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S. HRG. 111–894 

VA’S IT PROGRAM: LOOKING AHEAD 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

OCTOBER 6, 2010 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

ROLAND W. BURRIS, Illinois 

ARLEN SPECTER, Pennsylvania 

RICHARD BURR, North Carolina, Ranking 

Member 

LINDSEY O. GRAHAM, South Carolina 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

SCOTT P. BROWN, Massachusetts 

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

(III) 

C O N T E N T S 

WEDNESDAY, OCTOBER 6, 2010 

SENATORS 

Page 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1 

Burr, Hon. Richard, Ranking Member, U.S. Senator from North Carolina ....... 2 

Johanns, Hon. Mike, U.S. Senator from Nebraska ............................................... 3 

Brown, Hon. Scott, U.S. Senator from Massachusetts ......................................... 4 

WITNESSES 

Baker, Roger W., Assistant Secretary for Information and Technology, U.S. 

Department of Veterans Affairs .......................................................................... 4 

Prepared statement .......................................................................................... 6 

Enclosure .................................................................................................... 11 

Meagher, Edward Francis, Chairman, VistA Modernization Committee of the 

American Council for Technology Industry Advisory Council and Vice President, Healthcare Strategy, North American Public Sector, Computer 

Sciences Corporation ............................................................................................ 12 

Prepared statement .......................................................................................... 14 

ACT-IAC VistA Modernization Report ........................................................... 16 

Finn, Belinda J., Assistant Inspector General for Audits and Evaluations, 

Office of Inspector General, U.S. Department of Veterans Affairs .................. 116 

Prepared statement .......................................................................................... 118 

Tullman, Glen, Chief Executive Officer, Allscripts ............................................... 121 

Prepared statement .......................................................................................... 123 

Munnecke, Tom, Former Information Technology Official, U.S. Department 

of Veterans Affairs ............................................................................................... 125 

Prepared statement .......................................................................................... 127 

Appendix .................................................................................................... 130 

(1) 

VA’S IT PROGRAM: LOOKING AHEAD 

WEDNESDAY, OCTOBER 6, 2010 

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 9:33 a.m., in room 

418, Russell Senate Office Building, Hon. Daniel K. Akaka, Chairman of the Committee, presiding. 

Present: Senators Akaka, Burr, Johanns, and Brown of Massachusetts. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Chairman AKAKA. This hearing of the United States Senate Committee on Veterans’ Affairs will come to order. 

Today, the Committee examines VA’s IT program with an eye toward the future. I thank the Ranking Member, Senator Burr, very 

much for his deep interest in this issue. 

Many important VA benefits depend on information technology, 

from the delivery of quality care to the processing of education and 

disability claims, and to any effort to ensure seamless transition 

from DOD to VA. While it is true that VA has been a leader in 

adopting electronic health records, VA’s overall history with IT 

projects is far from perfect. VA has stumbled over the years on its 

path toward the goal of an electronic VA. 

More recently, we had a financial and logistics system fail known 

as CoreFLS. To make matters worse, the contractor was paid a 

bonus. Software systems processing G.I. Bill claims suffered many 

false starts. And last summer, VA halted 45 projects that were dramatically over budget and overdue, including an outpatient scheduling system that was 3 years overdue. 

I do not wish to dwell in the past. We must, however, learn from 

these mistakes and take action to avert them in the future. 

The administration has made it a priority to improve the delivery 

of veterans’ benefits through technology. With appropriate technologies VA will more efficiently serve veterans by reducing the 

time it takes to process benefits. Moving forward, VA must clearly 

articulate a vision for its IT program. VA’s day-to-day management 

must reflect this vision, and the lines of communication that compel IT development must remain open between VA leadership and 

users. 

Every VA medical facility across the Nation must operate with 

a fully electronic medical record. The Lifetime Electronic Record 

also needs to become a reality. G.I. Bill processing software needs 

2 

to be good enough to allow veterans, the schools, and VA to access 

and file claims in hours instead of weeks. And we must be in line 

to eventually replace the paper-centric disability claims process 

with an electronic business solution. 

This hearing is one effort among many to carry out oversight of 

IT. Again, I welcome everyone to today’s hearing. I look forward to 

the testimony from our panel and to continuing work with the 

many interested parties as we seek to ensure VA is on the right 

track. 

Let me call on our Ranking Member, Senator Burr, for his statement. 

STATEMENT OF HON. RICHARD BURR, RANKING MEMBER, 

U.S. SENATOR FROM NORTH CAROLINA 

Senator BURR. Aloha, Mr. Chairman. 

Chairman AKAKA. Aloha. 

Senator BURR. Welcome to our witnesses. 

Mr. Chairman, I thank you for your willingness to schedule this 

hearing even though the Senate is out of session. I want to thank 

my colleagues, Senator Johanns and Senator Brown, for being here. 

Mr. Chairman, seldom do we have a witness that you and I share 

from the standpoint of their State presence, but I would like to welcome Glen Tullman, the CEO of Allscripts. They have a presence 

in 15 States. I am proud to tell you two of those are Hawaii and 

North Carolina, so it is appropriate that we would have him here 

today and I want to thank him for taking time out of his busy 

schedule to discuss the company’s experience with electronic health 

records and interoperability in the private sector. 

We are here to discuss an integral tool of VA’s mission, the use 

of technology to deliver effective benefits and services to the American veterans. Within VA, the Office of Information and Technology 

is responsible for the management and oversight of VA’s information technology assets. With a budget of over $3 billion and a mission so important to the successful delivery of services to veterans, 

Congressional oversight and involvement is critical. 

Today, we take a step toward strengthening the partnership between this Committee and the Office of Information and Technology in addressing the challenges confronting VA’s effective management of its IT assets. We have seen a number of IT projects important to VA’s mission fail and others discontinued over the last 

decade. These failures and discontinuations have cost taxpayers 

hundreds of millions of dollars. Despite continued warnings from 

the IG, GAO, and Members of Congress, problems delivering useful 

IT projects on time and on budget persist at VA. At times, these 

failures have left me wondering whether or not VA has the capability to deliver IT programs of significance on time, on budget, and 

within specifications. 

However, since Mr. Baker’s appointment at VA 16 months ago, 

there seems to be a genuine effort to overhaul this portion of VA’s 

operations. The installation of the Project Management Accountability System by the Assistant Secretary appears to be a strong 

first step in reigning in out of control and oversized contracts and 

projects. I look forward to hearing Mr. Baker’s assessments about 

how PMAS has affected the culture at the VA. 

3 

With today’s modern technology, there are several IT capabilities 

that are expected from companies and health networks doing business across the country. These include the ability to process claims, 

schedule appointments, conduct real-time accounting, and share information seamlessly with other partners. Unfortunately, these are 

all areas where VA continues to struggle, oftentimes producing not 

a single result that was desired at the outset of the program. 

One example of this is their proposed scheduling program that took 9 years, $127 million to produce nothing. VA still needs a new 

scheduling program in order to improve patient health care delivery at each VA facility. 

The cancellation of the proposed accounting system is also concerning. Although this decision should be applauded as a sign that 

the VA is moving away from bloated and oversized projects and 

contracts, let me state that the inability to identify expenditures in 

real time is hamstringing VA’s capability to know how much their 

cost of conducting business really is. 

Interoperability with DOD is another area that continues to need 

improvement. As witnesses will testify, the capability to share information across systems is available, but to date, it appears that 

even though there has been nominal success by VA, we are far 

from where we need to be. 

I look forward to hearing specifically where VA currently stands 

with regard to having the appropriate technological capabilities to 

deliver veterans the time-sensitive services that they have earned, 

and more importantly, they deserve. 

Again, I thank you, Mr. Chairman. I thank our witnesses. 

Chairman AKAKA. Thank you very much, Senator Burr. 

Now we will have the opening statement from Senator Johanns. 

STATEMENT OF HON. MIKE JOHANNS, 

U.S. SENATOR FROM NEBRASKA 

Senator JOHANNS. Mr. Chairman and Ranking Member, thank 

you very much for putting this hearing together and welcome to 

the witnesses. 

As I was listening to the Chairman and Ranking Member speak, 

I thought back to my days as Secretary of Agriculture, and I have 

to tell you, IT systems were the bane of my existence. [Laughter.] 

So I start out telling you that because I think I understand what 

you are going through here. 

This is not a good history. There is just no way of getting around 

it. It is frustrating to me as it is to you, I am sure, that projects 

come in over budget; that after working on a project and spending 

enormous amounts of money, the project is abandoned. 

The other thing that is a little harder to quantify but is enormously real is the amount of staff time that is invested. Again, that 

is just very, very difficult to quantify, but those staff members who 

are committing their time to a project are not doing other things, 

and so they are constantly playing catch-up. 

So, I think this hearing is enormously important. I will say this, 

Secretary Baker, I do think you are trying to get on top of this and 

I think you are trying to move in the right direction. My hope for 

today’s hearing is that we get an honest assessment from all the 

witnesses as to where we are at to date, and although it is never 

4 

pleasant to talk about the problems that are out there that you 

know are going to end up on our desk and then your desk, I would 

like to hear some thoughts about where we are as we head toward 

the future here. 

So, Mr. Chairman and Ranking Member, thanks for pulling this 

hearing together. I look forward to the testimony. 

Chairman AKAKA. Thank you very much, Senator Johanns. 

Now we will have the opening statement of Senator Brown of 

Massachusetts. 

STATEMENT OF HON. SCOTT BROWN, 

U.S. SENATOR FROM MASSACHUSETTS 

Senator BROWN OF MASSACHUSETTS. Thank you, Mr. Chairman. 

I concur with the opening statements of the Ranking Member, Senator Johanns, and yourself: I am here to learn and to see what 

tools and resources we can either provide or are needed to do your 

job better for the folks that need your help. So thank you. 

Chairman AKAKA. Thank you very much, Senator Brown. 

I want to welcome the witnesses on today’s panel. In the interest 

of opening a dialog amongst our witnesses, we have only one panel. 

First, we have the Honorable Roger Baker, Assistant Secretary 

for Information and Technology at the Department of Veterans 

Affairs. 

We have Belinda Finn, Assistant Inspector General for Audits 

and Evaluations, Office of Inspector General for the Department of 

Veterans Affairs. Ms. Finn is accompanied today by Mario Carbone, 

Director of the Dallas Office of Audits and Evaluations. 

We also have Ed Meagher, Vice President of Healthcare Strategy 

for the Computer Science Corporation. 

We have Tom Munnecke, a former VA IT official. 

Finally, we have Glen Tullman, Chief Executive Office of 

Allscripts. 

I thank you all for being here this morning. Your testimony will 

appear in the record. 

Mr. Baker, you are now recognized for 5 minutes. 

STATEMENT OF ROGER W. BAKER, ASSISTANT SECRETARY 

FOR INFORMATION AND TECHNOLOGY, U.S. DEPARTMENT 

OF VETERANS AFFAIRS 

Mr. BAKER. Well, thank you, Chairman Akaka, Ranking Member 

Burr, Members of the Committee. It is indeed a pleasure to appear 

in front of you again to discuss the state of VA’s Office of Information and Technology. 

Sixteen months ago the Members of this Committee confirmed 

me as President Obama’s choice for Assistant Secretary for Information and Technology. At that time, you made it clear that you 

understood the significant challenges VA faces with information 

technology. I have appreciated your insights and your support over 

the last 16 months as we have worked to address those challenges. 

As my written testimony goes into much more detail, we have aggressively dealt with the largest issues facing IT at VA. First, Senator Burr, as you noted, we introduced the Program Management 

Accountability System, which has already had a dramatic impact 

in transforming the results of our development organization. 

5 

Today, VA hits its system development milestones 80 percent of the 

time, a rate that nearly every CIO, public or private sector, would 

envy. We achieved this transformation by forcing projects to deliver 

functionality in small increments and communicating a schedule 

adherence in the organization. During 2010, we generated over 

$200 million of cost avoidance in our development organization by 

stopping or reforming poorly performing projects, money we have 

asked to reprogram to other uses to benefit veterans. 

Second, in information security we have achieved our goal of having visibility to every desktop computer in the organization—as of 

yesterday, that is 310,722 of them—by September 30. What this 

means is that we can begin dealing with IT security holes in our 

infrastructure based on objective metrics and factual observations, 

not anecdotal incidents. 

Third, we are now publishing metrics from across our operations 

organization to measure our operational excellence. At an enterprise level, our metrics show that our key systems are highly available. For example, our VistA systems across the country average 

99.95 percent availability. We also know that customer support is 

a local experience so we are focused on measuring and publishing 

metrics on customer experience and customer satisfaction at an individual facility level. 

Fourth, we once again have established for fiscal year 2011 a 

prioritized operating plan that will guide our decisions about where 

to invest our resources during the year. The intent of this is to give 

us clear visibility from plan to budget to spend to results, on every 

one of those more than $3 billion in our appropriation. 

My written testimony also highlights several notable product delivery successes, deliveries that are tangible results of our disciplined approach to managing IT, including the new G.I. Bill Long 

Term Solution, Pharmacy Re-Engineering, and the Virtual Lifetime 

Electronic Record. These systems are already having an impact on 

the quality of care and the speed of benefits for our Nation’s 

veterans. 

While I am proud of the accomplishments of the VA IT organization over the last 16 months, I recognize that much more work remains to be done. As the only department-level consolidated IT organization in the Federal Government, I believe that VA IT must 

strive to be a leader both inside and outside of government. The 

Office of Information and Technology has made substantial strides 

forward and is well on its way toward achieving this goal. Indeed, 

in a number of areas, VA has blazed a trail of innovation that the 

rest of the government is beginning to follow. 

Looking forward, we must use our new and disciplined management approaches to help us deliver improved IT systems that will 

have a direct impact on veterans, including the new Veterans Benefits Management System that will aid the Veterans Benefits Administration in achieving the Secretary’s goal of ‘‘breaking the back 

of the backlog.’’ We must deliver the Virtual Lifetime Electronic 

Records Initiative, ensuring that all providers of services to veterans have ready access to the information they need to provide 

quick and effective services. 

We must deliver on the IT projects essential to the other 14 

major initiatives, including ending veterans’ homelessness and imVerDate Nov 24 2008 12:36 Mar 16, 2011 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 H:\ACTIVE\100610.TXT SVETS PsN: PAULIN
6 

proving access to care, that will promote the transformation of VA 

as envisioned by Secretary Shinseki. And we must create an open 

source model for the VistA Electronic Health Record System, bringing back the innovation that made VistA the best Electronic Health 

Record System in the country. 

Mr. Chairman, while we have made significant improvements 

and had many successes over the last 16 months, as we look forward, I think it best to look back to the words of my confirmation 

testimony, and that is that there is no easy path, no simple answer, and no short-cut solution to creating a strong IT capability 

at VA. Achieving this will require hard work, disciplined management, and honest communications. 

Thank you, Mr. Chairman, Ranking Member Burr, and Members 

of this Committee for your continued support of veterans, their 

families and their survivors, of the VA, and specifically of our efforts to transform VA IT. I am prepared to answer any questions 

you might have at this point. Thank you. 

[The prepared statement of Mr. Baker follows:] 

PREPARED STATEMENT OF ROGER W. BAKER, ASSISTANT SECRETARY FOR

INFORMATION AND TECHNOLOGY, U.S. DEPARTMENT OF VETERANS AFFAIRS

Thank you Chairman Akaka, Ranking Member Burr, and Members of the Committee. It is indeed a pleasure to appear in front of you again to discuss the state 

of VA’s Office of Information and Technology. My testimony will address the current 

status of the Department’s major Information and Technology (IT) transformation 

initiatives as well as our future plans. 

Sixteen months ago, the Members of this Committee confirmed me as President 

Obama’s choice for Assistant Secretary of Information and Technology. During our 

pre-hearing discussions, you made it clear that you understood the significant challenges VA faced with information technology. I have appreciated your insights and 

support over the last 16 months to bring VA’s technology into the 21st century. 

Under this Administration, the Office of Information and Technology has made 

substantial strides forward, and is well on its way toward achieving the goal of 

being the best IT organization in the Federal Government, and comparable to many 

well-run private sector IT organizations. Indeed, in a number of areas VA has 

blazed a trail of innovation that the rest of government is beginning to follow. I 

would like to hit the high points of the last 16 months for you. 

Customer Service: 

The most dramatic change at VA has been in the relationship between OI&T and 

the Administrations (Veterans Health, Veterans Benefits, and National Cemeteries). 

