Howard: Man, what a packed house. I feel like I'm on the New York subway
system here. Fourteen hundred. This is probably one of the larger groups
that's been assembled in the VA lately. Well, a very interesting
presentation by Dr. Agarwal, and I've got a couple of items here that
relate to that. I was asked to address some specific topics. First of
all, how many OI&T people are in the room? How many people who used to
be OI&T and IT people, and are still in VHA? Come on, raise your hands.
Good, we get some IT folks out there. These are the items that the folks
asked me to talk about. I'll give you just a few minutes to scan that,
but quite frankly the reorganization itself is obviously of key interest
to you, so the agenda that I want to cover here is indicated in this
slide. We will talk a bit about class three development. I know that's
near and dear to the hearts of this group, and very, very important, as
was pointed out already this morning. Now the IT transformation that's
going on is quite frankly very, very extensive, and very complicated.
And want to say right up front that we understand the importance of
supporting innovation, and I'm going to talk about that a little bit
here this morning because there's no question that it's probably one of
the biggest challenges we have. Most of the folks know why this
transformation took place. Mandates from the Congress, a lot of pressure
from outside entities, over a number of years, criticism if you will on
our budget and what have you, so much so that we took some budget
reductions. Fair or otherwise, it doesn't matter, it happened to us. So
there's a lot of reason behind the reorganization and why it occurred,
and I know some folks have different opinions about that, but it's
happened and now we got to make it work. This issue of keeping
innovation alive, and yet at the same time try to standardize and
understand exactly what's going on, properly resourced, properly
supported and all that, that is without a doubt the biggest challenge we
have, and Craig Luigart knows this too well, and that has been referred
to a number of times by Dr. Agarwal as a key aspect of VHA and OI&T
joining together. Standardization is absolutely critical, not just in
the health area, but obviously in the other administrations as well, and
the strengthening of program management across the board. Again, one of
the main reasons that the reorganization occurred was heavy criticism on
our management of the fiscal resources, reducing results that could be
spread across the organization, and all of that. So that's what we've
got to do, and as you know only too well we're getting a lot of heat
from Capitol Hill on a lot of that. I want to talk a little bit about
the development portion of OI&T. I think many of you know we have a
number of areas, in fact there's five of them that we've created. Just
very quickly as a reminder, I've got five deputy assistant secretaries,
one of them deals with information protection and risk management, one
of them deals with strategy and planning and all that, enterprise,
architecture, and then I've got one focused on resource management, you
know, budget, human resources, asset management. Asset management,
that's another one we need to talk about. And then the development
community headed by Dr. Paul Tibbetts, that's what I'm going to talk
about here, and then Jeff Shiska and the operations folks. Is Ray
Sullivan in the audience? He's not. Anyway, this is the design strategy
here as we move forward in the one area of development. Again, there's
five key areas in the new OI&T and this one is very important to what
we're talking about at this particular conference. Centralized,
standardized, merge things together, and then evolve and integrate. Just
let me talk a little bit about each one of those. The centralization is
pretty much done. There are some fine tuning elements that are going on,
but you'll notice that we're trying, at least to the extent possible, to
maintain the same reporting structure, the same functional structure,
the same job, trying to minimize disruption on the employees. I'm not
going to say that's perfect, there probably is some of that, but we're
trying to maintain those mandates as set out by the secretary and the
deputy when we started out. Now we've got four main subsets here in
development, and it goes without saying that we're oriented on the three
administrations. To use the DOD term, these are program executive
offices, PEO's, that's how DOD does business. One in the health area,
one in VBA and NCA, and then we've got one for the cross VA types of
applications. Like financial applications, identity management type
stuff, and that's the last one there. Numbers wise that gives you a feel
for the number of people involved, and obviously they're in a variety of
places across the country. The standardization of the organizations is
key. We want each of those PEO's to be set up pretty much the same way
because it assists us in cross collaboration and looking at things in a
consistent, standardized way. And this is what they look like. You can
see there we've got operations management service, systems engineering,
very, very key to the development process. In fact it's probably the
most important element in making sure we've got our plan laid out in
great detail before we do a whole heck of a lot of code writing or
whatever. Plans and controls obviously, and then system development. So
this particular structure is the one that we're trying to put in place
for each of those PEO's that I showed you on that earlier chart. Now
this one, a little bit on the PEO for veterans health IT. As you know,
Mike Hecker had that job and he left recently, so we're on the hunt now
for a PEO to take that particular job. This is our mission as you can
see. I want to say a little bit about the customer piece because this
quite frankly is the key element in this whole business of preserving
innovation and moving forward those innovations that have a lot of
promise and that we want to spread across the organization. Clearly for
most of the folks in this room, the veteran is the direct customer. We
obviously look to the veteran as a customer, but we go through the
health community, so we look at it a little bit different because you,
you folks in this room are our customers, and that's why we need a lot
of tight connectivity here. The IDMC is key to this, already quite
active, and one of the key things obviously that they do under Craig's
leadership is to prioritize. There are lots of innovations as you well
know, I've got some charts later, you already saw some that Dr. Agarwal
talked to, and I've got a laundry list that I'll show you later. There's
a lot of it. But remember what I told you. The Congress is on our back
from the efficiency of the resource side. None of us really want to deal
with that, we'd just rather have as much money as we can get and spend
it wherever we want, but that's not the way it is. So we have to be very
careful in trying to present ourselves in a very well-coordinated way.
