Eight years in the making, VA patient scheduling system founders

Veterans Affairs Department Secretary Eric Shinseki launched a review of the department's information technology programs on March 23, focusing on the $167 million patient scheduling program, which has failed to deliver a usable system after eight years in development, NextGov has learned.

Rep. Bob Filner, D-Calif., chairman of the House Veterans Affairs Committee, said at a press briefing on Thursday that either the full committee or the Subcommittee on Oversight and Investigations will schedule a hearing on the near collapse of the Replacement Scheduling Application Development Program, which an internal VA memo said "has not developed a single scheduling capability it can provide to the field, nor is there any expectation of delivery in the near future."

Filner said he wants to hold the hearing before top executives from the Bush administration leave the department at the end of April. The congressman expressed frustration that VA officials did not alert him to problems with the scheduling system, which he first learned about from a March 31 article on NextGov.

Shinseki directed VA staffers provide him with comprehensive review of the scheduling application by April 9, and planned a congressional briefing for April 10, according to internal memos provided to NextGov.

Paul Sullivan, executive director of Veterans for Common Sense, said the scheduling system is needed to reduce long patient wait times at VA facilities. The organization released a report in February that said one-quarter of the 105,000 Afghanistan and Iraq veterans diagnosed with post-traumatic stress disorder had to wait more than 30 days for an appointment at the Veterans Health Administration's 168 medical centers and 800 clinics.

VHA policy says veterans with serious service-related disabilities must be seen by medical staff within 30 days of their requested appointment date. But a September 2007 report by the VA inspector general said 27 percent of the veterans who had to wait more than 30 days for appointments had serious service-related disabilities, such as amputations and panic attacks.

VHA does not have the ability to properly manage canceled appoints, the inspector general said in a December 2008 survey of 10 clinics. This resulted in 4.9 million open appointment slots in 2008 that could have been used by other patients at those clinics, according to the report.

Besides frustrating patients with long wait times, this management dilemma hits VHA in the pocketbook. At the 10 clinics surveyed, the IG determined 830,000 appointments were canceled more than three days in advance, and estimated the cost of those unfilled appointments at $151 annually.

Keith Decker, an associate professor of computer science at the University of Delaware, who wrote a paper on patient scheduling, said developing such a system is a complex task, but not one that should take eight years.

He said the need to schedule patients at multiple clinics and then correlate those appointments with staff schedules is a computational challenge with many variables.

Decker said VA should approach the project in phases, with each part fielded and tested before the next bit of software is rolled out. Since the department has a problem maximizing the use of openings that result from canceled appointments, that might be a good place to start, he said.

Dr. Michael Kussman, VHA undersecretary for health, detailed such an incremental approach in a March 20 memo to Stephen Warren, VA acting assistant secretary for information and technology. The goal was to have a less functional but workable scheduling system fielded by September.

But testing this less functional system resulted in significant failures, Kussman said, and the scheduling program has been suspended while VHA examines alternatives, including the use of a commercial patient scheduling system.