With the Under Secretaries, and with the continuous support of Secretary Shinseki, 

we have set a tone of cooperation that has made it possible for us to effectively address many difficult problems at the second largest agency in the Federal Government. As an example, the successful delivery of the new GI Bill long-term processing solution, discussed in detail later in my testimony, was clearly an intense cooperative venture between OI&T and the Veterans Benefits Administration (VBA). 

Whenever asked by the Secretary about an issue or a success regarding the GI Bill, 

our team’s answer consistently starts with ‘‘we.’’ We built the system as a team, and 

we delivered the system as a team and that relationship is the single largest contributing factor to what is, for VA, a stunning victory and reversal of past practices—the successful installation of the GI Bill system on schedule in March of this 

year, and the complete conversion of all GI Bill processing to this system next August. 

Thanks to Robert Petzel, M.D., Under Secretary for Health, Mr. Michael Walcoff, 

Acting Under Secretary for Benefits, and Mr. Steve Muro, Acting Under Secretary 

for Memorial Affairs, that same cooperative approach has spread throughout VA 

and continues to thrive. Together, we are ensuring that our staffs ‘‘get the message’’ 

that only by working together can we solve problems and not point fingers. 

Program Management Accountability System: 

In June of last year, after dealing with the failure of the Replacement Scheduling 

Application (RSA), this administration introduced the Program Management AcVerDate Nov 24 2008 12:36 Mar 16, 2011 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6621 H:\ACTIVE\100610.TXT SVETS PsN: PAULIN
7 

countability System, or PMAS. Soon after, we stopped 45 ongoing and failing IT 

projects and, after analysis, canceled 12 and re-formed the other 33 to meet the 

strict requirements of PMAS. Our actions on those 45 projects generated $54 million 

in cost avoidance in 2010, allowing us to put those dollars to use on other critical 

investments to serve America’s Veterans, their families and survivors. More importantly, we substantially decreased the risk of failure in the 33 projects that were 

re-planned and re-formed. 

Under PMAS, all projects must deliver customer-facing functionality every 6 

months (or less) without exception. This rapid delivery approach, with names such 

as Incremental or Agile development, is already used extensively throughout the 

private sector, where they cannot afford to waste millions on IT projects that never 

deliver. For VA, we combined rapid delivery with a management methodology that 

enforces strict adherence to project milestones. 

The level of culture change accomplished within the VA IT development area over 

the last year simply cannot be understated. In March of this year, it became VA 

policy that all systems development projects would be managed under PMAS. Over 

2,500 development staff, employees and contractors, now focus on making committed 

schedule dates as paramount, and break down all projects into deliverables that can 

be accomplished in less than 6 months. The measurable results are dramatic. 

Last year, approximately 283 development projects at VA met their milestone 

dates an estimated 30 percent of the time. I say estimated because we have no real 

way of knowing, as IT development projects simply weren’t tracked to their committed dates prior to PMAS. Today, VA has 97 active development projects, tracked 

in real-time through a project database and dashboard—they are meeting their 

milestone dates over 80 percent of the time. I know of no other Chief Information 

Officer (CIO), government or private sector, who has this level of insight into such 

a large portfolio of development projects. I can assure you, however, that most IT 

development organizations, public or private sector, would be ecstatic with meeting 

80 percent of their committed milestones. 

In 2010, VA had a cost avoidance of nearly $200 million by eliminating poorly performing projects and restructuring many others to lower risk, reduce spend rates, 

and incremental development plans. 

Information Security: 

As you are aware, the VA IT enterprise is massive, with 153 hospitals, 853 community-based outpatient clinics (CBOC), 57 benefits processing offices, and 131 

cemeteries and 33 soldier’s lots and monument sites on a single, consolidated network. Our mission requires that we hold Personally Identifiable Information and 

Personal Health Information on approximately 26 million Veterans, and that we 

make that information available quickly to health care providers and benefits personnel who need it to provide the most effective services to Veterans. Our network 

supports over 400,000 users, and over 700,000 devices. 

To vastly improve our information security posture, this spring we embarked on 

a project to provide visibility to every desktop on the network by the end of the fiscal year. I am pleased to report that we achieved that goal, thanks to a lot of hard 

work on the part of many OI&T employees. By the end of the calendar year, we 

will also have achieved full implementation of our medical device isolation architecture, which is essential to mitigating security vulnerabilities in our medical devices. 

Finally, we will achieve full visibility to every device on our network during fiscal 

year 2011, putting us on par with the best managed private sector organizations. 

Our ability to provide immediate response to vulnerabilities and threats within our 

enterprise, as well as enacting a proactive approach to centralized monitoring, reporting, compliance validation and providing maximum service availability, is quickly establishing VA as a model of excellence for the rest of the Federal Government. 

Operational Excellence: 

I am proud to tell you that our operations organization provides excellent service 

to our hospitals, benefits offices, and cemeteries. I can tell you this because, starting 

in my first month at VA, we began to measure and publish key metrics that tell 

us how we are doing. We started at the core, measuring network availability (which 

averages 99.99 percent), Veterans Health Information Systems and Technology Architecture (VistA) system availability (99.95 percent), and help desk wait times. We 

have expanded these measurements to include a list of nearly 167 metrics covering 

aspects of our network, our service provision and our system/application provisioning that help us understand what works well and what does not. 

Along our customer service theme, we are now focusing on providing metrics on 

how well we are doing at each individual VA facility. We will soon begin reporting 

key IT support metrics at each VA facility, allowing national operations staff to 

8 

work more easily and more quickly with the facility CIO and the facility director 

to identify and address issues that cause poor support. We also recently introduced 

a program to allow continuous monitoring of customer satisfaction at each facility, 

measured in a way that lets us compare customer satisfaction for our services 

versus those of similar private sector organizations. We intend to continue to augment the reporting of metrics and automate the collection of vital information thru 

the implementation of Enterprise Management Framework (EMF). The ability to 

measure these key processes and adjust accordingly is central to continuous operational improvement—a hallmark of a mature operation. Customer satisfaction is a 

local issue. In an enterprise the size of VA, it is not enough to focus on the averages. 

We must work to identify and address issues that affect local customer support and 

satisfaction, and to play our part in ensuring that each Veteran receives the best 

services possible. 

Financial Management: 

Finally, we created a detailed financial plan for OI&T in both 2010 and 2011, 

known as the Prioritized Operating Plan. This plan has two main purposes. First, 

it creates a vehicle for us to agree, with our customers, on what the high priority 

IT services and projects are, and allocate our resources to ensure success on the 

most important items. It also allows us to communicate, clearly and objectively, 

which projects and services will not be accomplished. Second, it allows us to track 

our expenditures, from plan to budget to spend to results, and know the business 

purpose for spending each dollar and then track the results we expect to obtain from 

the expenditure. 

PROJECT DELIVERY HIGHLIGHTS

I would like to take a moment to talk about three projects that have been notable 

successes for VA IT over the last year. 

New GI Bill Long Term Solution (LTS): 

As I mentioned earlier, I’m pleased to report that VA has made tremendous 

strides in delivering Post-9/11 GI Bill benefits in a timely and accurate manner. 

We’ve also made significant progress in the development and deployment of our new 

processing and payment system. As a result of these significant strides, VBA recently reported that at the end of August last year, VA had processed payments for 

only 8,185 students for the fall 2009 semester. For the current fall term, VA has 

already processed payments for more than 135,000 students. The average time to 

process an enrollment certification in August 2010, was 10 days, down from 28 days 

one year ago. 

We delivered and deployed Release 1.0 of the long-term solution (LTS) on schedule on March 31, 2010. In June and August 2010, we successfully deployed Releases 

2.0 and 2.1 of the LTS. Release 2.0 allowed the complete processing of all new 

claims under the LTS, while Release 2.1 allowed the conversion of all previously 

processed records from the ‘‘Interim Solution’’ to the LTS. Through these deployments, we successfully converted over 500,000 Chapter 33 claimant records from our 

interim processing system into the LTS and are paying over 600,000 claimants from 

the LTS. We also added greater functionality to that originally planned for the LTS, 

adding functionality to include: enabling payment of retroactive housing allowance 

adjustments to those individuals eligible for the increased rates in 2010; automatically generating letters to individuals to provide them better information on their 

benefits; and facilitating claims processing for the Fry Scholarship recipients. VA is 

now processing all Post-9/11 GI Bill claims in this new system, thereby replacing 

the interim processing system and its associated manual job aides. 

Most importantly, the new system was installed, and record conversion accomplished, with no significant errors. This meant that we were able to achieve our primary goal, which was to have the LTS installed in time to process fall semester 

claims without introducing processing errors or delays that might affect claims processing. The success of this roll-out is well above the industry norm. 

While delivery of the LTS has been accomplished, functionality to automate interfaces to other systems has been delayed. The interfaces with the VA-ONCE system 

for certification of enrollment, and the benefits delivery payment system, previously 

scheduled for September 30, 2010, are now scheduled for October 30, 2010, and December 31, 2010, respectively. These delays are due primarily to the level of effort 

required to ensure that data conversion and basic allowance for housing (BAH) retroactive payment calculations were accomplished without introducing processing errors that would require manual correction and thus impact fall benefit processing. 

9 

Pharmacy Re-Engineering: 

Pharmacy Re-Engineering (PRE) was one of the original 45 projects stopped in 

June 2009 under PMAS. At that time, PRE was a classic case of a VA IT project 

that had been unable to deliver functionality to customers over a period of many 

years. At the time it was stopped, PRE had just announced another one year slip 

in its delivery schedule, and management was not confident that no further slips 

would be encountered. 

In October 2009, we re-formed and re-started the project under an incremental delivery project plan, with six increments originally defined. I am pleased to report 

that Pharmacy Re-Engineering is now in production in our Charleston, SC facility, 

and will soon move into beta test at additional facilities. 

PRE Increment 1 (Foundational Enhancements) reached Initial Operating Capability (IOC) on October 23, 2009, a full 39 days ahead of schedule. This release provides tools to allow sites to begin setup required for Increments 3–4 and minor enhancements to the existing pharmacy system. 

PRE Increment 2 (Pharmacy Enterprise Customization System) reached IOC as 

scheduled on March 5, 2010. This release provides tools to allow customization of 

commercial software system data used for medication order checking to better meet 

VA business practices. 

PRE Increment 3 (Medication Order Check Healthcare Application—Non Dosing) 

reached IOC on June 29, 2010. This release was delivered 28 days beyond its 

planned due date because of delays in dependent projects and issues related to testing required before going live in a hospital environment. Enhanced order checks included in this release address a number of critical patient safety issues in legacy 

pharmacy applications. 

PRE Increment 4 (Medication Order Check Healthcare Application—Dosing) 

reached IOC as scheduled on August 30, 2010. New maximum daily dose, daily dose 

range, and dosing guidelines provide clinicians with tools to reduce potential overor under-dosing of prescribed medications. 

When fully deployed, PRE increments 1–4 are expected to reduce accidental dosing errors (ADEs) by approximately 10 percent and will be used by approximately 

10,000 pharmacy employees in the processing of 108 million outpatient prescriptions 

and 15 million inpatient orders annually. All of this will enhance the continued success of our Malcom Baldridge Award-winning VA Pharmacy system. 

VLER

In April 2009, President Obama charged the Secretaries of Defense and Veterans 

Affairs with creating a Virtual Lifetime Electronic Record (VLER) to improve our 

ability to provide services to our Nation’s Servicemembers, Veterans, their families 

and their beneficiaries. We have made substantial progress. Most visibly, we are 

now ‘‘live’’ in two pilots of the Nationwide Health Information Network in San 

Diego, CA and Hampton Roads in Norfolk, VA. This Nationwide Network is critical 

to VLER in that it will provide access to private sector records that are a large part 

of the lifetime of care received by Servicemembers and Veterans. 

We have also implemented a consolidated eBenefits portal where Servicemembers 

and Veterans can access information on the benefits they are receiving or may be 

due. The eBenefits portal will eventually be the single point of entry for all benefits 

information. Perhaps most importantly, the eBenefits portal effectively bridges the 

conversion from active duty to Veteran status by allowing Servicemembers to retain 

the same login information they had as an active duty participant. This simple 

change is critical to the VLER concept. 

Also critical to the VLER concept is the adoption by VA this summer of the Department of Defense’s (DOD) Electronic Data Interchange—Personal Identifier, or 

EDI-PI, as the common identifier to be included in all VA records. This ensures 

that, once authenticated, both VA’s and DOD’s systems will have a shared, common 

way of identifying all records about a single individual. Thanks to outstanding DOD 

cooperation, we have also agreed that DOD will provide an EDI-PI for all individuals seen by VA, even if they were not known to DOD when the Veteran served. 

Looking Forward: 

While I am proud of the accomplishments of the VA IT organization over the last 

16 months, I also recognize that much, much more work remains to be done. As the 

only Department-level consolidated IT organization, I believe that VA IT must strive 

to be a leader both inside and outside of government. To that end, I would tell you 

what my goals are for us in the coming years: 

10 

1. Deliver effectively and efficiently the new Veterans Benefits Management System, aiding Veterans Benefits Administration in achieving the Secretary’s goal of 

‘‘breaking the back of the backlog.’’ 

2. Achieve the Virtual Lifetime Electronic Records initiative. 

3. Deliver the IT projects essential to the other 14 major initiatives that will promote the transformation of VA as envisioned by Secretary Shinseki. 

4. Create an Open Source model for the VistA electronic health record system, 

bringing back the innovation that made VistA the best electronic health record system in the country. 

5. Solidify and refine PMAS to ensure that VA IT development projects continue 

to meet aggressive yet realistic customer delivery milestones. 

6. Leverage the ‘‘visibility to the desktop’’ initiative to ensure compliance with 

critical information security policies throughout the enterprise. 

7. Continue to ensure VA IT transparency by publicly publishing PMAS data, 

operational metrics, privacy breaches, and other management information of interest to the public. 

8. Increase internal customer satisfaction with VA IT services by focusing on local 

support metrics and satisfaction. 

9. Maintain the prioritized operating plan as the primary vehicle for communicating with our internal customers on budget decisions. 

10. Continue to implement IT infrastructure improvements that increase our service levels and decrease cost. 

CONCLUSION

Mr. Chairman, while we have made many significant improvements and had 

many successes over the last 16 months, we have only just begun down the path 

that we must follow to achieve our ultimate goal of a 21st Century VA. I think it 

best to reiterate the words from my confirmation testimony that are still quite true 

today: ‘‘There is no easy path, no simple answer, and no short-cut solution to creating a strong IT capability at VA. Achieving this will require hard work, disciplined 

management, and honest communications.’’ Thank you Mr. Chairman, Ranking 

Member Burr, and Members of this Committee for your continued support: of Veterans, their families and survivors; of VA; and of our efforts to transform VA IT. 

I am prepared to answer any questions at this time. 

11 

ENCLOSURE

Chairman AKAKA. Thank you very much, Mr. Baker. 

Now, we will accept the testimony of Mr. Meagher. 


64910VADOD.eps
12 

STATEMENT OF EDWARD FRANCIS MEAGHER, CHAIRMAN, 

VISTA MODERNIZATION COMMITTEE OF THE AMERICAN 

COUNCIL FOR TECHNOLOGY INDUSTRY ADVISORY COUNCIL 

AND VICE PRESIDENT, HEALTHCARE STRATEGY, NORTH 

AMERICAN PUBLIC SECTOR, COMPUTER SCIENCES CORPORATION 

Mr. MEAGHER. Aloha, Chairman Akaka, Ranking Member Burr, 

and Members of the Committee. I am honored to be here and I 

thank you for the opportunity to appear before you today to discuss 

the findings of the Industry Advisory Council’s report, ‘‘VistA Modernization Report: Legacy to Leadership,’’ and as you requested, to 

provide my views on current successes and failures in VA IT and 

recommendations for success in the future. 

While discussing the VistA Modernization Report, I will be representing the Industry Advisory Council. However, while discussing 

any other issue, I will be representing myself only. 

ACT-IAC is a unique nonprofit public-private partnership dedicated to advancing the business of government through the application of technology. The agenda is government-driven. ACT-IAC provides an ethical forum for collaboration where government and industry can create solutions for the most pressing government IT 

issues and challenges. That forum is objective and vendor and technology neutral. ACT-IAC also provides education and training to 

build essential knowledge and skills for government and industry 

professionals who want to serve the IT community. The greatest 

value of ACT-IAC is in its ability to deliver strategic insight and 

actionable solutions to advance government’s ability to serve citizens and the Nation. Participation in the organization is open to 

any member of the government IT community who shares our commitment to advancing the business of government. 

