VA is acquiring new scheduling IT, says CIO

The Department of Veterans Affairs is in the market for a new scheduling system, with a request for proposals due out next week, agency CIO Stephen Warren said at a June 10 Senate hearing.

The VA is now seeking a commercial solution to work as a module inside the Veterans Health Information Systems and Technology Architecture electronic health record. Meetings with industry are slated for next week, and a product is due to be in place by the close of fiscal 2015.

The plan has been in the works for at least 18 months, in the wake of critical inspector general and Government Accountability Office reports that documented scheduling problems at the VA long before the recent troubles at the Phoenix hospital, where it was alleged that schedulers kept two sets of appointment books in order to comply with department-wide goals about getting veterans into the system to receive care.

A preliminary internal audit of VA scheduling practices found that workarounds to the computer appointment system were used at 70 percent of facilities.

According to Warren, a suboptimal scheduling system is built into the VA's VistA electronic health record system. "When we talk about VistA, it is important to think about it in two parts," Warren said. The clinical component, "that portion which focuses and enforces and supports how we provide care, is one of the best out there," he said. However, the administrative side functions -- including scheduling – were "not supported at the level they needed to have been."

Warren said that in the midst of the reorganization of the IT department at Veterans Affairs, from a distributed system with regional CIOs to consolidated system under a single leader, the agency jettisoned scheduling projects running for 10 years. "They were not delivering and were not going to deliver," Warren said.

Part of that IT reorganization put the VA on a more agile footing. The department leads federal agencies in delivering IT capabilities within six months of start to finish, according to GAO. VA IT also pioneered the kind of data-driven TechStat review process that was eventually incorporated governmentwide. Warren said the VA has so far conducted 20 TechStat reviews of IT projects this year, with 37 total for 2013 and 68 in 2012.

Improvements to the existing scheduling system are being made as a new system is being planned, Warren said. The challenge is that the scheduling system allows for appointments to be made and changed, but there aren't clear indications about whether an appointment has been changed at the request of a physician, a patient or on some other basis. Auditors are trying to reconstruct those changes to provide a record of the extent to which schedulers at VA facilities were abusing the system.

Asked if the new system would be able provide a trail for investigators in the future, Warren said, "I think you can be assured, sir, that the audit and audit features in terms of how you differentiate is one of the areas of concern for us."