13 things that are about to change at VA

The Veterans Access to Care through Choice, Accountability, and Transparency Act passed the House on July 30 with a vote of 420 to 5.  The Senate followed suit, 91 to 3, on July 31, and the president's signature is all but assured. Once enacted, the law would require outside review of most every aspect of VA operations, including "the competency of leadership with respect to culture, accountability... and performance management."

Scattered through the bill, however, are a number of specific IT and management mandates for the department -- many of which could entail significant new systems. Key provisions include:

1. Digital Waiting List: The department must create an electronic waiting list on www.myhealth.va.gov that will allow veterans to monitor the status of their position in line, as well as view the average wait times for each facility and type of care. The wait-time information must be available online to the general public.


2. Claims Processing System: As many veterans will now be able to go outside the VA for covered care, the department must develop an "efficient nationwide system for processing and paying bills and claims for authorized care." Regulations for the system must be drafted within 90 days.


3. Electronic Medical Records: Electronic medical records have been vital to veterans' health efforts for years. The department must now coordinate with external healthcare providers to ensure that compatible data is fed back into veterans' personal records.


4. VA Choice Cards: The VA will have 90 days to establish a system to monitor and issue veterans a "Veterans Choice Card," which will "facilitate the receipt of care" from non-VA health providers.


5. Electronic Notifications: Veterans must be notified electronically -- if that is deemed to be "the most effective means available"-- to describe the care or services they are individually eligible to receive.


6. Telemedicine: VA has been a leader in telemedicine, but Congress wants more. The department must now ensure that every "mobile medical center" is capable of providing telemedicine services.


7. Open Data: Data for patient safety, quality-of-care and outcomes must be published as "a comprehensive database" within 180 days. This data must then be fed into the Department of Health and Human Services' "Hospital Compare" website.


8. Off-the-Shelf Solutions First: The VA's history of developing in-house solutions is also targeted for special scrutiny. The bill calls for careful review of "any interim technology changes or attempts... to internally develop a long-term scheduling solutions [sic] with respect to the feasibility and cost effectiveness ... compared to commercially available solutions."


9. Outside Assessment of IT Systems and Workflows: The VA must contract with an external assessor to review the systems and workflows used for scheduling, staffing, length-of-care management, and documentation of care. This external review must also cover the department's core "information technology strategies" for furnishing and managing care--"including an identification of any weaknesses and opportunities with respect to the technology used."


10. Better access control: An additional assessment will explore whether system access ought to be limited to those employees who have been "properly trained" in scheduling appointments.


11. Technology Task Force: Additionally, newly-confirmed Secretary Robert McDonald has been instructed to establish a "technology task force" that will review the department's scheduling systems and software needs.


12. Bonuses & Prohibitions: Bonuses based on scheduling and wait-time metrics are no more, and any future falsifications of data concerning wait times will be met serious penalties, up to and including dismissal. McDonald must also ensure that annual awards and bonuses do not exceed $360 million.


13. Executive Performance: The secretary will be given expanded power to quickly remove VA executives for poor performance, and must report any such dismissal to Congress within 30 days, along with a justification for the decision.