In September 2009, VA’s Assistant Secretary Roger Baker asked 

IAC to assess the issues, challenges, and opportunities associated 

with modernizing the current legacy VistA system and make recommendations to address these issues and challenges to take advantage of the opportunities that are presented. At no expense to 

the government, IAC formed a committee of senior executives representing 42 of its over 500 member companies, and I was asked 

to chair this committee. 

We began a process of first educating ourselves about the issues 

involved in modernizing a large, mission-critical legacy system and 

then specifically looking at the current state of VA’s legacy VistA 

system. We looked at 24 alternative approaches to modernizing, 

and after narrowing those to six approaches, we examined those six 

in greater detail. In addition to the alternative subcommittee, we 

created subcommittees to explore and analyze options concerning 

architecture, implementation models, deployment models, governance, opportunities and impact, terms and definitions, and finally, 

reports and presentations. We estimate that over 7,000 man hours 

over a 6-month period went into the preparation and development 

of this report. 

The committee operated on a consensus-based model, and we are 

all very proud of the fact that the final report was unanimously endorsed by all members of the committee. Our recommendations can 

be summarized as two high-level strategic recommendations and 

13 

seven specific actionable recommendations that describe programmatic next steps to implement our strategic recommendations. 

We believe we successfully negotiated the middle path such that 

our recommendations are not overly prescriptive nor are they just 

simply well intended generalizations. We believe we have recommended a sound, realistic approach that, while challenging, has 

a high probability of success and the potential to reaffirm VA’s position as the preeminent leader in health information systems and 

electronic health records. 

The two high-level strategic recommendations are: one, that VA 

commit to and announce a plan to move to an open source, open 

standards model for the reengineering of the next generation of 

VistA. This action should be a strategic policy for the VA. The 

working group recommended, second, that current VistA applications be placed on an aggressive program of stabilization with limited tactical upgrades and enhancements, driven only by patient 

safety and other mandated requirements. 

If implemented, these recommendations will put the VA on a 

clear path to a future state where the next generation of VistA will 

be developed and deployed in a comprehensive state-of-the-art ecosystem that is more easily, robustly, and cost-effectively maintained; that allows for growth and change that encourages innovation; that promotes collaboration and interoperability; and most importantly, facilitates the delivery of the most advanced health care 

possible to the most deserving of populations, our Nation’s 

veterans. 

The working group then made four specific recommendations. So, 

based on their reputation for objectivity and sound judgment, the 

VA reached out to the federally Funded Research and Development 

Center community to rapidly tap into their skills and knowledge 

base resources to rapidly design and build a working model of the 

core ecosystem and to identify and validate the best model for the 

governance and business operation of this open source organization. Finally, FFRDC should be used to provide the functional decomposition of the current VistA application suite to deliver stateof-the-art functional specifications. 

Finally, we made three additional recommendations as to how 

the VA should acquire the functionality in the new ecosystem and 

manage the transition between legacy VistA and the new open 

source-based VistA 2.0. I would ask that the Committee include the 

entire ACT-IAC VistA Modernization Report as part of my testimony. 

[The report follows Mr. Meagher’s prepared statement.] 

Mr. MEAGHER. Now, speaking for myself exclusively as a former 

VA Acting Assistant Secretary, Acting CIO, Deputy Assistant Secretary, and also former Chief Technology Officer over a 6-year period, I would offer this personal assessment of the current VA IT 

environment. The centralization of all IT functions, funding, and 

personnel under the leadership of the CIO was and remains critical 

for the long-term success of IT at the VA. While a transition from 

decentralized to centralized management may have not gone 

smoothly, I believe that most of the issues have been addressed by 

Mr. Baker and his team. He has instituted a customer service orientation that puts the needs and requirements of the veteran and 

14 

the VA employee serving the veteran first and foremost. It is important to continue support for this centralized model. 

Next, while there are literally dozens of high-priority IT requirements that need to be addressed, I believe it is critical that two of 

them be assigned the highest priority and that critical resources, 

funding, and focus be applied to them first and continuously. They 

are the modernization of VistA and the movement of the benefit 

claim processing to an all-digital fully computable system with the 

expeditious phasing out of paper-based records and a 

minimalization of the use of imaging of paper to only those situations where a digital computer representation is not possible. The 

successful prosecution of these two programs—— 

Chairman AKAKA. Mr. Meagher—— 

Mr. MEAGHER [continuing]. Will yield the greatest improvements. 

Chairman AKAKA. Please summarize your statement. 

Mr. MEAGHER. Yes, sir. I would like to ask that the rest of my 

comments be submitted for the record. Thank you, sir. 

[The prepared statement of Mr. Meagher follows:] 

PREPARED STATEMENT OF EDWARD FRANCIS MEAGHER, CHAIRMAN, VISTA MOD- ERNIZATION, COMMITTEE OF THE AMERICAN COUNCIL FOR TECHNOLOGY INDUSTRY

ADVISORY COUNCIL AND VICE PRESIDENT, HEALTHCARE STRATEGY CSC 

Aloha Chairman Akaka, Ranking Member Burr, and Members of the Committee: 

I am honored to be here and I thank you for the opportunity to appear before you 

today to discuss the findings of the Industry Advisory Council’s report, ‘‘VistA Modernization Report; Legacy to Leadership’’ and as you requested to provide my views 

on current successes and failures in VA-IT and recommendations for success in the 

future. While discussing the VistA Modernization Report I will be representing the 

Industry Advisory Council. However, while discussing any other issue I will be representing myself only. ACT-IAC is a unique non-profit, public-private partnership 

dedicated to advancing the business of government through the application of technology. The agenda is government driven. ACT-IAC provides an ethical forum for 

collaboration where government and industry can create solutions to the most pressing government IT issues and challenges. That forum is objective and vendor and 

technology neutral. ACT-IAC also provides education and training to build essential 

knowledge and skills for government and industry professionals who want to serve 

the IT community. The greatest value of ACT-IAC is in its ability to deliver strategic insight and actionable solutions to advance government’s ability to serve citizens and the Nation. Participation in the organization is open to any member of the 

government IT community—government or private sector—who shares our commitment to advancing the business of government. 

In September 2009, VA’s Assistant Secretary for Information and Technology, 

Roger Baker asked IAC, ‘‘to assess the issues, challenges, and opportunities associated with modernizing the current legacy VistA system and make recommendations 

to address these issues and challenges and take advantage of the opportunities presented. IAC formed a committee of senior executives representing 42 of its over 500 

member companies and I was asked to chair this Committee. We began a process 

of first educating ourselves about the issues involved in modernizing a large, mission critical legacy system and then specifically looking at the current state of VA’s 

legacy VistA system. We looked at 24 alternative approaches to modernization and 

after narrowing those to 6 approaches we examined those 6 in greater detail. In addition to the alternatives subcommittee we created subcommittees to explore and 

analyze options concerning architecture, implementation models and extensions, deployment models, governance, opportunities and impacts, terms and definitions and 

finally reports and presentations. We estimate that over 7000 man hours over a six 

month period went into the preparation and development of this report. The Committee operated on a consensus based model and we are all very proud of the fact 

that the final report was unanimously endorsed by all Members of the Committee. 

Our recommendations can be summarized as two high level strategic recommendations and seven specific, actionable recommendations that describe programmatic 

next steps to implement our strategic recommendations. We believe we successfully 

negotiated a middle path such that our recommendations are not overly prescriptive 

nor are they well intended generalizations. We believe we have recommended a 

15 

sound, realistic approach that while challenging has a high probability of success 

and the potential to reaffirm the VA’s position as the preeminent leader in health 

information systems and electronic health records. 

The two high level strategic recommendations are: 

1. The working group recommends that the VA commit to and announce a plan 

to move to an open source, open standards model for the reengineering of the next 

generation of VistA (VistA 2.0). This action should be a strategic policy for the VA. 

2. The working group recommends that the current VistA application be placed 

on an aggressive program of stabilization, with limited tactical upgrades and enhancements driven only by patient safety and other mandated requirements 

If implemented these recommendations would put the VA on a clear path to a future state where the next generation of VistA would be developed and deployed in 

a comprehensive, state-of-the-art ecosystem that is more easily, robustly, and cost 

effectively maintained; that allows for growth and change; that encourages innovation; that promotes collaboration and interoperability; and most importantly facilitates the delivery of the most advanced healthcare possible to the most deserving 

of populations, our nations veterans. 

The working group then made four specific recommendations that the VA reach 

out to federally Funded Research and Development Centers (FFRDC) to tap into 

their skills and knowledge based resources to rapidly design and build a working 

model of the core ecosystem and to identify and validate the best model for the governance and business operation of the Open Source organization that will operate 

this ecosystem. Finally an FFRDC should be used to provide the functional decomposition of the current VistA Application Suite to deliver state-of-the-art: 

• functional and design specifications of current application functionality 

• functional and design specifications for required application functionality 

• functional and design specifications for additional application functionality 

Finally, we made three additional recommendations as to how the VA should acquire the functionality in the new ecosystem and manage the transition between 

legacy VistA and the new, Open source based VistA 2.0. I would ask that the Committee include the entire ACT-IAC Vista Modernization Report as part of my testimony. 

Speaking for myself, as a former VA Acting Assistant Secretary and Acting CIO 

and Deputy Assistant Secretary and Deputy CIO as well as the VA’s former Chief 

Technology Officer over a six year period I would offer this personal assessment of 

the current VA-IT environment. The centralization of all IT functions, funding, and 

personnel under the leadership of the CIO was and remains critical to the long term 

success of IT at the VA. And while the transition from decentralized to centralized 

management may not have been handled in the wisest, most thoughtful manner in 

the past I believe most of the oversights and the heavy handed approaches to operating within a centralized management model have been addressed by Assistant 

Secretary Baker and his team. He has instituted a customer service orientation that 

puts the needs and requirements of the veteran and the VA employee serving the 

veteran first and foremost. It is important to continue to support this centralized 

model. Next, while there are literally dozens of high priority IT requirements that 

need to be addressed I believe it is critical that two of them be assigned the highest 

priority and critical resources, funding, and focus be applied to them first and continuously. They are the modernization of VistA and the movement of all benefit 

claims processing to an all digital, fully computable system with the expeditious 

phasing out of paper based records and the minimalization of the use of the imaging 

of paper to only those situations where a digital, computable representation is not 

possible. The successful prosecution of these two programs will yield the greatest 

improvements to VA healthcare and benefits delivery that will allow the VA to deliver on Secretary Shinseki’s promise to transform the VA into a 21st century organization. Finally, I believe there must be a practical, over arching vision established 

that describes how all of this comes together and the long discussed but not yet realized goal of ‘‘One VA’’ becomes a reality. This will require the setting aside of traditional boundaries between VA healthcare and benefits delivery, between VA and 

DOD, and ultimately between VA and all of the other public and private sector entities that provide or could provide our veterans with the best care possible. The modernization of VistA along the lines our report recommends and the commitment to 

finally build and operate an all digital, all computable benefits administration system are critical, essential steps to achieving what we all want, a veteran centric VA 

capable of delivering on our nations sacred commitment to ‘‘care for him who shall 

have borne the battle and for his widow and his orphan.’’ 

16 


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Chairman AKAKA. Thank you. It will be placed in the record. 

Now we will receive the testimony of Ms. Finn. 

STATEMENT OF BELINDA J. FINN, ASSISTANT INSPECTOR 

GENERAL FOR AUDITS AND EVALUATIONS, OFFICE OF 

INSPECTOR GENERAL, U.S. DEPARTMENT OF VETERANS 

AFFAIRS 

Ms. FINN. Thank you, Mr. Chairman and Members of the Committee. Thank you for the opportunity to discuss VA’s management 

of its information technology projects. Mr. Mario Carbone, who is 


64910Vista101.eps
117 

with me today, is responsible for several of the audit reports I will 

be discussing. 

The OIG has reported on the Department’s management of its IT 

projects over recent years. My testimony today will summarize our 

work, highlight our insights regarding the IT governance structure, 

and discuss some key themes that we see reoccurring. 

As part of our audit of VA’s management of information technology capital investments, we examined VA’s realignment of its IT 

program from a decentralized to a centralized management structure. We reported that the ad hoc manner in which the Office of 

Information and Technology, or OI&T, had managed the realignment had resulted in an environment with inconsistent management controls and inadequate oversight. 

In September 2009, we reported that VA needed to manage its 

major IT development projects in a more disciplined and consistent 

manner. In general, we found that VA’s processes were adequate. 

However, OI&T had not always communicated, complied with, or 

enforced its software development requirements. Once again, we attributed these management lapses to the centralization in an ad 

hoc manner. 

Over the past 2 years, our audit work on several IT system development projects has identified problems with inadequate project 

and contract management, staffing shortages, and a lack of guidance. These recurring themes have repeatedly hindered OI&T’s efforts to develop their systems. 

For example, we have issued three reports on the Financial and 

Logistics Integrated Technology Enterprise. This is commonly 

known as FLITE. Our review of these programs concluded that program managers were repeating problems from the failed CoreFLS 

project. Specifically, the FLITE program managers did not always 

take well-timed actions to ensure the achievement of cost, schedule, 

and performance goals have sufficient staff in critical areas or 

clearly define staff roles and responsibilities; clearly define VA’s 

training requirements for the pilot project; effectively identify and 

manage all risk associated with the Strategic Asset Management 

pilot project. This was a key component of the FLITE system. 

We recommended that VA establish stronger program management controls to improve the deployment of the SAM pilot, beta, 

and national projects. Specifically, we recommended that the program establish controls to facilitate achieving cost, schedule, and 

performance goals, as well as mitigating program risk. 

Finally, our audit of the Post-9/11 G.I. Bill Long Term Solution 

reported that OI&T had developed and deployed both LTS releases 

one and two on time. However, these releases did not always meet 

the functionality that was expected for those releases. We concluded that the program still needed more management discipline 

and processes to ensure the project meets both the performance 

and the cost goals required. 

In conclusion, the Department historically has struggled to manage IT development projects to successfully deliver desired results 

within the cost and schedule constraints. 

Mr. Chairman, thank you for the opportunity to be here today. 

We would be pleased to answer any questions that you or the other 

Members of the Committee may have. 

118 

[The prepared statement of Ms. Finn follows:] 

PREPARED STATEMENT OF BELINDA J. FINN, ASSISTANT INSPECTOR GENERAL FOR AU- DITS AND EVALUATIONS, OFFICE OF INSPECTOR GENERAL, U.S. DEPARTMENT OF

VETERANS AFFAIRS

Mr. Chairman and Members of the Committee, thank you for the opportunity to 

discuss the Office of Inspector General’s (OIG) findings regarding VA’s management 

of its information technology (IT) projects. I am accompanied today by Mr. Mario 

Carbone, Director, Dallas Office of Audits and Evaluations, Office of Inspector General. 

BACKGROUND

The use of IT is critical to VA providing a range of benefits and services to veterans, from medical care to compensation and pensions. If managed effectively, IT 

capital investments can significantly enhance operations to support the delivery of 

VA benefits and services. 

However, when VA does not properly plan and manage its IT investments, they 

can become costly, risky, and counterproductive. As we have reported, IT management at VA is a longstanding high-risk area. Historically, VA has experienced significant challenges in managing its IT investments, including cost overruns, schedule slippages, performance problems, and in some cases, complete project failures. 

Some of VA’s most costly failures have involved management of major IT system 

development projects awarded to contractor organizations. 

My statement today focuses on the results of our audits of the Department’s management of its IT projects over recent years. In summarizing this work, I will highlight initial insights regarding VA’s IT governance structure and process and discuss 

some key themes that reoccur in VA’s IT system developments. 

IT GOVERNANCE CHALLENGES

In 2009, we provided an overarching view of VA’s structure and process for IT 

investment management [Audit of VA’s Management of Information Technology 

Capital Investments (Report No. 08–02679–134, May 29, 2009)]. As part of the audit, 

we examined VA’s realignment of its IT program from a decentralized to a centralized management structure. The realignment was to provide greater accountability 

and control over VA resources by centralizing IT operations under the management 

of the Chief Information Officer (CIO) and standardizing operations using new processes based on industry best practices—goals that have only partially been fulfilled. 

