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November 5, 2002:

The Honorable Steve Buyer

Chairman, Subcommittee on Oversight and Investigations

Committee on Veterans Affairs

House of Representatives

Subject: Veterans Affairs: Subcommittee Post-Hearing Questions 

Concerning the Departments Information Technology Management:

This letter responds to your October 10, 2002, request that we provide 

answers to questions relating to our testimony of September 26, 

2002.[Footnote 1] At that hearing, we discussed the Department of 

Veterans Affairs (VA) progress in improving its overall management of 

information technology, including the centralization of information 

technology functions, programs, and funding under the department-level 

chief information officer (CIO). We also discussed the departments 

progress since last March in developing an enterprise architecture, 

improving information security, and managing important information 

systems initiatives being pursued by the Veterans Benefits 

Administration (VBA) and the Veterans Health Administration (VHA). Your 

questions, along with our responses, follow.

1. On page 19, the GAO testimony stated that VA must also still develop 

a program management plan to delineate how it will develop, use, and 

maintain the enterprise architecture. GAO stated that such a plan is 

integral to providing definitive guidance for effective management of 

the enterprise architecture program. According to Dr. Gauss, VA has 

developed and will implement version 1.0 of the One-VA Enterprise 

Architecture, which establishes ten enterprise business functions and 

seven key enabling functions. Does GAO agree that these business and 

enabling functions provide the management tools necessary to start the 

process for implementing VAs enterprise architecture?

The Federal CIO Councils guidance on enterprise architecture[Footnote 

2] advises organizations to develop a set of controls to help them 

successfully manage the process of creating, changing, and using an 

enterprise architecture. These controls are intended to promote sound 

management of the enterprise architecture project through the use of 

plans, products, and requirements, including the program management 

plan that we referred to in our testimony. In particular, a program 

management plan would articulate critical factors guiding work on the 

architecture, including a work breakdown structure detailing the tasks 

and subtasks necessary to acquire, develop, and maintain the 

architecture; resource estimates for funding, staffing, training, 

workspace requirements, and equipment needs; and a roadmap for the 

initiation and completion of key project tasks. As our testimony noted, 

VA lacked such a management plan to support its enterprise architecture 

effort.

While the enterprise business functions and key enabling functions are 

essential components of the architecture that VA is developing, they 

cannot be considered a primary tool for managing the enterprise 

architecture effort. Rather, these business and enabling functions are 

the products of VAs efforts to develop the baseline, or as-is, and 

identify the target, or to-be, components of its enterprise 

architecture. Specifically, enterprise business functions are 

externally focused functions involving direct interactions with 

veterans across the enterprise, such as providing medical care 

benefits, vocational rehabilitation, and employment benefits. Key 

enabling functions are those necessary to support the enterprise 

business functions, such as eligibility and registration, and enable 

smooth operation of the overall enterprise both internally and 

externally.

As the CIO Councils guidance notes, one of the initial steps in 

developing an enterprise architecture is describing the enterprise as 

it currently exists, including business functions and information 

flows. By identifying the business and enabling functions, VA has set 

the stage for moving toward and measuring progress against its target 

architecture. Nonetheless, while these functions represent an important 

accomplishment in VAs development of its enterprise architecture, they 

do not satisfy the departments need for a program management plan to 

help provide a sound foundation for managing the development, 

implementation, and use of the architecture.

2. Concerning VETSNET, GAO testified that after six years the VA still 

has significant work to accomplish, and could be several years from 

fully implementing the system. In GAOs opinion, how have veterans 

benefited from this program, considering the significant capital that 

has been dedicated to this program?

Although VBA has spent more than $40 million on developing the VETSNET 

compensation and pension replacement system since 1996, veterans have 

not yet received measurable benefits from this initiative. At the time 

of our testimony, VBA was using its new software products to deliver 

benefits payments to only 9 of the more than 3 million compensation and 

pension benefits recipients on its rolls.[Footnote 3] Benefits payments 

to all other recipients continued to be made via the departments aging 

Benefits Delivery Network. Moreover, subsequent to our testimony, VBA 

officials told us that at the beginning of this month they intended to 

convert the processing of the nine benefits payments being made with 

the new software to the Benefits Delivery Network. An official 

explained that the February 2001 pilot test using the new VETSNET 

software had in essence been a proof of concept exercise to demonstrate 

that the software could deliver benefits payments. He stated that this 

exercise has now been completed.

