

weekly testing and technical meetings are being held; and

monthly interagency in- process reviews are being conducted by VA*s Deputy
CIO for Health and DOD*s CIO for Military Health Systems.

VA and DOD officials reported that the nationwide deployment and
implementation of the first phase of FHIE was successfully completed in
July. The first phase has enabled the oneway transfer of demographic
information, 8 laboratory results, outpatient pharmacy data, and

7 U. S. General Accounting Office, Veterans Affairs: Sustained Management
Attention Is Key to Achieving Information Technology Results, GAO- 02- 703
(Washington, D. C.: June 12, 2002). 8 The demographic information consists
of patient name, DOD eligibility category, Social Security number,
address, date of birth, religion, primary language, sex, race, and marital
status.

GAO- 03- 261R Post- Hearing Questions on VA IT Page 5 radiology reports
for separated service members from DOD*s Military Health System

Composite Health Care System to VA*s FHIE repository. Clinicians
throughout VHA now have access to over 14 million lab messages, almost 14
million pharmacy messages, and over 2 million radiology messages on over 1
million service personnel who separated between

1987 and 2001. A second, final phase of FHIE began in October and is
intended to make additional health information* in- patient histories,
diagnoses, and procedures; allergy information; admission, disposition,
and transfer information; and consult results* available to VA clinicians.
This phase will rely on the existing technology supporting phase 1, and
thus will only involve adding data to the existing repository. Completion
of the final phase is scheduled for September 2003.

As VA and DOD proceed with implementing the final phase of FHIE and move
forward with HealthePeople (Federal), providing consistent project
management and oversight will continue to be essential for successful
project completion. As such, sustained adherence to the program management
structure that VA and DOD have already put in place will be critical.
Moreover, these agencies can further strengthen their management and
oversight through the use of performance measures to gauge the progress
and effectiveness of their efforts.

4. The VA testified that HealtheVet- Vista should be implemented by the
end of 2005. In GAO*s opinion, is this timetable realistic? Please
elaborate.

As noted, beyond FHIE, VA and DOD have envisioned a long- term strategy*
HealthePeople (Federal)* involving the two- way exchange of patient health
care information. This exchange is expected to depend on the successful
interoperability, and resultant sharing of secure health care data,
between DOD*s Composite Health Care System (CHCS) II and VA*s

HealtheVet VISTA, both of which continue under development. At this time,
we are unable to determine whether plans for implementing this long- term
strategy are realistic. When our review concluded, VA and DOD had just
begun this initiative, and program officials stated that they had not
completed an implementation plan. Until DOD*s CHCS II and VA*s HealtheVet
VISTA have been fully developed and a plan detailing the work tasks,
resources, and completion milestones for HealthePeople (Federal) has been
developed and made available for our review, we will not have a basis for
assessing VA*s potential for implementing this initiative by the end of
2005.

-- -- -- -- -- We requested comments on a draft of this letter from the
Department of Veterans Affairs, but none were provided.

GAO- 03- 261R Post- Hearing Questions on VA IT Page 6 We are sending
copies of this letter to the Secretary of Veterans Affairs; copies will
also be available on our Web site at www. gao. gov. Should you or your
office have any questions

on matters discussed in the letter, please contact me at (202) 512- 6253.
I can also be reached by e- mail at willemssenj@ gao. gov. Sincerely
yours,

Joel C. Willemssen Managing Director, Information Technology Issues
(310357)
*** End of document. ***