We reported that the ad hoc manner in which the Office of Information and Technology (OI&T) managed the realignment inadvertently resulted in an environment 

with inconsistent management controls and inadequate oversight. Although we conducted this audit more than two years after VA centralized its IT program, senior 

OI&T officials were still working to develop policies and procedures needed to effectively manage IT investments in a centralized environment. For example, OI&T had 

not clearly defined the roles of IT governance boards responsible for facilitating 

budget oversight and IT project management. OI&T also had not established the 

governance board criteria needed to select, review, and assess IT projects. OI&T 

does not expect to complete key elements of these new critical processes until FY 

2011. 

Further, in September 2009, we reported that VA needed to better manage its 

major IT development projects, valued at that time at over $3.4 billion, in a more 

disciplined and consistent manner [Audit of VA’s System Development Life Cycle 

Process (Report No. 09–01239–232, September 30, 2009)]. In general, we found that 

VA’s System Development Life Cycle (SDLC) processes were adequate and comparable to Federal standards. However, OI&T did not communicate, comply with, 

or enforce its mandatory software development requirements. OI&T did not ensure 

that required independent milestone reviews of VA’s IT projects were conducted to 

identify and address system development and implementation issues. Once again, 

we attributed these management lapses to OI&T centralizing IT operations in an 

ad hoc manner, leaving little assurance that VA was making appropriate investment decisions and best use of available resources. Moreover, VA increased the risk 

that its IT projects would not meet cost, schedule, and performance goals, adversely 

affecting VA’s ability to timely and adequately provide veterans health services and 

benefits. 

These audits demonstrated that OI&T needed to implement effective centralized 

management controls over VA’s IT investments. Specifically, we recommended that 

OI&T develop and issue a directive that communicated the mandatory requirements 

119 

of VA’s SDLC process across the Department. We also recommended that OI&T implement controls to conduct continuous monitoring and enforce disciplined performance and quality reviews of the major programs and projects in VA’s IT investment 

portfolio. Although OI&T concurred with our recommendations and provided acceptable plans of actions, OI&T’s implementation of the corrective actions is not yet 

complete. 

PROJECT MANAGEMENT SHORTFALLS IN RECENT YEARS

Over the past two years, our audit work on several IT system development 

projects has identified themes as to why VA has continued to fall short in its IT 

project management. These issues include inadequate project and contract management, staffing shortages, lack of guidance, and poor risk management—issues that 

have repeatedly hindered the success of IT major development projects undertaken 

by OI&T. 

VA’s Replacement Scheduling Application (RSA) 

In August 2009, we reported that the RSA project failed because of ineffective 

planning and oversight [Review of the Award and Administration of Task Orders 

Issued by the Department of Veterans Affairs for the Replacement Scheduling Application Development Program (Report No. 09–01926–207, August 26, 2009)]. RSA 

was a multi-year project to replace the system the Veterans Health Administration 

used to schedule medical appointments for VA patients. Lacking defined requirements, an IT architecture, and a properly executed acquisition plan, RSA was at significant risk of failure from the start. We suggested that VA needed experienced 

personnel to plan and manage the development and implementation of complex IT 

projects effectively. We also suggested that a system to monitor and identify problems affecting the progress of projects could support VA’s leadership in making effective and timely decisions to either redirect or terminate troubled projects. 

Financial and Logistics Integrated Technology Enterprise (FLITE) 

In September 2005, VA began developing the FLITE program to address the longstanding need for an integrated financial management system. As a successor to the 

failed Core Financial and Logistics System (CoreFLS), FLITE was a multi-year development effort comprised of three components: an Integrated Financial Accounting 

System (IFAS), Strategic Asset Management, and a Data Warehouse. FLITE was 

intended to provide timely and accurate financial, logistics, and asset management 

information. FLITE was also to resolve material weaknesses cited in the annual financial statement audit by integrating multiple systems and reducing manual accounting processes. In the past year, we issued three reports identifying project 

management shortcomings that hindered VA’s efforts to accomplish the FLITE program’s stated goals. 

Audit of FLITE Program Management’s Implementation of Lessons Learned 

Our first report on FLITE determined that program managers did not fully incorporate lessons learned from the failed CoreFLS program to increase the probability 

of success in FLITE development [Audit of FLITE Program Management’s Implementation of Lessons Learned, (Report No. 09–01467–216, September 16, 2009)]. We 

found deficiencies similar to those identified in CoreFLS reviews also occurred within FLITE because program managers had not implemented a systematic process to 

address lessons learned. For example, critical FLITE program functions were not 

fully staffed, non-FLITE expenditures were improperly funded through the FLITE 

program, and contract awards did not comply with competition requirements. We 

recommended that FLITE program managers develop written procedures to manage 

and monitor lessons learned and expedite actions to ensure full staffing of the 

FLITE program. 

Audit of the FLITE Strategic Asset Management (SAM) Pilot Project 

Our second report on the Strategic Asset Management (SAM) pilot project disclosed that FLITE program managers did not take well-timed actions to ensure VA 

achieved cost, schedule, and performance goals. Further, the contractor did not provide acceptable deliverables in a timely manner [Audit of the FLITE Strategic Asset 

Management Pilot Project (Report No. 09–03861–238, September 14, 2010)]. Once 

again, we identified instances where FLITE program managers could have avoided 

mistakes by paying closer attention to lessons learned from the CoreFLS effort. 

Specifically, FLITE program managers: 

• Awarded a task order on April 21, 2009 to General Dynamics for implementation of the SAM pilot project, even though the FLITE program suffered from a 

120 

known shortage of legacy system programmers critical to integration efforts required to make FLITE a success. • Did not clearly define FLITE program and SAM pilot project roles and responsibilities, resulting in confusion and unclear communications between VA and General Dynamics. Contractor personnel indicated that they received directions and 

guidance from multiple sources. One of their biggest obstacles was trying to overcome the lack of one clear voice for VA’s FLITE program. • Did not ensure that the solicitation for the SAM pilot project clearly described 

VA’s requirements for SAM end-user training. As such, VA contractually agreed to 

a training solution that did not meet its expectations. General Dynamics subsequently revised its training approach to meet VA’s needs, but at a total cost of 

$1,090,175, which was more than a 300 percent increase from the original $244,451 

training cost. • Did not always effectively identify and manage risks associated with the SAM 

pilot project even though inadequate risk management had also been a problem 

with the failed CoreFLS. Specifically, FLITE program managers did not take steps 

early on to ensure that the contractor participated in the risk management process 

and that the Risk Control Review Board adequately mitigated risks before closing 

them. 

Because of such issues, at the time of our audit, VA was considering extending 

the SAM pilot project by 17 months (from 12 to 29 months), potentially more than 

doubling the original contract cost of $8 million. We recommended that VA establish 

stronger program management controls to facilitate achieving cost, schedule, and 

performance goals, as well as mitigating risks related to the successful accomplishment of the SAM pilot project. 

Review of Alleged Improper Program Management within the FLITE Strategic Asset 

Management Pilot Project 

This third report, in response to a hotline allegation, disclosed that FLITE program managers needed to improve their overall management of the SAM pilot 

project [Review of Alleged Improper Program Management within the FLITE Strategic Asset Management Pilot Project, (Report No. 10–01374–237, September 7, 

2010)]. FLITE program managers did not develop written procedures that clearly 

defined roles and responsibilities, provide timely guidance to program and contract 

staff, or foster an effective working environment within the FLITE program. FLITE 

program managers also did not ensure certain elements considered necessary for a 

successful software development effort, such as ‘‘to be’’ and architectural models 

were included as project deliverables in the FLITE program. In general, we recommended that VA strengthen project management controls to improve the SAM 

pilot, beta, and national deployment projects. 

New Office of Management and Budget (OMB) guidance on financial systems IT 

projects, issued on June 28, 2010, also had a major impact on the FLITE Program. 

OMB issued the guidance because large-scale financial system modernization efforts 

undertaken by Federal agencies have historically led to complex project management requirements that are difficult to manage. Moreover, by the time the lengthy 

projects are finished, they are technologically obsolete. Consequently, OMB directed 

all Chief Financial Officer Act agencies immediately to halt the issuance of new procurements for financial system projects until it approves new project plans developed by the agencies. On July 12, 2010, VA’s Assistant Secretary for Information 

and Technology announced the termination of IFAS and Data Warehouse portions 

of FLITE. 

GI Bill Long Term Solution (LTS) 

In September 2010, we reported that OI&T’s plan for deployment of the LTS was 

effective in part [Audit of VA’s Implementation of the Post-9/11 GI Bill Long Term 

Solution, (Report No. 10–00717–261, September 30, 2010)]. LTS is a fully automated 

claims processing system that utilizes a rules-based engine to process Post-9/11 GI 

Bill Chapter 33 veterans’ education benefits. 

OI&T developed and deployed both LTS Releases 1 and 2 on time. Lacking the 

management discipline and processes necessary to control performance and cost in 

project development, OI&T has relied upon Project Management Accountability System (PMAS) to achieve project scheduling goals. PMAS is VA’s new IT management 

approach that focuses on achieving schedule objectives while the scope of 

functionality provided remains flexible. With this schedule-driven strategy, OI&T 

has been able to satisfy users and incrementally move VA forward in providing 

automated support for education benefits processing under the Post-9/11 GI Bill. 

However, OI&T’s achievement of the timeframes for LTS Releases 1 and 2 required that VA sacrifice much of the system functionality promised. Specifically, due 

121 

to unanticipated complexities in developing the system, OI&T deployed Release 1 

as a ‘‘pilot’’ to approximately 16 claims examiners, with the functionality to handle 

only 15 percent of the Chapter 33 education claims that VBA anticipated processing. 

Release 2 caught up on the functionality postponed from Release 1, while providing 

the capability to process 95 percent of all Chapter 33 education claims. However, 

due to data structure and quality issues that still had to be overcome, users could 

not make use of all of the functionality provided through Release 2 and were able 

to process only 30 percent of all Chapter 33 education claims. In addition to these 

performance issues, OI&T did not have processes in place to track actual LTS 

project costs. 

In the absence of effective performance and cost controls, OI&T runs the risk that 

future LTS releases may continue to meet schedule, but at the expense of performance and cost project goals. We recommended that OI&T improve LTS management 

by conducting periodic independent reviews to help identify and address system development and implementation issues as they arise. We also recommended that 

OI&T adopt cost control processes and tools to ensure accountability for LTS costs 

in accordance with Federal IT investment management requirements. 

CONCLUSION

VA continues to rely on IT advancements to provide better services to our Nation’s 

veterans. Historically, the department has struggled to manage IT developments 

that successfully deliver desired results within cost, schedule, and performance objectives. OI&T recently implemented PMAS to strengthen IT project management 

and improve the rate of success of VA’s IT projects. Our oversight of the department’s IT initiatives should provide valuable information to VA and Congress as the 

Department moves forward in managing its IT capital investments. 

Mr. Chairman, this concludes my statement. I would be pleased to answer any 

questions that you or other Members of the Committee may have. 

Chairman AKAKA. Thank you very much, Ms. Finn. 

Now we will accept the testimony of Mr. Tullman. 

STATEMENT OF GLEN TULLMAN, CHIEF EXECUTIVE OFFICER, 

ALLSCRIPTS 

Mr. TULLMAN. Thank you, Mr. Chairman, thank you, Ranking 

Member Burr and other distinguished Members of the Committee. 

Thank you for the opportunity to share our perspectives on the use 

of health information technology within the Veterans Affairs Administration and the best path forward. 

My name is Glen Tullman and I serve as the Chief Executive Officer of Allscripts. Allscripts is the largest provider of health information technology software that physicians, hospitals, and other 

caregivers use to manage care. We serve more than 180,000 physicians, 1,500 hospitals, and more than 10,000 post-acute care facilities and home care agencies who use Allscripts solutions to improve 

their clinical and business operations, and importantly, to connect 

with each other to provide care across health care stakeholders. 

Physicians and other health care professionals who use our systems in the civilian sector care for thousands of active duty and retired military personnel, and we process almost 3.5 million 

TRICARE claims each year. 

In the 19 months since the passage of the HITECH Act, the conversation about health care information technology has been 

changed forever. It is my belief that we are at the beginning of the 

single fastest transformation of a major industry in the history of 

our country. Beyond the positive effect on hiring, which in our case 

equates to more than 600 new jobs since ARRA passed, new standards, certification, and the concept of meaningful use combined 

with incentives have combined with private sector ingenuity to creVerDate Nov 24 2008 12:36 Mar 16, 2011 Jkt 000000 PO 00000 Frm 00125 Fmt 6633 Sfmt 6601 H:\ACTIVE\100610.TXT SVETS PsN: PAULIN
122 

ate a new best of breed in health care information technology 

platforms. 

While the private sector has been moving forward in light of 

these incentives, the government has been investing in their own 

proprietary systems for many years. The VA system is made up of 

some of the country’s best physicians and has played a critical role 

in demonstrating the value of technology, specifically electronic 

medical records. There is no question that VistA was a groundbreaking technology when it was first developed. However, today, 

things are different. The military is different. The care delivery 

model is different. And the technology is different. All of this necessitates a change. 

The military has evolved, and during the Iraq and Afghanistan 

conflicts has drawn extensively from the civilian ranks, namely the 

National Guard. That flexibility poses a new requirement on electronic medical records. The ability to move those records around 

the world and between civilian and military systems is now a must, 

as compared with the past, where treatment was delivered mostly 

inside of the military and VA. 

Just as the military has changed, so has the care delivery model. 

We are saving more wounded warriors. Military and VA providers 

are relying on advanced technologies and newly designed collaborative care models. Then, once home, many of our wounded soldiers 

are living examples of the fact that it is not just the surgery, but 

the rehabilitation that is critical. Complex patients require teams 

of physicians to drive successful outcomes, and the trends in the civilian world move toward Accountable Care Organizations, the Patient Centered Medical Home, and efficient care coordination as a 

means of improving quality and better managing cost will be critical for the military, as well. 

Patients already increasingly move between the military health 

system, the VA, and the private sector, with physicians thus being 

required to manage patient hand-offs through the formation of care 

teams. It is clear that they need systems that can track, manage, 

and facilitate this communication. 

Even with its strong start and the good work by Assistant Secretary Baker over the last year in trying to implement positive 

changes, the fact remained that VistA’s basic platform, which relies 

on 25-year-old technology called MUMPS, cannot support the open, 

flexible approach needed to provide care to our Nation’s wounded 

servicemen and women. Rather, the demands of today’s military 

and veteran health care environment necessitates the use of technologies such as those based on Microsoft architecture and open 

source that can support an open, shared approach that will not just 

be desirable, but a fundamental requirement in the near future. A 

fitting analogy is the move the world made from a reliance on selfcontained mainframes to a distributed flexible system like the 

Internet. 

To optimize both care and cost, we need a system that easily and 

natively can talk with each other. Our belief is that usability and 

interoperability are core to the success of true IT adoption and 

should drive not only the development of individual products, but 

also the infrastructure underpinning health information technology 

exchange efforts. 

123 

Allscripts clients share information successfully today in the private sector with colleagues in the VA and the military health system. For example, in Hartford, CT, we have been partners with a 

project for almost 2 years that led to widespread health care IT 

adoption as well as successful implementation of open source 

health care information connectivity. Our partnership with Karen 

Fox and her team at Delta Health Care Alliance in Mississippi has 

enabled VHA to make substantial progress on information exchange. The University of Massachusetts is another example of fostering connectivity between communities and large organizations 

providing health care. Finally, last but not least, we are partnered 

with TeamPraxis, an organization based in Hawaii where we are 

connecting almost one-third of the physicians in Hawaii. 

In the end, health care is about information and we simply cannot address the challenges the Nation is experiencing today in both 

private and public sector health care without ensuring providers 

have the information they need to make better decisions and the 

ability to communicate with others on a patient’s care team, independent of the system they are using. It is time to learn from the 

successes in the private sector and make technology work for the 

Veterans Health Care Administration and the military health 

system. 

So I want to thank you for the opportunity to share my thoughts 

today and I look forward to your questions. 

[The prepared statement of Mr. Tullman follows:] 

PREPARED STATEMENT OF GLEN TULLMAN, CHIEF EXECUTIVE OFFICER, ALLSCRIPTS

Chairman Akaka, Ranking Member Burr, and other distinguished Members of the 

Committee, thank you for the opportunity to share with you today our perspectives 

on the use of health information technology within the Veterans’ Affairs Administration and the best path forward. 