So this prioritization, what is the requirement, where does it sit on
the priority, do we want to fund it, and if we want to fund it we fund
it fully to make it happen. That's very, very important. I mentioned to
you earlier that Congress cut us. They cut us a lot of money back in
2006, as a result of 2005. We did some things in 2005 that got them
really upset, so they took the meat axe to us in 2006, and we're trying
to recover from that. And they've told me, they've told Craig, they've
told a number of folks, you guys come on up here when you're ready and
convince us that you got your act together. So that's what we're doing.
We definitely have to go up there and convince them that we need more
money, we need it applied in the right place, and there's no question
that we need more. Dr. Agarwal had some very interesting innovations,
the last one dealing with a complete systematic approach to a veteran
starting from his genes and all of that, great idea. But we've got to
convince the Congress for more money in order to push these things
ahead. So this particular element, and the IDMC, which involves a lot of
folks and most important, defining the requirement and prioritizing
them. This is a difficult chart to read, I'm sorry, but obviously we
have a key role in the defining of the health segment, and identifying
the technical solutions as these requirements are brought forward. And
then the acquisition plan. Sometimes it's fun to create the innovation
and get it moving and all that, but then you got to come back to some
things that are a little bit more less fun. You've got to put an
acquisition plan together, you've got to put the money together, you've
got to figure out how to convince people that this is the right way to
do business. There's a lot of back room type work that takes place to
move the innovation forward in the right kind of way. Obviously the
bottom, and as was indicated on Craig's bar chart there, that horizontal
arrow chart, where we fit in. Manage the design, the development, the
testing and the fielding, the fielding aspect again is a joint effort
with the field. I mentioned that one of the organizations that we have
stood up deals with cross VA types of activities. I just thought I'd
mention what some of those are. We've got registration eligibility,
contact management, that goes across all the VA. Identity, identity
management is key, in fact, this is probably the first presentation I've
given where the title wasn't information protection. I mean, that's all
I've been talking about here and you guys know exactly why that is.
Identity protection, identity management is absolutely key to this whole
business of information security. FLITE is the financial integrated
technology enterprise, that's the program that brings together the
financial and the logistics, where we've also got a lot of criticism. We
don't have an integrated method to tie that together, and if we could
finally get there I believe we could save a lot of money, if we really
got our act together, and that's a major program that's working out of
Bob Henke's shop. E authentication, E signature, a lot of things there,
and I won't go into each one. But these are the programs that go across
the VA, that we also have a PEO structure put in place that we're
working on quite heavily. Moving across as you can see there on the
bottom, centralized, standardized, merge, evolve, and integrate. Into
the evolve part we're now into the process part. As we move forward, one
of the things that we told everybody was that we would put consistent
and standardized processes in place across the board to help us do our
work in a standardized way. In fact, there's 36 of these processes, we
had IBM help us put those together, and they're now being implemented.
There's about four of them in the development community that deal with
designing, testing, and fielding and all of that. There's specific
processes that many of you are probably familiar with, and we're looking
at those right now to implement them across the board. And in order to
help us do that, we actually have a separate organization, and I
mentioned the five key parts of OI&T. Each one of those deputy assistant
secretaries has a number of these processes to put in place. Like for
example, I mentioned the guy who was in charge of resource management.