VBA still has numerous tasks to accomplish before its software 

applications comprising the compensation and pension replacement system 

can be fully implemented and capitalized upon. As our testimony noted, 

all but one of the six software applications constituting the new 
system

[Footnote 4] still need to be fully deployed or developed. 

Specifically, two applications--Share, which is used to establish a 

claim, and Modern Award Processing-Development, which is used to help 

develop a claim--still need to be implemented in the majority of VBAs 

57 regional offices.[Footnote 5] In addition, three applications 

continue to require development and, according to VBA officials, are 

not expected to be fully deployed until December 2004. At that time, 

Award Processing will be expected to record award decisions; generate, 

authorize, and validate on-line awards; and interface with a 

correspondence application to develop notification letters to veterans. 

The Finance and Accounting System will be expected to perform 

accounting and benefits payments functions and interface with the 

Department of the Treasury.

Beyond these applications that VBA must still deploy and/or develop, it 

faces the more immediate task of ensuring that the one application 

already deployed--Rating Board Automation 2000--is utilized to its full 

potential. When implemented in November 2000, this application was 

expected to assist veterans service representatives in rating benefits 

claims. However, according to a VBA official, some regional offices 

indicated that rather than improve service delivery, use of the 

software tool actually resulted in longer processing times. Given the 

departments backlog of compensation and pension benefits claims, the 

undersecretary for benefits subsequently suspended the requirement for 

regional offices to use the software until its backlog had been 

reduced. At the time of our testimony, VBA did not plan to require its 

regional offices to fully utilize this software until July 2003.

3.Since VA has been given the lead in making the renamed Federal Health 

Information Exchange (FHIE) a reality, what must be done to assure 

successful implementation?

Successful implementation of FHIE will largely depend on the extent to 

which consistent and effective project management and oversight exists 

to guide the initiative. In April 2001,[Footnote 6] we recommended that 

the participating agencies--VA, the Department of Defense (DOD), and 

the Indian Health Service--take various actions to strengthen the 

management and oversight of the government computer-based patient 

record (GCPR) project (the predecessor strategy). These steps included 

(1) designating a lead entity with final decision-making authority and 

(2) creating comprehensive and coordinated plans that included an 

agreed-upon mission and clear goals, objectives, and performance 

measures to ensure that the agencies could share comprehensive, 

meaningful, accurate, and secure patient health care data. We 

reiterated the need for VA to implement these recommendations in our 

June 2002 report,[Footnote 7] and also made additional recommendations 

that the participating agencies (1) revisit the original goals and 

objectives of the GCPR initiative to determine if they remained valid 

and, where necessary, revise the goals and objectives to be aligned 

with the current strategy and direction of the project; and (2) commit 

the executive support necessary for adequately managing the project and 

ensure that sound project management principles are followed in 

carrying out the initiative. VA concurred with these recommendations.

The actions that VA and DOD took in response to the recommendations 

resulted in a revised strategy whereby patient data would be exchanged 

and a common health information infrastructure and architecture 

comprised of standardized data, communications, security, and high-

performance health information systems would be developed. VA and DOD 

intend to accomplish this with two initiatives. The first, FHIE, is 

focused on DOD providing information to VA clinicians. A second 

initiative, referred to as HealthePeople (Federal), is intended to 

allow the two-way exchange of clinical information, with an emphasis on 

establishing a common health information infrastructure and 

architecture. VA and DOD have stated that they plan to complete this 

initiative by the end of 2005.

Along with designating VA as the lead agency for FHIE, VA and DOD took 

actions to improve project management that should continue to help 

guide this initiative to a successful outcome. For example,

goals and objectives have been revised and aligned with the new FHIE 

strategy;

 a permanent project manager has been assigned to the initiative, and 

he is using project management software to facilitate the monitoring of 

assigned tasks;

 executive-level reviews are being conducted for systems development 

and deployment approval;

 weekly testing and technical meetings are being held; and:

 monthly interagency in-process reviews are being conducted by VAs 

Deputy CIO for Health and DODs CIO for Military Health Systems.

VA and DOD officials reported that the nationwide deployment and 

implementation of the first phase of FHIE was successfully completed in 

July. The first phase has enabled the one-way transfer of demographic 

information,[Footnote 8] laboratory results, outpatient pharmacy data, 

and radiology reports for separated service members from DODs Military 

Health System Composite Health Care System to VAs FHIE repository. 