My name is Glen Tullman, and I serve as the Chief Executive Officer of Allscripts. 

Allscripts is the largest provider of health information technology software that physicians, hospitals and other caregivers use to manage patient care. Following our 

merger with Eclipsys in August, there are now more than 180,000 physicians, 1,500 

hospitals and more than 10,000 post-acute care facilities and homecare agencies utilizing Allscripts solutions to improve their clinical and business operations and to 

connect to a variety of healthcare stakeholders. Allscripts is also the largest provider of electronic prescribing solutions, and through our revenue cycle management 

clearinghouse, we process more than 300 million claims, remittance and eligibility 

transactions each year. 

Physicians and other healthcare professionals who use our systems in the civilian 

sector care for thousands of active duty and retired military personnel, and we process almost three-and-a-half million TRICARE claims each year. For example, in 

North Carolina, where one of every two physicians in the State is an Allscripts client, there are 750 physician practices using our systems while caring for the large 

local military population. 

In the 19 months since the passage of the HITECH Act within the Stimulus legislation, the conversation about health information technology has been changed forever. It is my belief that we are at the beginning of the single fastest transformation 

of a major industry in the history of our country. Beyond the positive effect on hiring, which in our case equates to more than 600 new jobs since ARRA passed (most 

of which are in North Carolina, Illinois and Vermont), the incentives, along with 

new standards, certification, and the concept of Meaningful Use, have combined 

with private sector ingenuity to create a new ‘‘best-of-breed’’ in healthcare information technology platforms. The investment Congress and the Administration has 

made will lead to the delivery of better care, yield savings due to efficiency improvements, and markedly improve patient safety in the private sector. 

While the private sector has been moving forward in light of these incentives, the 

Government has been investing in their own proprietary systems for many years. 

Billions of dollars have been spent to build and implement the VistA/CPRS system 

124 

within the Veteran Health Administration and the AHLTA system within the Military Health System. 

The VA health system is made up some of the country’s best physicians and has 

played a critical role in demonstrating the value of technology, specifically electronic 

medical records. There is no question that VistA was a groundbreaking technology 

when it was first developed, and over the years it has been improved with the development of CPRS, VistARad and other expansions. However, today things are different: the military is different. The care delivery model is different. And the technology is different. All of this necessitates a change. Let me explain. 

The military has evolved significantly when compared to what existed even only 

a few years ago. It moves people around frequently, conducting joint exercises and, 

during the Iraq and Afghanistan conflicts, has drawn extensively from the civilian 

ranks, namely the National Guard. That flexibility is key to successes by the Armed 

Forces, but it also poses a new requirement of medical records—the ability to move 

those records around the world and between civilian and military systems is now 

a must, as compared to the past when most treatment was delivered inside of the 

military and VA systems. 

Just as the military has changed, so has the care delivery model. First and foremost, we are saving more wounded warriors. Military and VA providers are relying 

on advanced technologies and newly-designed, collaborative care models. And, once 

home, many of our wounded soldiers are living examples of the fact that it isn’t just 

surgery but rehabilitation that is critical. Complex patients require teams of physicians to drive successful outcomes, and the trends in the civilian world—the move 

to Accountable Care Organizations, the Patient Centered Medical Home and efficient care coordination as means of improving quality and better managing costs— 

will be critical for the military, as well. Patients already increasingly move between 

the Military Health System, the VA and private sector, with physicians thus being 

required to manage the patient hand-offs through the formation of care teams—either formal or informal—designed to ensure smooth care transitions. It is clear they 

need systems which can track, manage and facilitate this communication. 

Even with its strong start and the good work by Assistant Secretary Baker over 

the last year in trying to implement positive change, the fact remains that VistA’s 

basic platform, which relies on the 25-year old technology called Mumps, cannot 

support the open, flexible approach needed by those providing care to our Nation’s 

wounded servicemen and women. Rather, the demands of today’s military and veteran healthcare environment necessitate the use of technologies—such as those 

based on Microsoft’s architecture—that can support an open, shared approach that 

will not just be desirable, but a fundamental requirement in the near future. A fitting analogy is the move the world made from reliance on self-contained mainframes 

to a distributed, flexible system like the Internet. The fact is, if you happen to live 

in one of the few areas with a closed healthcare system, merely moving healthcare 

records from paper silos into electronic silos—which is more or less what we’ve been 

doing for the last decade—can be made to work. But in the interconnected world 

that exists today, a closed system is not the norm for healthcare in the private sector, with patients moving from Point A to Point B to Point C, and increasingly, it 

is clear that the interchangeable requirements of the military environment means 

that a closed system approach simply isn’t sufficient there, either. To optimize care 

and costs, we need systems that easily and natively talk with each other. 

Unfortunately, attempts to share information between AHLTA and VistA have 

largely been unsuccessful. The North Chicago project—near my own home—is an example. Reports, including local newspapers, indicate that to date, the project has not 

achieved the goals set out of delivering interoperability between the two systems, 

with an exchange of medication information but no exchange of allergies, problems 

or clinical orders. We understand that physicians treating the patients who move 

between the two systems have, in many cases, resorted to housing two workstations 

in the exam room because of the double documentation that they are required to 

complete. It is simply not yet delivering on its potential, but it is my belief that coupling the focused effort to date with the right architecture and system design, as 

used in the private sector, could right the ship and deliver the results we seeking. 

It is our belief that usability and interoperability are core to the success of true 

health IT adoption and should drive not only the development of individual products 

but also the infrastructure underpinning health information exchange efforts. 

Allscripts clients share information successfully today in the private sector and with 

colleagues in the VA and the military health system. For example, in Hartford, Connecticut, we have been partners in a project for almost two years that has not only 

led to widespread health IT adoption but successful implementation of open source 

health information exchange technologies. Our partnership with Karen Fox and her 

team at Delta Health Alliance in Mississippi has enabled DHA to make substantial 

125 

progress toward their goals of improving care through improved access to information. The University of Massachusetts is another example, not only fostering health 

IT adoption among local physicians in their area but also leading the state in 

connectivity efforts through an active exchange of information every single day. 

Allscripts is also working in the state of Vermont to facilitate Electronic Health 

Record adoption and deliver interoperability through a focused partnership with the 

Vermont Information Technology Leaders (VITL) project, one that has established 

a leadership position that other states in the country have chosen to emulate. 

In the end, healthcare is about information, and we simply can’t address the challenges the Nation is experiencing today in both private and public sector healthcare 

without ensuring that providers have the information they need to make better decisions, no matter where they’re delivering care, and the ability to communicate with 

others on the patient’s care team, independent of the system they are using. There 

is no one who would disagree that patients moving between providers and sites of 

care in the healthcare system deserve the best quality possible, which means that 

the information about the patient has to be available where it’s needed, when it’s 

needed. We can also agree that the government should lead the way by delivering 

world class healthcare to the Armed Forces of this Country and doing everything 

it can to make this happen in a timely and cost-efficient manner. It is time to learn 

from the successes of the private sector and make technology work for the Veterans 

Health Administration and the Military Health System. 

I want to thank you for the opportunity to testify, and I look forward to your questions. 

Chairman AKAKA. Thank you very much, Mr. Tullman. 

Mr. TULLMAN. Thank you. 

Chairman AKAKA. Now we will receive the testimony of Mr. 

Munnecke. 

STATEMENT OF TOM MUNNECKE, FORMER INFORMATION 

TECHNOLOGY OFFICIAL, U.S. DEPARTMENT OF VETERANS 

AFFAIRS 

Mr. MUNNECKE. Thank you very much, Chairman Akaka and 

Members of the Committee, for this opportunity to speak. I would 

also like to say that I sympathize with the Senator’s complaints 

about the VA. As someone who has worked with or watched the VA 

for 32 years, I have many of my own complaints about the central 

office, but Roger Baker, I think, has a very good grip on the IT situation. I am impressed with what I hear he is doing so 

congratulations. 

Thirty years ago, I was a computer specialist at the Loma Linda 

VA Hospital, working with a small group of programmers developing VistA. Things were at a fever pitch of innovation. Tens of 

thousands of VA employees from all over the country were connected on an electronic conferencing system which today would be 

called a social networking site. For any given issue, the VA had 

world class experts available that could be tapped internally. From 

this tiny seed, the VistA system flowered in one of the world’s great 

medical information systems, as we see today. 

At that time, under a VA/DOD sharing legislation set up by Representative Sonny Montgomery, Loma Linda and March Air Force 

Base made a local agreement to install a modified VistA at March 

Hospital. This was a successful case of VA-DOD information sharing dating back to 1983. 

One of the key factors of the success of VistA was the decentralization and the direct day-to-day involvement of field-based VA 

clinical staff. The original developers all came from a clinical background and were deeply experienced in the nuances of medical 

126 

informatics. We were able to focus on medical needs rather than 

be distracted by the problems of administrative computing. 

We designed the system to be an adaptive system, starting with 

good enough and then putting it out in the field for direct user involvement to make it better. We did not presume to know the final 

answer in advance, so we employed a generation’s, not specifications, approach to controlling the system’s evolution. We were a 

skunk works—replacing the bureaucratic procedures with a notion 

of creating a path of least resistance to our desired goal. 

We used a language called MUMPS, a language that was designed specifically for medical informatics. This attracted much 

criticism at the time, which continues to this day. The DOD, VA, 

and Indian Health Service all enjoy, however, stable long-term 

electronic health records that are based on decentralized MUMPS, 

and in looking toward the future, I would suggest that we maintain 

an understanding of what did succeed in the past. 

I would also caution the Committee that the electronic medical 

record systems are far more complex and specialized in their needs 

than standard IT applications. The open source technology that is 

proposed for the next generation of VistA is a very good move, I 

think, but I also want to suggest that the VA carry forward the lessons learned and the innovation learned with the VistA architecture to future architectures. Future technologies should not pave 

the cow path of replicating the old model, but rather support bold 

innovations in the delivery of care to our Nation’s veterans. 

One of the things I noticed when I first joined the VA was the 

difficulty of communicating across the stovepipes. I will call this a 

failure to communicate. I also noticed that one of the most highly 

used applications in the VistA system was the Mailman system— 

simply people communicating their clinical needs in an informal, 

person-to-person, peer-to-peer model. At some points, this reached 

25 percent of a hospital’s traffic. It was just people communicating. 

So I want to strengthen the idea that part of the role of IT is 

to overcome this failure to communicate. There are rich opportunities for improving communications in general over and above the 

current focus on the medical record, which I think should be 

viewed as only one form of communication. 

While VistA’s success was based on the principles of decentralization, I would like to suggest that future systems be based on 

the notion of personalization, in which the veteran is at the center 

of their personal health care universe. Personalization includes the 

personalized health record, personalized medicine, personal 

genomics, home health care, telemedicine, and others. It also includes the role of social networks and building communities of 

health, which allows us to develop a positive health-oriented model 

that is integrated and balanced with the disease model we have 

today. Perhaps we might even achieve Jonas Salk’s vision of creating an epidemic of health. 

When Pierre Omidyar started eBay, he personalized the auction 

experience between millions of buyers and sellers. He did not try 

to integrate the auction industry. He provided the tools to connect 

the dots. I suggest that we envision a future consisting of a thriving Federal health care community personalized around the individual’s health needs. Much can be done with simple, inexpensive, 

127 

and quick-to-implement tools that could reduce many of the public 

fears about privacy and open the system to innovation to deliver 

better care to our Nation’s veterans. 

Thank you very much for your time, and I look forward to answering any questions. 

[The prepared statement of Mr. Munnecke follows:] 

PREPARED STATEMENT OF TOM MUNNECKE, FORMER VA IT OFFICIAL

Thank you, Chairman Akaka, Ranking Member Burr, and Members of the Committee. As someone who has been passionately involved with health IT in the VA 

for 32 years, it is a pleasure to appear at this hearing to discuss the elements that 

led to success in VistA as well as how this might contribute to a Health IT system 

of the future. 

Thanks to modern day communications technology, your staff reached me to invite 

me to this hearing during a vacation in the middle of Oregon’s Cascades mountains. 

I only had one day at home to prepare for the hearing, so please understand that 

this is a rather hurried set of comments. 

I was one of a small set of programmers hired by the VA in 1978 to work on an 

ANS MUMPS-based decentralized hospital computer system, what is now called 

VistA. I was a computer specialist employed at VA Loma Linda, California, working 

with a network of others around the country who pulled together a most remarkable 

effort to bring computing technology to clinical users in the VA. I was one of the 

lead software architects of the effort until 1986, when I went to Science Applications 

International Corporation in San Diego to play a similar role for the Composite 

Health Care System (CHCS) an adaptation of VistA. I was a consultant to VHA in 

the late 1990’s in which I wrote a number of papers looking at future applications 

of IT in the VA (see Appendix). I took an early retirement as a VP and Chief Scientist at SAIC to pursue a broader field of philanthropic, humanitarian, and educational uses of technology, particularly with regard to those at the ‘‘bottom of the 

pyramid.’’ I became a fellow at Stanford University, and was funded by Omidyar 

Foundation to develop a social network toolkit for philanthropic activities. I founded 

a group called the Uplift Academy, and have held workshops and salons around the 

world on the broader role of technology and society, including health care. 

I appear at this Committee as a private citizen at my own expense, with the sole 

motivation of improving service to our veterans through appropriate uses of information technology. 

Twenty-eight years ago, the Decentralized Hospital Computer Program (DHCP, 

later called VistA) was at a fever pitch of innovation. Tens of thousands of VA employees were connected on an electronic FORUM on a daily basis, sharing ideas, giving feedback, starting up new projects, complaining about others, and contributing 

in one way or another to the clinical application of computer technology to the delivery of service to our veterans. I would install a new version of the software one 

night, and the next day at the hospital cafeteria I would hear about what was good 

and what was bad about the changes. I would communicate these ideas to the developers via FORUM, and we would see changes in the software in hours or days. I 

installed a computer running VistA at the March Air Force Base hospital, an early 

instance of VA/DOD IT sharing. 

Lesson Learned: Clinical information is vastly different from administrative information. One of VistA’s strengths was that it was able to focus directly on the 

clinical. 

VistA was developed directly as a clinical tool, by clinicians, for direct patient 

care. While there are many administrative needs of an enterprise for logistics, cost 

accounting, billing, payroll, and the like, these are a fundamentally different kind 

of computing. 

Lesson Learned: Decentralization works. The extensive end-user collaboration was 

a key factor to the success of VistA. 

When I first started at the VA, I ran into the bureaucratic ‘‘stovepipe’’ mentality 

everywhere I went, even though everyone had a supposedly common goal of providing health care to our veterans. Recalling the words of the Sheriff in Cool Hand 

Luke, it seemed that the core problem could be expressed as ‘‘What we have here 

is a failure to communicate.’’ 

In college, I was struck by the Sapir-Whorf hypothesis that language shapes our 

thought. I began to focus my attention on ways of using IT to overcome the failure 

to communicate. This led to the development of an integrated data dictionary that 

served as a ‘‘roadmap’’ to the patient data. Today, this would be called a ‘‘Semantic 

Web’’ (See http://www.caregraf.org/semanticvista for a modern semantic web interVerDate Nov 24 2008 12:36 Mar 16, 2011 Jkt 000000 PO 00000 Frm 00131 Fmt 6633 Sfmt 6621 H:\ACTIVE\100610.TXT SVETS PsN: PAULIN
128 

1http://www.actgov.org/sigcom/vistapublic/VistA%20Documents/VistA%20Modernization%20 

Report%20-%20Legacy%20to%20Leadership,%20May%204,%202010.pdf 

face to the VistA database). We integrated electronic mail directly into the clinical 

interface, allowing database activities to generate email messages through an email/ 

discussion/workflow system called MailMan. I was amazed at how heavily used 

MailMan was—in some cases, 25% of the traffic in a VistA system was email traffic. 

This demonstrated how communications-intensive clinical care is, even outside the 

formal communications traffic in the specific applications such as pharmacy, laboratory, or radiology. I think that VistA broke down many of the bureaucratic stovepipe 

barriers, allowing people to focus on what was best for their clinical practice. 

Lesson Learned: The fundamental goal in health IT should be to improve communications. The medical record is but one form of communication. 

All of the initial developers of VistA were employed in the field, working closely 

with end users. Riding the elevator with a gurney headed to the morgue was a sobering experience, and helped keep me focused on the implications of the software 

I was developing. The trust we placed in the VistA community was well-placed. People felt respected and acted accordingly, knowing that they were contributing to a 

larger, more successful whole. 