Obviously the financial process is one, in fact, CW Furlow is in charge
of that particular area, and that's one that he is responsible for as
well as human resources. Paul Tibbetts who heads development, again, his
testing process, the design process that we've got to put in place. And
we believe that when we put these processes in place we will have a
better shot at trying to standardize and field things and convince the
Congress to resource us better in some of these particular areas. The
risk that you run, though, and I'm very well aware of this, is you could
wind up with the tail wagging the dog. You get inundated by processes
and you forget what the work is. I'm very, very worried about that, it's
sort of a balance issue. We've got to put these things in place to get
consistency, but we don't need to spend our whole life writing process
books as opposed to actually doing some real work. So we put together a
management steering group, an engineering process group, and a technical
working group to help us put these processes in place. And you can see
them arrayed on this particular chart, feeding in to the developmental
organization, and again, what you're looking at here is just one of the
five areas within OI&T as we move forward to involve the organization.
And then we finally get into integration, integration of processes and
collaboration across, not only within OI&T, but with other organizations
within the VA. For example, cross collaboration is key in OI&T,
obviously between the development community, but then the operations and
maintenance community because the operations folks under Jeff Shiska,
they're the ones that are out there, there's probably many of you in the
room today, they're the ones that are out there care and feeding the
systems, keeping them running, working with the folks on class three
development and what have you. So the coordination between those two
groups, the developers and the folks that are in the field at the
hospitals and clinics, is absolutely key. And then what we want to do,
to the degree we can, is centralize common functions, and this is
already looking very difficult but we know we have to do that. Now let
me move ahead into some particular highlights, and I just want to
mention a couple that are on this chart. The first one is the identity
management area. We have got a lot of effort going on, in fact, some of
this is mandated out of the office of management and budget and the
Congress on identity management. That's the idea where we have an ID
card and all of that. In fact, Dr. Agarwal had one of the innovations
that relied on that. The class three software strategy, I'm going to
address that next in a little bit more detail. Way down the bottom of
the chart, we'll talk a little bit about governance models that we're
working. And then the last one is a very important application that
we're working very hard to field, and that's scheduling. That's one that
we probably should have fielded by now, but we're moving as hard as we
can to move that forward. You'll notice an alpha site here in September
of '07, and Craig and his folks are side-by-side on this particular one.
By the way, the schedule one, that's one that we've told the Congress
that we're going to field, so we're on the hook to get that out to you.
Not only to you, but to the Congress, and hopefully we can pull that off
and they might be a little more generous with us on funding some of
these other initiatives. Now into class three. This is a real dilemma in
many ways because there are great ideas, you saw many of them today, and
in the past we could fund these at a particular hospital level, the
color of money was not a problem, we didn't have the IT appropriation,
we had separate amount of money over here, you could move medical money
to fund these initiatives, and it was a very decentralized way of doing
business. Quite frankly, the decentralized approach is the best way to
bring out innovation. But it's different now. They've created an IT
appropriation, now if you want to buy a computer it's got to come out of
this different pot of money. It makes it a little bit more difficult in
terms of management. As we move forward, if you want to take this
particular idea and bring it forward, and then spread it across the VA,
spread it across into other activities, you need to what? You need to
fund it right, you need to put the help desk in place, you need to
support it in the proper way. All of that has to take place, which means
more money. So that's why we have to keep the innovations going, keep
the good ideas going, but also have a system to bring forward the ones
that really have promise, in the correct way so we can properly support
them. That's the dilemma we face, and it's no small task because the
problem is intuitively we know we need to do that, but we've got to do
it quickly. We can't do it in like five years, we've got to do it
quickly. And that's the challenge we have. So you need to know we are
well aware of this challenge, and are working hard to try to figure out
the best approach to do that. The work at the hospital level obviously
is very, very key to that, and the communication that takes place. One
thing I will tell you, if the OI&T reorganization has done one thing, it
has brought forward a lot of very good information that heretofore may
not have been known at the VA departmental level. And we've got some
very good people in the OI&T community out in the field with knowledge
of both sides, both the health side and the IT side. In fact, Jim
Breeling sitting right over here is up there in New England as you know,
and we have a number of other individuals, probably some of them here in
