VA to Pilot New Scheduling System at Same Ohio Facility that Tested the Last Solution

While the Veterans Affairs Department’s transition to a new electronic health records platform consumes much of the conversation around IT modernization efforts, the agency also has been working on its problematic scheduling system, the issue that turned VA’s IT into national news five years ago.

VA has a history of deploying—or attempting to deploy—faulty scheduling systems. The issues came to a head in 2014 when a series of reports emerged showing at least 40 veterans died while waiting for care at one facility in Phoenix, Arizona and officials attempted to cover up issues by falsifying appointment records. VA IT officials promised a (relatively) quick fix by implementing a new system, though those efforts continually fell short.

“The appointment scheduling system is the VA IT system most badly in need of an overhaul. More so than the financial system, the claims-paying system or even the EHR,” Rep. Jim Banks, R-Ind., said during a hearing Thursday held by the House VA Subcommittee on Technology Modernization. “That was true five years ago when the secret waitlist scandal in Phoenix broke and, despite some incremental improvements to VistA, it’s still true today.”

Since that time, VA has developed and partially deployed two replacement systems. The first, the VistA Scheduling Enhancements, or VSE, program looked to build on the agency’s in-house system. Ultimately, the project was nothing more than a reskin of the existing scheduling system, according to VA Assistant Inspector General for Audits and Evaluations Larry Reinkemeyer, who said the agency merely replaced the user interface without fixing any of the underlying issues.

After the VSE program was canceled, officials began work on the Medical Appointment Scheduling System, or MASS, a commercial system developed by Epic and Lockheed Martin subsidiary Systems Made Simple that saw limited release in VA environments. The contract for that system, currently deployed at the Chalmers P. Wylie Ambulatory Care Center in Columbus, Ohio, is set to expire in June 2020.

As VA transitions to the Cerner Millennium EHR platform, the agency also will move over to the Cerner Scheduling System, or CSS, which the agency gained access to as part of the larger contract.

John Windom, executive director of VA’s Office of Electronic Health Record Modernization, told lawmakers Thursday that moving to CSS would decrease the time and funds needed to ensure systems like MASS were fully interoperable with the new EHR system. He also said the scheduling system rollout could be coordinated within the current Cerner contract and would not require new licenses or funds.

The current plan calls for the Cerner system to be piloted at the Columbus site that currently uses Epic’s MASS system. The new scheduling system will go live in Columbus in April, around the same time the EHR pilots begin in the Pacific Northwest.

“The driving element for replacing Columbus is the expiring contract that supports the present EHR system,” he said. “That expires in June 2020, hence we’re trying to get there and replace it before that contract expires and there’s no software support.”

Initiating the pilot at the Columbus facility comes with some additional advantages, including recently updated infrastructure and a staff who is already familiar with commercial scheduling systems, as well as transitions.

“We would be remiss if we didn’t go there first,” Windom said. “The infrastructure needs are minimum, such that we can inject a very similar, functional resource planning tool.”

After Columbus comes the real test and a true measure of what the average VA facility will encounter during the transition.

“The Louis Stokes VA Medical Center in Cleveland, Ohio, will serve as the next and larger pilot site for CSS,” Windom said.

If the schedule holds, all VA centers will be using the new scheduling system by 2025.

That’s two years longer than was originally projected, according to Rep. Susie Lee, D-Nevada, who chairs the Technology Modernization Subcommittee.

“The three-year deployment track was a number drawn without all of the comprehensive research that’s necessary to develop an integrated schedule. Five years is more appropriate, especially appropriate for doing it right, in a risk-mitigating fashion, in support of the least amount of disruption for our veterans,” Windom told the committee.

“What we want to give you is a realistic timeline and then impress you with our deployment efforts and actually deliver sooner,” he added.

Windom also said the agency expects it can accomplish this goal by reprogramming funds already allocated for the $16 billion EHR system rollout, with Congress’ permission. The program office is working to pin down infrastructure costs, but Windom said they expect to be able to finalize negotiations with the contractors over the next few weeks.

Early estimates pull the full rollout between $350 million and $700 million.