The goal of our system was to produce a constantly improving, evolutionary system. Our goal was to get something ‘‘good enough’’ out into the field, and then begin 

the improvement process. We had neither money nor time for gold-plated requirements and specifications. Our motto was, ‘‘generations, not specifications.’’ We didn’t 

claim to know the end point of the system when we started, but rather created tools 

for users to adapt. Someone used to waterfall/requirements driven life cycle process 

might find this appalling—that users could interactively develop a system in tandem with developers—but it was a key factor to the success of VistA. 

Lesson Learned: Generations, not Specifications. Start with ‘‘good enough’’ and 

allow it to continuously improve through end user interaction. 

VistA was designed to be adaptable to change. When we began, we were using 

PDP–11 computers, which now exist only in museums. Over the years, the system 

was hosted on VAX, Alpha, IBM Mainframe, PowerPC, and Intel computers with 

little or no modification. VistA was designed around a ‘‘kernel’’ architecture, consisting of common foundation that was used by all applications, but customized for 

specific needs of the various departmental needs such as laboratory, pharmacy, radiology, etc. The closest modern day equivalent to this is Facebook, which provides 

all users with a common set of tools, and then allows them to install ‘‘apps’’ to do 

specific tasks. We used a trimmed down version of the ANS MUMPS language, 

using only 19 commands and 22 functions. 

Lesson Learned: Create a Path of Least Resistance to where you want to go. 

For example, at the 1978 Oklahoma City conference, we decided on a standard 

format for storing dates in the computer. We knew that some patients had been 

born in the 1900’s, and we also knew that we would eventually be dealing with 

dates in the 2000’s. We created a program that would handle dates in this way, 

making it easier to do it the right way. We had a design ethic of making it easier 

to do the right thing: creating a path of least resistance to where we wanted to go. 

COMMENTS ON THE VISTA MODERNIZATION REPORT: FROM LEGACY TO LEADERSHIP

The report1 is an impressive effort by a large number of committed industry advisors. I applaud the recommendation to move toward open source, and many of the 

recommendations. 

However, I did not see the elements that lead to the success of VistA particularly 

well-represented in the report. The report focused on a heavily centralized, Washington-based development effort. User involvement was not stressed to the degree 

that it drove the original VistA development. It did not seem to fully recognize the 

unique needs of medical informatics, and seemed to make the all-to-common mistake of lumping clinical information with transaction-based administrative and billing systems. 

COMMENTS ON MUMPS

Key to the success of VistA was the ANS MUMPS programming language. The 

Federal health IT systems that have been written have all been successful, stable 

systems: VistA, DOD’s CHCS, IHS’ RPMS. The Health IT systems that have been 

programmed in non-MUMPS languages (TRIMIS, IOCs, AHLTA) have been failures. 

Kaiser Permanente’s EHR system is based on MUMPS (Epic), and a leading contender for the AHLTA replacement is also MUMPS-based. 

129 

Yes, MUMPS is an old language, but the fact that it has enjoyed all of this success bears close scrutiny by those seeking to replace it. 

Question. Is the weakness of the current VistA due to MUMPS, or the VA’s management of development process? 

The report criticizes MUMPS as being a legacy system, as being brittle and difficult to maintain. However, VA Central Office has been responsible for the architecture for 25 years now, and has had 25 years to address these problems. Instead of 

investing in its basic infrastructure, it has deferred its maintenance reach the 

breaking point we see today. 

If you asked a carpenter to build a house for you, and the house turned out to 

be crooked, you wouldn’t accept the carpenter saying, ‘‘That darn hammer made the 

house crooked. You are going to have to buy me a better hammer.’’ VA Central Office has been using a tool for 25 years, and rather than keeping it current and up 

to date, is now blaming the tool, not their management of it, for the problems we 

see today. 

If indeed the VA needs to move away from a MUMPS-based architecture, it is imperative that it understands exactly what worked in the past. I think that this will 

require a deeper dive into the foundations of VistA to be fully appreciated. 

Lesson Learned: VistA is not just computer screens. 

VistA was an outpouring of creativity of thousands of VA employees working together to improve service to veterans. This created many bonds of innovation and 

a shared sense of purpose that drove the community. The report seems to reduce 

VistA to strictly an IT issue—replicating the screens of the old system. VistA needs 

a broader organizational context in order to thrive in the future. 

Question. Is the VA just ‘‘paving the cowpaths’’ with new technology? 

The recommendation that VA freeze development of the legacy system while engineering a new one that is functionally equivalent is a high-risk approach that 

threatens to stall IT innovation in the VA for a significant period. If the new approach is delayed or fails, the VA would be freezing itself out of innovation and 

years of new development. 

LOOKING FORWARD

A mobile phone today has about 1000 times the computing and communications 

capacity of the computer I first used to install VistA at Loma Linda Hospital. It 

costs about one one-thousandth the price: a millionfold price-performance improvement. One would expect that this drop in the cost of the electronics would lead to 

a corresponding drop in the cost of Health IT. Internet users today have access to 

an incredible array of free services for email, social networking, photo and video 

sharing, text messaging, mailing lists, auction sites, and the ability to search billions of web pages instantly. 

Unfortunately, this is not the case. Health IT costs are spirally upwards rapidly, 

and systems that used to cost millions in the 1980s are costing in the billions today. 

Why is this? Why is it that costs outside of health IT are plummeting and 

functionality exploding, while the cost of health IT is exploding and the functionality 

creeping forward slowly, if at all? 

Imagine someone trying to sell the world’s greatest automobile. He offers the best 

car parts: an engine from a Corvette, the seats from a Rolls Royce, and a transmission from a Porsche. All that is required, he says, as a customer leaves with a 

truckload of these best of breed parts is ‘‘a little bit of integration.’’ 

So it is with Health IT today. Vendors are offering ‘‘best of breed’’ components 

(with corresponding premium prices) and then offering integration services to customize them to specific customer needs. Yet the integration costs—connecting the 

dots—are the overwhelming factor. 

One way out of this is to reframe our thinking of IT architecture as a ‘‘space’’ 

rather than a ‘‘system.’’ Consider what Tim Berners-Lee said about the creation of 

the World Wide Web: 

What was often difficult for people to understand about the design of the 

web was that there was nothing else beyond URLs, HTTP, and HTML. 

There was no central computer ‘‘controlling’’ the web, no single network on 

which these protocols worked, not even an organization anywhere that 

‘‘ran’’ the Web. The web was not a physical ‘‘thing’’ that existed in a certain 

‘‘place.’’ It was a ‘‘space’’ in which information could exist.’’ 

This opens up an extremely fertile discussion on how health IT might be supported using web-like information structures, as well as reduce the complexity we 

see in our systems today. 

130 

I have written other papers on this topic (see Appendix). Some of the more directly pertinent papers include: 

• HealthSpace architecture: http://munnecke.com/papers/HealthSpace.doc 

• Ensembles and Transformations: http://munnecke.com/papers/D16.doc 

• Concepts of the Health Data Vault: http://munnecke.com/papers/D03.doc 

SUMMARY

VistA was an amazing outpouring of innovative collaboration within the VA that 

changed both its information technology and its organization. Decentralization and 

direct user involvement were key to its success, as well as having a technical infrastructure capable of supporting it. 

Going forward, the VA should look to a theme of personalization of health—both 

in its IT infrastructure and its delivery of health care in today’s rapidly changing 

environment. 

I would be happy to answer any questions you may have now or from those reading this transcript. 

APPENDIX: 

These were papers relating to the future of Health IT in the VA that I wrote 

under contract to the VA from 1998 to 2000. A full list may be found on the web 

at http://munnecke.com/blog/?page—id=248 

HealthSpace (139kb) January, 

1998 

Some early thoughts on the notion of creating a ‘‘space’’ 

rather than a ‘‘system’’ of health. 

Some Applications of 

Complexity Theory to 

Health Care (93kb) 

December, 

1998 

Discusses the concepts of Dee Hock’s ‘‘Chaordic’’ thinking 

to health care, as well as general complexity theory 

issues 

Shared Meaning and Health 

Informatics (70kb) 

January, 

1999 

Discusses some of the challenges of overspecific standards 

efforts, as well as some of the underlying philosophies. 

Concepts of the Data Vault 

(57kb) 

February, 

1999 

Introduces the notion of a personal data vault as a key 

component of a personal health space per patient. 

From Enterprise to PersonCentric Health 

Information 

Systems(54kb) 

April, 1999 Discusses the shift from enterprise-based health care to 

person-centric. 

Health as a Medium 

(241kb) 

May, 1999 Portrays health as a medium, and many health problems 

as a ‘‘failure to communicate.′′ 

Personalizing Health 

(107kb) 

June, 1999 Discusses the issues of personalization at several levels 

Steps towards an Epidemic 

of Health (95kb) 

July, 1999 Discusses some of the initial conditions required to create 

an epidemic of health. 

Design Patterns for Health 

(461kb) 

August, 

1999 

Explores the application of architect/philosopher Christopher 

Alexander’s ideas to health 

New Health and the New 

Economy (67kb) 

October, 

1999 

Compares a new vision of health with the ‘‘New Rules of 

the New Economy’’ book by Kevin Kelly 

Rethinking Complexity 

(63kb) 

November, 

1999 

Discusses issues of complexity and how to circumvent them 

using ‘‘space’’ metaphor. 

Health and the Devil’s 

Staircase (45kb) 

January, 

2000 

Applies fractal thinking to health 

Systemic Issues of Patient 

Safety (208kb) 

March, 

2000 

Introduces a spectrum of scales to think about health, relates this to the notion of patient safety. 

131 

Tipping an Epidemic of 

Health (95kb) 

May, 2000 Discusses why the connectivity provided by the Internet is 

on the verge of creating an epidemic of health 

Ensembles and 

Transformations (23kb) 

July, 2000 Introduces ensembles as communities of interest which 

provide a context for transformations. 

Health and Positive 

Discourse (109kb) 

August, 

2000 

Examines notions of Appreciative Inquiry, positive discourse, 

and optimism in light of Internet technology 

Flipping from Negative to 

Positive Discourse (25k) 

September, 

2000 

Examines the effects of negative discourse, how naming a 

problem can make it worse, and examples of positive 

discourse. 

Assumptions of the 

Transactional Health 

Model 

October, 

2000 

Examines some of the assumptions of the transactional 

model of health, such as linearity, the economics of 

scarcity, and deficit discourse. 

A Transformational Notion 

of Health 

November, 

2000 

Discusses transformational concepts in health, flipping assumptions of the above transformational model 

New Perspectives July, 2001 Discusses the inversion of enterprise/person relationship, 

complementary currencies, and HailStorm architecture(.pdf) (html) 

Towards a language of 

Health (122K) 

Nov, 2001 Proposes Genos, a language which would allow expression 

of health and genomic information for clinical use. 

(html) (pdf) 

Can Health Care IT Adapt? 

(800K) 

Jan, 2002 Discusses issues for adaptation in our information technology infrastructure, in light of prospective advances in 

Genomics and Proteomics (html) 

From Systems to Spaces June, 2002 A space-based metaphor for patient health information systems (htm) (pdf) 

Chairman AKAKA. Thank you. Thank you very much, Mr. 

Munnecke. 

Mr. Baker, what can you point out that would help persuade the 

Committee that VA has learned from its past and that we will not 

experience expensive IT project failures in the future? 

Mr. BAKER. Thank you, Senator. I will keep this answer brief, because I would love to give you 10 minutes on that one. I think the 

biggest lesson that we took from the failure of the replacement 

scheduling application was that we have to make certain that the 

hard decisions are faced and made. From there, I think you have 

seen a series of hard decisions made at the VA relative to other 

projects. Stopping 45 projects in July of last year was, frankly, a 

hard decision for our customers, facing up that those projects were 

not delivering. Stopping some of those projects and just saying we 

are not going to be able to be successful at those, has been a series 

of hard decisions. Frankly, reforming a few of them was not viewed 

positively, but we recognized that they were not going to deliver if 

we did not change them to an incremental delivery. 

Some of the more notable ones that I think we get criticized for, 

for example, stopping the FLITE program; they are hard decisions. 

They are not decisions that we take lightly and they are not decisions that we view from only one aspect. But in the end, we have 

to determine if we can be successful. If we believe, we cannot be, 

if we believe it is an overreach, we need to not do the program. So 

I would point you to not just some of the things we have done, 

132 

some of the programs we have instituted, but the results of those 

programs. 

Most importantly, we do not allow a project to move forward 

today if they do not have a customer facing deliverable within the 

next 6 months. What that means is they are not going to go a long 

time, like the replacement scheduling project did. Replacement 

scheduling went years without delivering anything before they finally figured out it could not deliver anything. 

We now are implementing a technique we are calling Fail Fast. 

You know, if it is going to fail, figure it out quickly and stop spending money on it. That has generated a lot of us facing up to those 

hard decisions, again, inside the organization. 

So I would give you those two things. Again, in many ways, that 

is my life inside the VA, making certain we do not replicate those 

things from the past and that we do not have any more replacement scheduling scenarios. 

One thing I would add is I have also promised Secretary 

Shinseki that we will not have another replacement scheduling 

while he and I are at the VA. 

Chairman AKAKA. Well, let me give the other witnesses a chance 

to add anything about how to avoid these high-profile failures. Mr. 

Munnecke? 

Mr. MUNNECKE. As a software architect being faced with these 

demands on the technical side, I find that the users—and this 

might come from Senate and Congressional committees, by the 

way—want to have the penthouse suite of a skyscraper, but they 

do not want to pay for the lower 22 floors and the foundation of 

the building. So they say, I want this thing up at the top. Give it 

to me tomorrow, or yesterday. Then everybody has to scramble to 

build the skyscraper. As an architect, I have to dig a hole in the 

ground to build a foundation. They say, no, no, I want the skyscraper. I want the penthouse suite. 

So I think Mr. Baker’s approach, which I wholly endorse, should 

also include the requirements that people who are building not 

make them gold-plated penthouse suites, but maybe even accept 

the tenth floor of an existing building and scale it down to allow 

it to evolve over time rather than go for the big push and the big 

bang that may not be possible. So it should be a process of discovery and working forward gracefully rather than expecting the 

gold-plated requirement to be met immediately. 

Chairman AKAKA. Mr. Meagher? 

Mr. MEAGHER. Thank you, sir. One thing I would add is this notion of accountability, personal accountability. When you have the 

projects broken up into small pieces where you make sure all the 

parts are in place before you begin: that there is an agreed-upon 

business requirement; there is a business owner; there is competent, experienced program management. Then you hold people 

accountable for their deliverables and for meeting their milestones. 

That is a culture change that is taking place, I would suggest to 

you, over the last 18 months that is very dramatic and is probably 

one of the main pillars to why I think you are seeing the turnaround that some of you have recognized and I really believe is 

there. 

Chairman AKAKA. Mr. Tullman? 

133 

Mr. TULLMAN. Yes. I would again compliment Assistant Secretary Baker on the progress in what I heard today. You know, we 

believe that the private sector should play an increasingly large 

role in developing these systems. We are developing very similar 

systems for the civilian health care system, and increasingly what 

we are seeing is these two are meshing together. People are moving 

back and forth, in and out of the military and other services, and 

the government, as well. 

So we would like to make sure that, number 1, the government 

is looking at what the private sector has to offer, and two, we believe that there are much better systems to form the community 

that my counterpart here talked about, a community of the VA. 

They are out there. There are social networking systems. There are 

open platforms. There are Microsoft-based systems. They are not 

based on what is essentially a 25-year-old transaction processing 

language called MUMPS. So we would like to see the new systems 

based on newer, broader standards and have the government in the 

role of setting the standards for what they want and let the private 

sector compete to deliver and be punished if they do not. 

Chairman AKAKA. Let me now ask for questions from our Ranking Member, Senator Burr. 

Senator BURR. Thank you, Mr. Chairman. 

Mr. Baker, just a comment. You made the observation that as 

you cut IT programs, some of that money was reprogrammed over 

to operations and maintenance. At the same time as that is going 

on, we had savings in the construction of facilities area of which 

we are in the process of reprogramming over to build additional 

facilities. 

I would only make this comment. VA continues to short operations and maintenance, year in and year out. Now, you are going 

to come back to us and you are going to ask for additional money 

for IT programs and we are going to feel compelled to give it to 

you. It is going to happen. We keep moving money around and we 

do not leave it where it not only does the most long-term good, but 

this reprogramming lets us off the hook from actually making the 

right decisions on operations and maintenance for this year, next 

year, every year. 