this audience that have very good and deep credentials in both the IT
business, the acquisition business, and the medical business. So
extremely valuable folks to have those on board, and we leverage their
talent whenever we can. So let's get into the class three stuff. You're
going to see a series of charts entitled "orphans". Why do I use the
word orphans? Because they're running around looking to be adopted or
what? Yeah. What we have discovered, as a result of the reorganization,
is that there are some great ideas out there, and I've got about three
or four charts, in fact as Dr. Agarwal was going through hers I had my
charts out seeing do I have that one on the list? And I don't. There's
more that are out there that we don't have. But what these are, these
are good ideas that were being funded at a local level, but as a result
of the IT reorganization, what happened to the money, what happened to
the support? And we've got a joint effort going on now with VHA to
identify these and to properly prioritize them and put the money, if we
want to move forward and you'll probably see some of your orphans out
here, your children, that are now called orphans. You'll say hey, that's
my stuff, I got to move that forward. But that's what we're trying to
do. We are making a survey here across VHA, so if your item is not on
this list, you need to get with Craig. You need to run up here with a
3x5 card and hand him the name of your orphan, and get on the list,
because we've got to bring these forward because many of these are very
good ideas and we want to properly support them and move them forward
and spread them out through the organization. And it's not easy because
we've got to figure out where to get the money, too. So there's some,
there's some local ones, there's some more of them, dental record
management, I didn't see any of these on your list, Dr. Agarwal. Here
are some more, voice record management, good ideas, things that are
needed. And all of these are local initiatives, just exactly what we've
been talking about. Innovations at the grassroots level. Innovations
which caused the electronic medical record that we see today. That's
where all of that was born, and Dr. Agarwal had some others that I don't
even have on my chart, but I'm going to put them on the chart because we
want to make sure that they get proper funding. And some of these are in
various stages of development, if you will. There are some of these that
are much further along and you want to pump the money in there and move
ahead, others maybe need a little bit more R&D type stuff, a little more
fine-tuning as we bring forward. I'll just leave a couple of these up,
insurance capture buffer, I'm not sure what that is. The doc manager
explanation of benefits. Jim, do you know what that one is? Is that your
innovation or what? Okay. So you understand where I'm coming from. There
are a lot of innovations out there that we need to properly fund and
properly support, and this is just the listing that I brought with me
today. As you can see from the earlier presentation, there are probably
many others. So now what we need to do is prioritize these, properly
fund them, figure out which ones have merit for moving across the
organization and putting them in place properly supported. And that
means resources, that means properly financed, properly supported from a
people standpoint. Because you know when you put these out, you can't
just set it up and walk away, because you got to fine-tune them once in
a while, fix the code, do that sort of thing, take care of the help
desk, so that it functions properly. Unfortunately, that costs money. So
this particular effort I think is very important, very important too in
our campaign, if you will, to convince the Congress that we're going to
be able to pull this off and move forward. This is key to that because
we can demonstrate that we want these innovations, we want them properly
resourced, and we move forward and hopefully they'll support us with
additional funding. And on the funding side, '07 was a tight year for
the IT appropriation, '08 quite frankly is not going to be much better,
so we need to be as efficient as we possibly can. '09 is when we're
trying to present a strong case. I can't go into the details on the
numbers, but '09 without question now we're going to try to go forward
and present a united front. We got our act together here, come on, help
us out and fund these great ideas, because even the Congress praises a
lot of these innovations on the one hand, but then on the other hand
we're not getting the money that we perhaps need to pull it off. And the
criticism in some respects is correct. They've got a right to hammer us
when we're not watching the pennies like we should. Okay, so what are we
doing on the migration? We take the class three innovations and move
them forward to class one. That's the idea. Get them out of the class
three category and move them forward as no longer an orphan, adopted.
They're adopted and they're in a family and they're moving forward, in
fact, they've got a big family. They're going to all the hospitals
across the U.S. And there's a couple of key points on this chart,
obviously the coordination between VHA and OI&T, between Craig Sharp and
Paul Tibbetts, very, very important. And then the cross organizational
work groups are working those. But I do want to talk about the sandbox
concept. Sandbox concept being very important here, and many of you know
what that is. In fact the first time I heard it, about two years ago
when I was working for the deputy for the time as an advisor or
whatever, and I was into HealthyVet. In fact, that's when I first met
Dr. Fletcher and a few other docs over there in the DC Medical Center.