Clinicians throughout VHA now have access to over 14 million lab 

messages, almost 14 million pharmacy messages, and over 2 million 

radiology messages on over 1 million service personnel who separated 

between 1987 and 2001.

A second, final phase of FHIE began in October and is intended to make 

additional health information--in-patient histories, diagnoses, and 

procedures; allergy information; admission, disposition, and transfer 

information; and consult results--available to VA clinicians. This 

phase will rely on the existing technology supporting phase 1, and thus 

will only involve adding data to the existing repository. Completion of 

the final phase is scheduled for September 2003.

As VA and DOD proceed with implementing the final phase of FHIE and 

move forward with HealthePeople (Federal), providing consistent project 

management and oversight will continue to be essential for successful 

project completion. As such, sustained adherence to the program 

management structure that VA and DOD have already put in place will be 

critical. Moreover, these agencies can further strengthen their 

management and oversight through the use of performance measures to 

gauge the progress and effectiveness of their efforts.

4. The VA testified that HealtheVet-Vista should be implemented by the 

end of 2005. In GAOs opinion, is this timetable realistic? Please 

elaborate.

As noted, beyond FHIE, VA and DOD have envisioned a long-term strategy-

-HealthePeople (Federal)--involving the two-way exchange of patient 

health care information. This exchange is expected to depend on the 

successful interoperability, and resultant sharing of secure health 

care data, between DODs Composite Health Care System (CHCS) II and 

VAs HealtheVet VISTA, both of which continue under development.

At this time, we are unable to determine whether plans for implementing 

this long-term strategy are realistic. When our review concluded, VA 

and DOD had just begun this initiative, and program officials stated 

that they had not completed an implementation plan. Until DODs CHCS II 

and VAs HealtheVet VISTA have been fully developed and a plan 

detailing the work tasks, resources, and completion milestones for 

HealthePeople (Federal) has been developed and made available for our 

review, we will not have a basis for assessing VAs potential for 

implementing this initiative by the end of 2005.

----------:

We requested comments on a draft of this letter from the Department of 

Veterans Affairs, but none were provided.

We are sending copies of this letter to the Secretary of Veterans 

Affairs; copies will also be available on our Web site at www.gao.gov. 

Should you or your office have any questions on matters discussed in 

the letter, please contact me at (202) 512-6253. I can also be reached 

by e-mail at willemssenj@gao.gov.

Sincerely yours,

Signed by Joel C. Willemssen:

Joel C. Willemssen

Managing Director, Information Technology Issues:

FOOTNOTES

[1] U.S. General Accounting Office, VA Information Technology: 

Management Making Important Progress in Addressing Key Challenges, GAO-

02-1054T (Washington, D.C.: Sept. 26, 2002).

[2] Chief Information Officer Council, A Practical Guide to Federal 

Enterprise Architecture, Version 1.0 (Washington, D.C.: February 2001).

[3] As part of a pilot test in February 2001, VBA began processing ten 

original benefits claims using its new software. However, according to 

VBA, one of the ten veterans subsequently moved outside of the area 

covered by the pilot test and now receives his payments via the 

Benefits Delivery Network.

[4] The six software applications constituting the replacement system 

are Share, Modern Award Processing-Development, Rating Board Automation 

2000, Award Processing, Finance and Accounting System, and 

Correspondence. 

[5] Among the 57 regional offices that are expected to benefit from the 

replacement system, only 6 currently use Share to establish a claim; 

only 2 offices (Salt Lake and Little Rock) have pilot-tested and 

currently use Modern Award Processing-Development to assist in 

developing most compensation claims. 

[6] U.S. General Accounting Office, Computer-Based Patient Records: 

Better Planning and Oversight by VA, DOD, and IHS Would Enhance Data 

Sharing, GAO-01-459 (Washington, D.C.: Apr. 30, 2001).

[7] U.S. General Accounting Office, Veterans Affairs: Sustained 

Management Attention Is Key to Achieving Information Technology 

Results, GAO-02-703 (Washington, D.C.: June 12, 2002).

[8] The demographic information consists of patient name, DOD 

eligibility category, Social Security number, address, date of birth, 

religion, primary language, sex, race, and marital status.

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