So my hope is you will carry a message back. I, for one, as a 

Member of the Committee, am going to become much more observant of the reprogramming of money. If we get at the end of the 

year and we see money left over in your account, it will be because 

either, one, we projected wrong; two, we got savings; or three, we 

eliminated programs. We can reprogram that money for the next 

year so that it goes toward the program needs that you are going 

to have. 

Let me stay with you, Mr. Baker. You listened to two competing 

views on future architecture, for MUMPS, against MUMPS. Who 

is right? 

Mr. BAKER. Well, I guess being a political appointee, my job is 

to kind of run down the middle of this, and I do, technically. Several things come together from my standpoint here. One is an old 

adage that I have that the definition of a legacy system is that is 

the one you know works. We have—— 

134 

Senator BURR. Let me just ask a follow-up question. If you maintain MUMPS, can the private sector have full access into the VA 

system, into the MUMPS system, for the exchange of electronic 

information? 

Mr. BAKER. I would answer it this way. I believe just as much 

as if we implement it in any other language, because at the bottom, 

it is the data that is important. 

Senator BURR. OK. Now let me turn to Mr. Tullman, if I can, 

simply because he is out there in the private sector. Now let us see 

what the limitation is. 

Mr. TULLMAN. What I would say is, and again, I think you can 

extract data for any system. What we are really talking about, and 

I do not want to get too technical, is the native exchange of information. So you can pull information out of a mainframe system and 

put it into a PC if you want two people to talk to each other. The 

question is, why would you do that when you could have two PCs 

that were talking with each other? 

So again, we think MUMPS was the right decision to make when 

it was made. We think there is a reason to carry forward. We are 

just saying, as we go forward into the future we need to broaden 

the understanding of what systems to use, what architectures to 

use, and what are the general reason we need these systems, and 

that is for communication. And I think that is this idea that this 

community is important, yet no one is using MUMPS to build systems that communicate and exchange data efficiently today—— 

Senator BURR. OK. Mr. Munnecke—— 

Mr. TULLMAN [continuing]. Anywhere else but the U.S. Government. 

Senator BURR. What is wrong with two PCs? 

Mr. MUNNECKE. Excuse me? 

Senator BURR. What is wrong with two PCs? 

Mr. MUNNECKE. Two PCs, that is basically the architecture we 

used. I was an avid anti-mainframe designer. We thought that 

mainframes were the devils and personal computers and microcomputers were the angels. I almost went to work for Apple Computer before I started at the VA and was a total fan of microcomputers. That was 1977. Mr. Tullman’s comments have a number of technical issues that I think we need to talk about over coffee sometime. Yet, I probably largely agree with his conclusions. 

I do not want to be characterized as being pro-MUMPS. I do 

want to be characterized as understanding that we have a very 

successful legacy system that has accomplished a lot, and just 

going with the standards of the information technology industry 

and thinking that we are going to take these shiny new technologies and buzzwords on PowerPoint presentations and come up 

with a successful system is not going to work. There are tremendous medical informatic needs that need to be dealt with, and dealing with them in a way that actually works and is on the ground 

and is working in IHS, DOD, and VA is quite a—— 

Senator BURR. I am not sure I have heard anybody describe an 

electronic health component of DOD actually working. 

Mr. MUNNECKE. CHCS, Composite Health Care System, installed 

in 1986 in all facilities worldwide. We developed it at SAIC. That 

135 

was one of my projects. If you had somebody from DOD here that 

was using CHCS, I think they would have very good things—— 

Senator BURR. Well, why do they have such a hard time building 

medical records in a fashion that they can actually be transferred 

to VA? 

Mr. MUNNECKE. I think that you would have to look at DOD actually throttling back CHCS and crippling the features that were 

designed into it for communication in order to protect their bureaucratic stovepipes. It is not a matter of technology. It was not 

MUMPS. It was the DOD’s management of it and decision to centralize it and pull it apart and replace it with AHLTA. 

Senator BURR. My time has run out, but let me just make one 

observation, if I can. There should be no committee of Congress 

that is trying to determine whether MUMPS is right or wrong, but 

I would say this to the VA: it is absolutely essential, in my estimation, that private sector companies buy into what technology decisions you make at VA because of exactly what Mr. Tullman 

raised, and that is that this is no longer our population of people 

that we are taking care of. They are bouncing back and forth, and 

that is going to happen for some time. As a matter of fact, they 

bounce back and forth today based upon what particular problem 

they have got and whether they want to be seen on the private sector side or whether they want to be seen on the VA side. So if we 

want to reach the efficiencies, long-term, of private health care, as 

most have realized, then we have got to have this interoperability 

solved. 

So my observation would be, if a company like Allscripts, a leader, is questioning whether they will be able to exchange through 

your system, I think we ought to pause for a minute and talk to 

those companies and find out what their concerns are, how we 

overcome those concerns. There may be aspects that can be redesigned that overcome those. If, in fact, we end up at the end of the 

day and the private sector says, we cannot play in your world, well, 

we have got a big problem. The problem is we will not get as many 

efficiencies on the private sector side. And I certainly do not think 

that we will get efficiencies that we are going to have to get out 

of the VA side. 

I thank the Chairman. 

Chairman AKAKA. Thank you. 

Senator Johanns? 

Senator JOHANNS. Mr. Chairman, thank you. 

I have to tell you, I am sitting here and it just brings back frightful memories. This is enormously expensive. Projects get abandoned. Huge costs to the taxpayers. Nothing to show for it while 

this debate goes on. And for us, I have to tell you that it is very, 

very frustrating. But again, I was in your position at one time. 

Now, let me offer an observation or two, hopefully with a question. One observation I had about IT was that the process of creating a system was enormously influenced by a legislative process 

that was not connected at all to the IT requirements. I will give 

you a perfect example. Things would be written into the farm bill. 

They would have a nationwide impact, right down to the nuances 

of an individual farmer, yet the system was not able to deal with 

that. 

136 

So let me just start out and ask you, do you feel that kind of influence also at the Veterans Administration, or was that unique to 

USDA? 

Mr. BAKER. From my observation, I would say we see it more on 

the benefits side than on the health side. One of the things that 

made the new G.I. Bill Long Term Solution a large-scale project 

was that there were substantial additions that are great features 

from the veterans’ standpoint, and we fully support them, but they 

made the software much more complex than the software that processed the previous G.I. Bill, the previous educational benefits. Recognizing that we are going to see continued requests from Congress 

to enhance what that bill does for veterans, we have built it to be 

as flexible as possible. It is not perfect. Our answer is never going 

to be every time, sure, we can do that; no problem. But we have 

tried to build things in that would allow us to give an answer of, 

that will take a month or two versus that will take a year or two 

in—— 

Senator JOHANNS. So let me jump right in here, then, and ask 

another question. And it is OK to be critical of us. I mean, we are 

trying to figure this out. Even though we are your oversight, it is 

still OK to be critical. 

Those policy determinations may be the absolute right policy, 

and I think we can all agree upon that, but is there a disconnect 

in the staff work driving that policy, or our work in driving that 

policy and the impact it has on the VA? 

Mr. BAKER. There is an interesting balance in there, and I will 

reflect on—— 

Senator JOHANNS. You are being so diplomatic. 

[Laughter.] 

Mr. BAKER. Well, I am trying to give you the answer as I see it. 

I am a private sector person. These systems should not take forever 

to develop. So when the answer comes back to your staffers, ‘‘if you 

do that, it will take 3 years,’’ they should not listen. At the same 

time, sometimes you get to the point where the answer really is, 

yes, that is going to take more than a year. We wrestled mightily 

with implementing the Chapter 33 system and a lot of it was because of the short timeframe to get it implemented, and then the 

fact that it was very popular with the folks using it. So we had a 

relatively poor IT system that VBA had to use in that first semester, which we saw the impact of. Veterans did not get paid in a 

timely fashion. With another year, we are able to implement the 

Long Term Solution and it is much better. 

Senator JOHANNS. The other thing I wanted to ask you about— 

it is great to go home and tell people how we improved benefits. 

They are not quite as understanding when we tell them that we 

improved the funding for IT or bureaucrats to run it. Are you feeling that tension, also? 

Mr. BAKER. Yes. It is certainly, as you point out, for example, 

easier to justify increases in the health accounts than in the IT accounts. Yet, as Dr. Petzel would tell you, because of how fundamental the VistA system and IT is to health, as they open a new 

facility, as they do new things for health, as they do the patient 

centered medical home, IT is fundamental. 

137 

We are constrained in our ability to meet the health demands by 

the fact that we are not tightly tied any longer. We have a separate 

appropriation for IT. We are wrestling with that, frankly, inside 

the VA right now and looking for what we can bring forward to 

Congress from a proposal standpoint that would let us address that 

issue without breaking down what we accomplished by centralizing 

IT management. It is what a private sector company would face directly. How do we most optimally do these things? Our difference 

is that instead of going to our CEO, we also go to our Board of Directors to do those sorts of things. 

Senator JOHANNS. I will wrap up with this because I am out of 

time, also. One of the things that really, really came home to me 

when I was in your position—and you are serving this role now— 

is you need strong central management. It is just so obvious after 

doing what you are doing for about 3 years. You just need the very 

best person you can have in charge of this. 

The second thing is, there has to be better coordination between 

the policymaking process and what you have to implement, because 

if there is a breakdown there, it can really cause serious problems. 

Then, no offense to the private sector, because I agree, the private sector plays an important role here, but you have to have 

somebody who can push back, because my experience is they love 

to design the penthouse suite, to use the analogy. They are not so 

excited about designing the basement. And yet you have got to 

build the basement, the floors. It is kind of like building an interstate highway system. It is probably not the sexiest thing to acquire right-of-way, but guess what; if you do not have the right-ofway, you cannot lay the concrete. Everybody loves to see the concrete laid down. 

So I think that it is enormously important that somebody there 

is very, very strong and knows their business, so the building 

blocks are there. Even if you do not get to the final epitome with 

that first contract, built a step at a time it just seems to go better 

and the money is better managed. Does that make sense? 

Mr. BAKER. Absolutely. In software terms, we would call that incremental development. Show the customer something as quick as 

you can and get their feedback on whether it is what they want or 

not, and then build further to that. It is the way the private sector 

builds things. Government has traditionally done the big bang 

thing, which is tell me all your requirements. I will spend 5 years, 

I will wrap it up in a bow, and I will hand it to you. The problem 

is it does not account for something that we all know is a fact, 

which is change. 

Senator JOHANNS. Yes. 

Mr. BAKER. This is why so many large-scale government projects 

fail. 

Senator JOHANNS. Thank you, Mr. Chairman, for your patience. 

Chairman AKAKA. Thank you, Senator Johanns. 

Senator Brown? 

Senator BROWN OF MASSACHUSETTS. Thank you, Mr. Chairman. 

You know, when I go home, people say, ‘‘Scott, have you 

changed? Have you changed at all?’’ And I say, well, yes, I have 

changed, because I have learned a lot doing my job and at the 

Committee hearings. As a matter of fact, I learned that the ArlingVerDate Nov 24 2008 12:36 Mar 16, 2011 Jkt 000000 PO 00000 Frm 00141 Fmt 6633 Sfmt 6601 H:\ACTIVE\100610.TXT SVETS PsN: PAULIN
138 

ton Cemetery folks are still accounting for all the people on index 

cards. They are using index cards to identify where graves are and 

who is there. They do not have an iPad or they do not use computers. Can you believe that? It is amazing to me. 

I have learned also that we waste a tremendous amount of 

money beginning programs, putting a few hundred million dollars 

in it, and then just say, oh, that does not work. We will do something else. I have learned also that the IT systems in the various 

departments are critical, especially with the changing nature of 

how we communicate worldwide, and I am not opposed to providing 

the tools and resources to update IT. I think it makes sense. But 

I do have a problem when we always—and I know I am still somewhat new here—but we put these tremendous amounts of money 

into programs and then we change course midstream, and do another one and another one. 

So I guess my question ultimately is, are you satisfied at this 

point that you have the IT system in place to basically do your job? 

Mr. BAKER. I am going to start by answering that from my private sector perspective, which is absolutely not. You know, this is 

a large still government-oriented organization. I am pleased with 

the progress we have made. I very early learned to separate our 

customer support and operations, which are on a par with the private sector, from our development, which is far behind what a private sector organization would do. 

We are putting in the disciplines in our development organization that a private sector organization would expect, but frankly, 

we have nearly 3,000 developers. We spend about $800 million a 

year on development, and while we have started to change that organization, we are nowhere close to the level of output I would expect from that level of investment. 

We will not have another $100 million ‘‘go off and spend money 

and fail’’ program in the VA. Like a private sector organization, we 

are going to have a lot of a few million dollar projects, to discover 

that is not the right program. Let us go do something different. We 

want to do speculative things, take some risks, find things that are 

going to be big wins, and stop things early before they turn into 

big losses. That is the way the private sector approaches these 

things. 

But to come back fundamentally to your question, we are trying 

to get to the point where we can be compared to a good private sector organization. We are several years away from that at this point 

still. 

Senator BROWN OF MASSACHUSETTS. Well, considering that, has 

your ability to hire and fire improved at all? 

Mr. BAKER. No. 

Senator BROWN OF MASSACHUSETTS. OK. And is there something 

that we can do to help you in that mission? Maybe offline, you can 

let us know so we can streamline and do whatever we need to do 

to give you that authority so you can get your house in order. 

Mr. BAKER. Senator, I can certainly tell you what, as a CEO in 

the private sector, I had from an authority standpoint. 

Senator BROWN OF MASSACHUSETTS. No, I understand that. I 

am—— 

139 

Mr. BAKER. I long ago gave up being able to have the equivalent 

in the Federal Government. 

Senator BROWN OF MASSACHUSETTS. All right. Well, maybe we 

can talk about that offline and figure out a way to help you get to 

where you need to be. 

There is obviously an initiative by DOD to find a way to save $100 billion. What are you doing to try to save money, as well, because the money tree is getting smaller. 

Mr. BAKER. I agree. I have been focused since I arrived at VA 

on making certain that the dollars we spend are spent on things 

that are going to benefit veterans, that we are not wasting the dollars. We requested no increase from fiscal year 2010 to fiscal year 

2011. We will request no—I am sorry, I am not allowed to talk 

about the President’s budget, but I would not anticipate the VA requesting an IT increase going into 2012, as well. My focus is on 

how we get more out of the dollars that we have. We have to deliver more things for the veterans, and I want to be careful to make 

certain that we are not cutting back in areas that we should not 

be cutting back, specifically to Senator Burr’s comment about the 

maintenance and the operations and the infrastructure. But my 

main focus is on making certain that when we spend a dollar, we 

have got real return for that dollar inside VA. 

Senator BROWN OF MASSACHUSETTS. That is appreciated. As a 

30-year, almost 31-year Guardsman, if somebody is in the Guard 

and they deploy, then get home and decide they want to get out 

of the military, what assurances can you provide that his medical 

records from deployment and home station will be transferred to 

the VA CBOCs 3, 4, or 5 years down the line? 

Mr. BAKER. From my understanding of that system, that is a 

great question. 

Senator BROWN OF MASSACHUSETTS. That is why I asked it. 

[Laughter.] 

Mr. BAKER. Anything that is electronically generated inside the 

DOD comes to the VA through a system called the Federal Health 

Information Exchange. There is a lot of electronic information. I do 

not know the DOD system well enough to know how much of that 

Guard’s information comes over in that system and how much of 

it does not come into that for the VA to see. I will be happy to get 

an answer on that one so that we both get a little bit better educated on what does occur and what does not occur. 

Senator BROWN OF MASSACHUSETTS. Well, I think it is important 

because you have a tremendous amount of Guardsmen who are 

serving in the One Army concept, doing their time, getting out, and 

getting the appropriate care and treatment. If the records are not 

complete, it is a waste of time and money for a whole host of reasons, so thank you. If you could maybe get back to me; just call the 

office. You do not need to send anything. Just pick up the phone. 

It is a ‘‘keep it simple, stupid’’ type of thing. 

Mr. BAKER. OK. 

Senator BROWN OF MASSACHUSETTS. OK? 

Mr. BAKER. I appreciate it. Thank you. 

Senator BROWN OF MASSACHUSETTS. Thank you, sir. I appreciate 

it. Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Brown. 