As we were trying to convince the Congress to again let us continue to
move forward with HealtheVet, the modernization of VistA. I was showing
the deputy the program management tool, Primavera. I don't know if
you're familiar with that, but that's the system that we use for
recording what we do and the timecards and the money and all that stuff
that you've got to keep track of as you move forward in a big program.
On the chart was sandbox. The sandbox crowd. If someone was recording
their time in the sandbox, and the deputy had no idea what that was, so
we had to explain to him what a sandbox was. The code writers and the
programmers playing in the sandbox. So that's the concept, and it is a
very important concept, but the key is it does allow innovation, it does
allow a way to get in there and think, I don't want to use the word play
around, but that's kind of what you're doing, you're thinking through
how things might be. Absolutely key to innovation. What we refer to the
entry point into the sandbox, to get into the sandbox, low bar. Low bar.
Almost anybody can get into the sandbox with a good idea. But getting
out of the sandbox is the high bar. In other words, bringing it out of
the sandbox, bringing it into the class one world, if you will. Bringing
it now where it's in production, it's going to be a production system
used every day and spread across the activities in a very useful way.
That's when you're coming out. You're no longer in the sandbox, you're
bringing it out as a class one type activity. Now it says here start
before end of 2007, it's already going on. We've been operating out of
sandboxes for years, but this means in a new way. In a new way as we
move forward with OI&T and VHA in a collaborative effort. This is
extremely important concept. Very, very important. Moving class three
forward into class one, and it is at the heart of what we're talking
about here. We create the innovation, we mature it and bring it along,
and then we figure out a way to move it forward into the field. Joint
effort as I said, the idea being to promote innovation. We also believe
that this whole notion is critical, as you know, we've been working much
closer now with DOD, and we believe that this particular way of doing
business will be very helpful in solidifying that collaboration across
the board. And in fact, we in VHA actually are better postured to do
this work, I believe, than the DOD folks. I know we've got some DOD
folks in the room and they can talk throughout the week on some of this,
but my belief is, and Craig can comment perhaps more on this, is we are
actually better postured if you will to pull off this innovations and
actually support this VA/DOD collaboration in a very robust way. So why
are we doing this? Why are we trying to take the class three innovation
world if you will and move it as rapidly as we can forward into class
one? First of all is the user acceptance. When it's developed down there
at the grassroots you're going to get user acceptance across the board.
And the high priority needs is obviously very key. But to formalize the
class three as an OI&T and VHA asset is absolutely critical as we move
forward. And the last one there is also very important, and I didn't
talk much about this when I was speaking to the class three slides, and
that's security. One thing that is evident, first of all, VistA had
great innovation, great ideas, but as we all know we're discovering now
that we probably did not pay enough attention to the security aspect of
that. Quite frankly, VA was not the only activity. This whole business
of paying attention to security and information protection and all that
stuff, this is relatively new. I mean five or six years ago very few
agencies were paying adequate attention to this, and as you know, as a
result of the May 2006 breach that occurred, we were stood on our heads
along with everybody else, and now we're really worried about it and
paying a lot of attention to it, because it is serious business. So now
when we move forward and bring these innovations forward as class one
activities, it's something we have to think about. In fact, we're
actually putting a software solution in place, hopefully by the end of
the fiscal year, that will permit more secure transfer and transmissions
for the current VistA system. We didn't have that before, but we will
very soon. It's nobody's fault per se, it's just something we didn't
think about to the degree we should have in the past. And as I told you
earlier, I'm thinking about it a lot. I spend my life in information
protection, I'm telling you. You just worry about the next breach that's
going to occur. So as we move forward, ensuring these systems have the
adequate security aspect to it, and we can operate in a very secure way,
protecting the information of the veteran, protecting the information of
the employee, the veteran's family, whatever the information is that
we're entrusted to, and whatever the innovation is, if it's a scheduling
package, whether it belongs to radiology or whatever it is, we've got to
make sure the adequate secure controls are in place. And the technology
is available. In fact, five or six years ago the technology in this area
was not very good. Now it is very good, and we have a better capability
to do this part of our job as we move from class three forward into
class one. Now very quickly on the board process, you probably have
difficulty reading this, but I'd like to just talk a second about this,
some of you probably have already seen it. We have put a governance
process in place, it is a collaborative process and all those blue boxes
already exist. We already have the VA executive board, we have the
strategic management council, the executive board is chaired by the
secretary, that's his board. The members on it are the under
secretaries. That's a very high level board. The strategic management
council, that's at our level. The assistant secretaries are in there,
the deputies for the administration, chaired by the deputy secretary.
