Decision time for scheduling tech at VA

The Department of Veterans Affairs is on the cusp of a decision that could have broad repercussions on whether the agency pursues a broad strategy of commercializing its technology core, including its homegrown Vista electronic health record system.

The agency is on the hook to tell lawmakers about whether it plans to pursue the testing of an internally developed scheduling product, or proceed with a long-planned commercial acquisition.

Dr. David Shulkin, currently the VA's undersecretary for health and President Donald Trump's pick to lead the agency, told a Senate panel on Feb. 1 that the agency was looking at whether to begin testing the internally developed Vista Scheduling Enhancement, which interfaces with VA's electronic health record system, or go with a commercial solution for which a contract was awarded in 2015.

The VA's scheduling system became enmeshed in a larger controversy, when it was revealed in 2014 that schedulers at the Phoenix medical center kept two sets of books to conceal lengthy wait times for appointments, while appearing to comply with agency regulations. The scheme was abetted by an imprecise logging system in the Vista scheduling module that made it impossible to discern who was responsible for an appointment being scheduled and then changed.

The scheduling scandal changed a lot at VA. It led to the resignation of Eric Shinseki as secretary, and the appointment of Procter and Gamble CEO Bob McDonald to replace him. The new agency head focused on building a veteran-focused VA, with a heavy emphasis on usable technology.

But one thing that hasn't changed is the scheduling system. VA still uses the native Vista application.

"They're using what I would call old blue DOS screens to schedule," Shulkin said at his confirmation hearing. "I don't even know how they do their jobs."

Back in 2014, Steph Warren, then the agency's acting CIO, told a Senate panel that he hoped to have a new system in place by the end of fiscal year 2015. The VA had been taking steps to modernize its scheduling, in part as a result of a critical 2012 Government Accountability Office report on problems with scheduling.

In 2015, VHA picked the leading electronic medical records provider Epic along with Lockheed subsidiary Systems Made Simple for a five-year, $624 million contract for the Medical Appointment Scheduling System program.

MASS was put on hold in April 2016, after developers inside VA said they could supply the needed application at a fraction of the cost of the commercial solution. VSE is an Outlook-style interface that offers schedulers a dashboard view of appointments. The VSE 1.0 is currently in use on a pilot basis to schedule appointments by 46 schedulers at 32 clinics across five test sites, according to a VA spokesperson. If approved for nationwide implementation, VSE 1.1 will go live in the spring at primary care facilities.

MASS implementation stalled out during the VSE pilots, but put back in gear in January 2017. An 18-month pilot is moving ahead in Boise, Idaho. The Epic product contracted under the MASS program would replace the Vista scheduling application and monitor demand for medical care and VA's capacity across the enterprise.

This is further complicated by the coming procurement for a commercial self-scheduling system required under the Faster Cares for Veterans Act of 2016, and an effort to expand the Vista Veterans Access Request self-scheduling module.

The situation has lawmakers somewhat befuddled. Reps. David Roe (R-Tenn.) and Tim Walz (D-Minn.), the chairman and ranking member of the House Veterans Affairs committee, are eager for VA to make a final call in the scheduling decision, and they aren't hiding their preference for a commercial product.

"Suddenly, VA has four similar scheduling programs going at once," Roe and Walz wrote in a Feb. 8 letter to acting CIO Rob Thomas, seeking insight on why they weren't informed about the MASS reboot and looking for more regular progress reports on scheduling efforts.

"Additionally, please explain how these four programs will be managed so that modern scheduling technology can be quickly delivered without creating duplication, and without undermining [the Office of Information and Technology's] preference for existing commercial off-the-shelf solutions.

At a Feb. 7 hearing of the House Veterans Affairs Committee, Thomas told lawmakers, "My goal is to go commercial to the greatest extent possible."

If the VA goes with a commercial product, it could augur more commercialization, including a move off the home-grown Vista electronic health record platform.

"VA needs to let go of Vista and go to a commercial solution," Dave Powner, who works on oversight of VA information technology at the Government Accountability Office, said at the same hearing.