140 

Senator BROWN OF MASSACHUSETTS. I did not mean to say that 

you are stupid. It is the KISS theory, just so—— 

Mr. BAKER. I love the KISS theory. 

Senator BROWN OF MASSACHUSETTS [continuing]. I am not misquoted. I think you are doing a very thorough job. So I just want 

to make sure—— 

[Laughter.] 

Mr. BAKER. I took it as intended, sir. Thank you. 

Senator BROWN OF MASSACHUSETTS. OK. Thank you. 

Chairman AKAKA. Thank you very much, Senator Brown. 

Mr. Baker, with the failure of CoreFLS, the Committee learned 

that the contractor was still paid a bonus due to contractual obligations. Are bonuses being used to encourage contractor performance, 

and how are they structured? 

Mr. BAKER. To answer the first question, I am certain that there 

still are incentives in our contracts to encourage the contractor to 

do what we want them to do. My experience from both the private 

and the government sector sides are that there are frequently costplus-incentive fee contracts, and I expect that we would use those 

where appropriate. 

The issue that you frequently see is when a contractor does exactly or close to exactly what the contract asks them to do and the 

project still fails for either reasons that they did not even contribute to or reasons that were not contemplated in the contract, 

and I think the government has fairly traditionally continued to 

pay those incentive fees when contractually required in those. 

It is an interesting dilemma, because, if you will, the environment that a program exists in is multiple contractors, lots of different government offices, and as we have all seen, pinning the 

blame on who caused the failure inside the government programs 

is almost impossible. There are so many people involved, so many 

people insulate themselves from taking charge, that it is perfectly 

feasible for the contractor to say, I did what I told you I would do. 

I earned my incentive payment. Please pay me. Do I like it? No, 

but it is part of the contractual process. 

Chairman AKAKA. For our other witnesses, do you have any 

thoughts on bonuses built into these IT contracts? Mr. Munnecke? 

Mr. MUNNECKE. Well, as a VA employee who was demoted for 

my work with VistA, I think there is a lot to be said for aligning 

incentives to support innovation. I would like to focus on innovation and giving bonuses for innovation. I guess I would like to see 

innovation tracked as well as costs and budget. 

Chairman AKAKA. Ms. Finn, with regard to the recent IG report 

on the G.I. Bill, why is it so important to have an independent 

milestone review in place, and also, does VA’s solution fit the bill? 

Ms. FINN. We believe the independent review is important because it helps people making decisions, like Mr. Baker, have a solid 

understanding of what is going on, separate from just the program 

managers’ or the project managers’ assertion of how things are 

going. It gets down to the facts of what is happening, where the 

costs are, how much things have cost, and what the progress really 

is. 

The response from the Department was that although this has 

not been accomplished yet through the PMAS oversight process, it 

141 

is planned to be and will be part of future PMAS. That is a solution. We are still waiting to see how that works out. We are currently working on an audit of the PMAS system to take a closer 

look at the controls and the processes being used to oversee system 

developments. So, hopefully when we finish that, we will have better insight as to how well PMAS can fit the independent review 

portion. 

Chairman AKAKA. For the other witnesses, should these independent reviews be done on some of the other large-scale projects, 

as well? 

Mr. BAKER. Senator, I will just point out that one of our main 

philosophies is that we are looking to the customer to tell us 

whether they are getting what they are expecting from us, and that 

is an integral part of PMAS. 

We have, I believe, an exceedingly good relationship with our IG 

folks on the technical side. We get very good constructive criticisms 

from them. It is extremely useful. I believe you will find, in general, with the recommendations they make to us these days, we are 

going to concur. We can take all the help we can get in making this 

work well. I appreciate the work that Ms. Finn and Mr. Carbone 

and their folks do for us. It helps. 

Chairman AKAKA. Any others? Well, my time has expired. 

Senator Burr? 

Senator BURR. I got to thinking as Senator Brown held up his 

iPad. My last trip to Mid-Valley Hospital, as I saw kids come in 

from Landstuhl, I think all of them had their medical records taped 

to their belly. That is why I made the comment I did about DOD. 

I am sure there are some areas that do work. But I am also struck 

by the fact that I think three of our witnesses brought their iPads 

with them. I think that gives us a great indication as to how much 

most of you, if not all of you, look at the new technologies available 

that change the way you personally communicate. So I think the 

challenge, Mr. Baker, is to change the culture, not just at VA, I 

would say throughout government, though it may be a bridge too 

far. 

My hope is that like we see business collaboration with academia 

that did not exist 20 years ago, we now see business collaboration 

with academia is an absolutely crucial component to where business chooses to invest capital because it is essential to their longterm viability of the business. 

Again, my hope is that VA will collaborate with the private sector, not just from a contractual standpoint, but from a strategic and 

tactical standpoint with business, because when we both get on the 

same page, when we both agree with the platforms, when the highway goes to the same end place—you may have different exits on 

yours, the private sector may have different exits, but where you 

stop and where you end have to be one and the same. I think we 

will find that we can leverage things that we are currently not 

leveraging in our efforts. 

Let me ask you about skilled staff. I think IT projects are a lot 

about staffing, and I would ask you, what is your assessment of the 

professional competence of the program managers within the office 

who manage these expensive and critical IT programs? 

142 

Mr. BAKER. Senator, one of the reasons that we have cut back 

on the number of projects that we are doing is because we do not 

have a sufficient amount of project management skills to run the 

number of projects that our customers would like us to compete. 

One of the primary premises of the Program Management Accountability System is we are not going to ask a project manager to start 

a project when he or she already knows it is going to fail. Those 

project management skills have proven to be where we are weakest, where we have the most trouble hiring, and where we compete 

most directly head-to-head on dollars with the private sector. A 

great project manager is worth every penny he or she is paid in 

what they save you in what they do in delivering a project. 

Senator BURR. Do you have all the tools you need to improve the 

competency and the performance of your program managers? 

Mr. BAKER. I would never say we have all the tools we need. We 

are doing a lot of training. We are doing a lot of hiring. But we 

need more than 100 good project managers at the VA right now. 

We are able to hire one or two at a time. It is difficult. Everybody 

needs them. And while we have a mission that I believe is more 

communicable than anybody else’s, great project managers are in 

high demand in the private sector and in government. 

Senator BURR. We currently have an RFP with IBM for the 

Agent Orange claims. What is the amount of that relationship with 

IBM for that project? 

Mr. BAKER. I believe that is a firm fixed price at about $9 million. 

Senator BURR. OK. The first 45-day mark, they missed. 

Mr. BAKER. That is correct. 

Senator BURR. You then issued a second, a back-up RFP. 

Mr. BAKER. Correct. 

Senator BURR. What is the reason IBM missed it? 

Mr. BAKER. From our perspective, I do not believe they understood—just being blunt—they did not understand it was not ‘‘business as usual’’ in the government, that we were absolutely committed to making the 45-day mark from the VA’s standpoint. 

Anecdotally—I will talk about this because I have read it in the 

press—I believe that they were probably surprised on day 46 that 

a Cabinet Secretary called the CEO and said, ‘‘I am concerned.’’ 

That is not government as usual. 

Senator BURR. I agree. 

Mr. BAKER. We must process Agent Orange claims when they 

come in and demonstrate that we can do that effectively and that 

we can involve the private sector in doing that. I believe with the 

path IBM is on right now, they will succeed. I can assure you they 

got the message, and they have responded like you would expect 

from one of our Nation’s leading technology companies. 

We also, however, recognize that in this case, a reasonable probability of success may not be enough. We may need to have a backup system that if for any reason they were not to deliver, we would 

have an alternative. We have not yet, to my knowledge, let that 

second RFP, but I believe that the motions that we made that were 

seen in the public probably are interpreted the right way, which is 

we are going to deliver this system. 

Senator BURR. We both know we do not have any choice. 

143 

Mr. BAKER. That is right. 

Senator BURR. If we do not, we will have an implosion of our 

claims processing, and I dare say we are close to that today anyway, and we both know that. 

The Chairman is being awfully accommodating to me. Let me 

move to Mr. Tullman just real quick, because Allscripts has an extensive experience in electronic health services in the private sector, and I think you even commented in your testimony that you 

had processed, I think, 3.5 million or 3.5 trillion claims? 

Mr. TULLMAN. Million. 

Senator BURR. Million. Well, we are in Washington, so—— 

[Laughter.] 

Senator BURR. I wondered if you could talk just a little bit about 

the partnerships Delta Health Alliance and the University of Massachusetts have and what lessons you learned from that which 

might assist the VA and DOD efforts in their quest for a seamless 

electronic medical records system. 

Mr. TULLMAN. I would start off by saying that clearly the challenge that the VA has is a larger one than those that we will talk 

about with Delta Health Alliance or with University of Massachusetts. That said, the general principle was we were not going to put 

the patient between the interest of various bureaucracies that 

might be involved, and those could be—in both cases, we are talking about a variety of competitors actually exchanging information 

based on standards published by the government and, in fact, exceeding those standards. So what we have set up is an information 

exchange, private information exchanges that are secure. We have 

asked that each of the entities put aside the competitive aspects of 

what they do and look at the patient. 

So I think the biggest message there was we went in with an objective that said, we have to exchange basic information across 

these systems. We have not always been able to use standard technology, so there we have applied new technologies from innovative 

companies like dbMotion, which allows us to essentially do semantic interoperability, which is allowing French, German, English all 

to connect into one virtual patient record. 

So net/net, I think it has been both a technology accomplishment, 

and also one, as was mentioned earlier, that has to do with the politics of what goes on, because large academic medical centers in a 

variety of other community-based organizations do not always want 

to—it is not a natural act to communicate, but it has to be in 

health care. It is too important a problem. And as you mentioned, 

we cannot have especially our young service men and women not 

have full access to the information to allow our physicians to make 

better decisions. 

So we have taken both a technology approach and also a political 

approach in terms of managing that and I think that is the same 

approach that we will need to take in the government. 

Senator BURR. Thank you, Mr. Chairman. 

Chairman AKAKA. Thank you very much, Senator Burr. 

Mr. Baker, two points about VA’s pharmacy program. First, 

medication safety is a priority for VA. Second, VA’s pharmacy program is renowned for its delivery system. Many pharmacy IT solutions are critical, so I have two questions. What is the status of the 

144 

pharmacy reengineering project, and has there been any decision 

to cut funding for this project? And second, are you confident that 

the development for such a program is now on the right course? 

Mr. BAKER. Senator, let me answer the second question first. 

Yes, I do. Pharmacy reengineering was one of the 45 projects we 

originally paused. I have frequently said that if you laid the schedule for Replacement Scheduling next to the one for Pharmacy and 

took the names off, you would not have been able to tell the 

difference. 

Pharmacy, as you point out, is critical to us. What this application does is enhance our ability to detect drug interactions and 

avoid adverse impact from those drug interactions by using, frankly—by giving us access to private sector technology that now exceeds what we were able to develop inside the VA. 

We right-sized that project and basically forced it to start delivering in one hospital. The Charleston, SC, hospital, is, I believe, 

the one where it is operational. It is either now or soon to be at 

more hospitals, basically following the same thing that Mr. 

Munnecke and the VistA developers did in the early days. Develop 

it in one, move it to more to prove out what it does, and then distribute it throughout the organization. 

From a funding standpoint, I would tell you that I believe we have right-sized the program. I know that we spent $10 million 

less on it in 2010 than we had planned, but we delivered 

functionality to the schedule we established there. I would tell you 

that my belief as a computer scientist is that we could easily have 

spent that $10 million and gotten nothing more than we got out of 

the programs. I do believe we right-sized it. 

I do not have the numbers for 2011 for that program right off 

the top of my head, but I believe we have the dollars allocated for 

it to move ahead on a path that will continue its success. 

Chairman AKAKA. Mr. Baker, with respect to the lifetime electronic record, what discussions have taken place among members 

of the Joint Executive Council about the goal of the single or 

shared program that handles DOD and VA electronic medical 

records? 

Mr. BAKER. Senator, I would tell you there are extensive discussions occurring almost every day on that topic between DOD and 

VA. I know that Deputy Secretary Gould, who is the VA Co-Chair 

along with Deputy Secretary Lynn of the DOD, has had discussions 

on that topic. We clearly would like to achieve that if possible, but 

there are mission differences between the DOD and the VA. The 

DOD right now is working on their electronic health record way 

ahead and I know that our future path for VistA is one of the options that they still consider to be a possibility. We certainly consider working with the DOD on a single record system to be something that we would like to do and we would like to figure out a 

way to do. But clearly, both of us must accomplish our missions as 

the primary goal. 

Chairman AKAKA. Mr. Meagher, we have discussed a bit already 

about project management, but project management is a key to 

successful projects. What changes in IT project management have 

you seen within VA? Are these the right changes? Are more 

changes needed? 

145 

Mr. MEAGHER. Well, sir, I think the primary difference can be 

summed up in leadership and accountability. I think the substantiation of the PMAS system that Mr. Baker brought to the Department and the formalization of some of the rules of the road, these 

are things that are commonly understood to lead to success. So 

when you say you bring these things, you break the projects up 

into more manageable pieces. You make sure that there is a program manager and a business owner associated from the very beginning. You make sure the funding is adequate to the task. You 

make sure the milestones are reasonable and that they deliver results in our lifetimes so that the technology does not change while 

they are on a 3–5-year plan. You are familiar with how quickly 

technology does change. 

So if you break these into 3- and 6-month increments, you make 

sure you have got the right people, you hold those people accountable, and you make—there is the old saying that ‘‘what gets measured gets managed’’—so you have meaningful measures built in 

from the very beginning. Everyone understands. I think the example that you were discussing earlier about IBM, all of a sudden, everyone understands that the VA is serious now. They are not just 

mouthing platitudes. There will be consequences if you do not deliver according to the agreed-upon schedule. 

Those leadership changes, and then the actual programmatic mechanics of it that have been put in place, I think have dramatically 

changed how VA is now capable of delivering. I think, as Roger 

said, you will not see any big failure coming out of the VA if they 

stick to the path they are on today. It will not be possible. If there 

is going to be any failure, it will be where they are taking risks, 

where they are trying innovative things. If it comes to pass that 

this is not within the capabilities or the realm of possibilities given 

current circumstances, you shut them down before they become too 

big to fail. 

So I think the leadership and the focus on personal accountability, where a program manager knows they will be held accountable, their career will be affected if they do not deliver on time and 

on budget—I think is the biggest change—and having measured 

my time at the VA against what has happened in the last 18 

months, I can only applaud the changes that have been made. 

Chairman AKAKA. For the other witnesses, what can you share 

with us about VA’s project management? 

Ms. FINN. I will speak from a bit larger perspective. In project 

management, one of the things I see as positive is that when we 

work now within the Department, we are not arguing with OI&T 

or Mr. Baker and his staff about whether or not an issue exists 

based on the facts that we find. Sometimes we are discussing how 

best to address it, but we do not have resistance. So that kind of 

acceptance of input and information is critical to doing good project 

management. 

Chairman AKAKA. Mr. Baker, on a scale of one to ten, what degree of confidence do you have that VA will make the December 31 

deadline for the G.I. Bill Long Term Solution and what contingency 

plans are there should that deadline not be met? 

Mr. BAKER. Senator, as you can imagine, we watch that one 

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cember 31. The key question there is the inclusion of the financial 

payments interface in that delivery, and I would tell you that I 

have good confidence in that. Call that a seven-and-a-half to an 

eight. I am an experienced software developer. It is not going above 

nine until the customers are using it, as far as I am concerned. 

There are so many moving parts in any software development 

project of this scale that lots of things can go wrong. But I believe 

we have a good degree of confidence in what we have seen, in our 

ability to deliver in that area, and the realism of the project at this 

point. 

Chairman AKAKA. In closing, I again want to thank all of our 

witnesses for appearing today. As Chairman, it is my responsibility 

to make certain that this Committee fulfills its obligation to conduct oversight of the Department of Veterans Affairs. How VA conducts its IT development impacts nearly every program and benefit 

veterans enjoy today. With the appropriate technology, management, and attention, I remain hopeful that VA will continue to be 

a leader and innovator in the area of health technology. 

I thank you all for participating today. I would also like to acknowledge three VA leadership participants, Sylvia Tennent, 

Trenna Carter, and Timothy Graham, in the room today. I hope 

that the skills you have developed will aid you during your career 

at VA, especially those that will assist in improving VA’s IT 

program. 

The hearing is now adjourned. 

[Whereupon, at 11:12 a.m., the Committee was adjourned.] 

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