And then you see there's some policy type processes there, budget
formulation, strategic planning, those already exist, and then way over
there on the right is you see the information and technology planning
process. That already existed, that was already there, already there.
And what we have done is we've just expanded that. We've taken that
particular segment of the VA governance process and created three
subordinate boards. We've created the leadership board, information
technology leadership board, that's my board, that's my level, with the
administration heads. And then there's two down there at the bottom, the
business needs and investment board, and then the planning architecture
and planning board, if you'll take a look at those two on the bottom,
the one on the right is kind of a future oriented board, where are we
going in terms of a multi-year program? Which is the other thing that we
don't do very well, multi-year programming and that kind of thing, we're
trying to improve ourselves there. And then the one on the left is more
of a near term focus budget formulation and what have you. All of these
boards have been meeting, the first time they met was on the '09 budget
formulation. We've already had two meetings of the leadership board, one
on the budget and one on information protection. Again, I chair that
leadership board, Scott Craig, who's head of planning and architecture
chairs the PACS board, and then the business needs and investment board
is chaired by my principal deputy, he chairs that, but the provision
there is any one of my deputy assistant secretaries can chair that board
if the element under discussion happens to be in their area, so that's
kind of the way we've organized ourselves there. And then to take it a
step further, how does that work at the program level? Whether it's
VistA modernization, whether it's E authentication, whatever it happens
to be, whether it's a class three really robust idea that we're moving
forward and we want to put a program in place to manage that as it moves
forward. This is how we're doing business. Two sides. The left side
there is the functional side. This one happens to be the financial
logistics integrated technology enterprise. That's the program core FLS.
You guys remember that term? Especially you guys down here in Florida.
Okay? Well this is our second try. To move forward in the financial
logistics we got to do this, because we have a major material weakness
being laid on us by GAO in the financial and, I know five minutes, give
me about three and I'll be done here. Anyway, very important program to
put in place from a financial and logistics standpoint, and a lot of
good activity going on. But on the left side of this is the functional
side. The FLITE oversight board is chaired by Bob Henke, not me. Bob
Henke is the assistant secretary for management. This is his area. So he
chairs that, and the FLITE program director actually works for Bob
Henke, doesn't work for me. So this is the functional side over here
that presents the requirement, that puts everything down the way they
want it to happen, the financial people and logistics people and what
have you. And this is our side over here, the IT leadership board, and
then under those boards is the VAIT development office and the FLITE IT
program office. We have a program official that deals the technology
aspect of this, to move that program forward. So that's the governance
structure at a program level, a particular, very important program that
we need to bring forward. Last chart here is on customer feedback.
Obviously the success of all this depends to a great deal on feedback
from our customers and you folks in the room are clearly in that
category. We need to develop, we need the feedback, we need the good
ideas, and we also need to document stuff. The enterprise system
management office has been established to help us better consolidate
ideas in collaboration and cooperation and communication across the
board as we move forward. These were the topics that you wanted me to
talk to, this was the first chart I put up, and that's kind of what I
focused in on today. I hope I've mentioned a little bit of what you
wanted to discuss. I'll be around here for a little while if you want to
talk to me more, if you want to give me your ideas, if you want to
holler at me or whatever, I'm here. And in summary, the reorganization
is tough business because it's a brand new paradigm that we're operating
in. We are well aware that keeping this community together, keeping the
innovations moving as rapidly as we can in a consistent, standardized
way, so we can satisfy the folks who are responsible for our oversight
and all of that, it will bring us forward and bring us success in the
future. And one thing we are committed to, as I've told my folks many,
many times, you're committed to the success of those you serve, and
you're the people that we serve. So thank you very much.