Veterans Affairs Information Technology: Management Attention Needed to Improve Critical System Modernizations, Consolidate Data Centers, and Retire Legacy Systems
Published: 2017-02-07T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The use of IT is crucial to helping VA effectively serve the nation's veterans, and each year, the department spends over $4 billion on IT. However, over many years, VA has had difficulty managing its information systems, raising questions about the effectiveness of its operations and its ability to deliver intended outcomes needed to help advance the department's mission. GAO has previously reported on a number of the department's IT initiatives.
This statement summarizes results from key GAO reports related to increasing electronic health record interoperability between VA and DOD; system challenges that have contributed to GAO's designation of VA health care as a high-risk area; and VA's development of its system for processing disability benefits, data center consolidation, and legacy systems.
section_title: What GAO Found
paragraphs: GAO noted in July 2016 that the Department of Veterans Affairs (VA) had moved forward with an effort to modernize its health information system—the Veterans Health Information Systems and Technology Architecture (VistA)—but that the department is uncertain of its long-term plan for addressing its electronic health record system needs beyond fiscal year 2018. Beyond modernizing VistA, GAO reported in August 2015 that VA and the Department of Defense (DOD) had not identified outcome-oriented goals and metrics to clearly define what they aim to achieve from their efforts to increase electronic health record interoperability (i.e., the electronic exchange and use of health records) between the two departments. Moreover, VA has begun to modernize VistA separate from DOD's planned acquisition of a commercially available electronic health record system, even though both departments have many health care business needs in common. In 2014, GAO noted that the departments' decision to abandon the development of a single system in favor of modernizing their two separate systems was not justified and was identified as an example of duplication among government activities. The departments have not yet provided a comparison of the estimated costs and schedules of their current and previous approaches as GAO recommended.
In February 2015, GAO designated VA health care as a high-risk area, with IT challenges being one contributing factor. Specifically, GAO noted that the outpatient appointment scheduling system, which is currently about 30 years old, is time-consuming to use and error prone. However, the project to modernize that system failed after VA spent an estimated $127 million over 9 years. VA has begun a new initiative to build or purchase another scheduling system.
GAO reported in September 2015, that VA had made progress implementing the Veterans Benefits Management System (VBMS) for processing disability benefits. However, the department had not developed a time frame and a reliable cost estimate for completing VBMS. VA also had not established goals for system response time, and had not minimized incidences of high and medium severity system defects for future VBMS releases. Further, the department had not assessed user satisfaction, or established user satisfaction goals.
In addition, VA's consolidation and closure of data centers has lagged behind other agencies, as GAO reported in March 2016. For example, VA's closure of 20 out of a total of 356 data centers gave the department a 6 percent closure rate through fiscal year 2015 that ranked 19th of the 24 agencies in GAO's study. Also, VA's reported $19.1 million in cost savings or avoidances from fiscal year 2011 through fiscal year 2015 was only about 0.7 percent of the total of about $2.8 billion that all 24 agencies reported saving. In addition, the department had not met any of the data center optimization areas established by the Office of Management and Budget.
VA was identified in a May 2016 GAO report as using antiquated and expensive to maintain, legacy IT systems. At that time, the 53-year-old Personnel and Accounting Integrated Data (PAID) system was slated to be replaced in 2017. Further, VA has plans to retire the 51-year-old Benefits Delivery Network, which tracks veterans' claims for benefits, eligibility, and death dates in 2018.
section_title: What GAO Recommends
paragraphs: GAO has made numerous recommendations to VA to improve the modernization of its IT systems. For example, GAO has recommended that VA develop goals and metrics for determining the extent to which its modernized electronic health record system is achieving interoperability with DOD's; address challenges associated with modernizing its scheduling system; address shortcomings with VBMS planning and implementation; take actions to improve progress in data center optimization; and modernize or replace obsolete legacy IT systems. VA agreed with these recommendations and said it has begun taking actions to implement them.

section_title: Letter
paragraphs: Thank you for the opportunity to participate in today’s hearing on the  information technology (IT) modernization projects and programs at the  Department of Veterans Affairs (VA). As you know, the use of IT is crucial  to helping VA effectively serve the nation’s veterans and, each year, the  department spends billions of dollars on its information systems and  assets.
However, over many years, VA has experienced challenges in managing  its IT projects and programs, raising questions about the efficiency and  effectiveness of its operations and its ability to deliver intended outcomes  needed to help advance the department’s mission. These challenges  have spanned a number of critical initiatives related to sharing electronic  health record data and developing major systems, in addition to improving  the efficiency of operations by closing and optimizing data centers and  decommissioning antiquated legacy systems. We have previously  reported on these and other IT management challenges at the  department.
At your request, my testimony today summarizes findings from a number  of our reports that addressed VA’s efforts toward exchanging electronic  health records with the Department of Defense (DOD) and highlighted IT  challenges that have contributed to our designation of VA health care as  a high-risk area. In addition, it discusses our prior work on the  department’s development and use of its benefits claims processing  system, the Veterans Benefits Management System (VBMS), as well as  our recent reports that addressed VA’s data center consolidation and  legacy systems.
In developing this testimony, we relied on our previous reports, as well as  information provided by the department on its actions in response to our  previous recommendations. The reports cited throughout this statement  include detailed information on the scope and methodology for our  reviews.
The work upon which this statement is based was conducted in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: VA’s mission is to promote the health, welfare, and dignity of all veterans  in recognition of their service to the nation by ensuring that they receive  medical care, benefits, social support, and lasting memorials. VA is the  second largest federal department and, in addition to its central office  located in Washington, D.C., has field offices throughout the United  States, as well as the U.S. territories and the Philippines.
The department’s three major components—the Veterans Health  Administration (VHA), the Veterans Benefits Administration (VBA), and  the National Cemetery Administration (NCA)—are primarily responsible  for carrying out its mission. More specifically, VHA provides health care  services, including primary care and specialized care, and it performs  research and development to improve veterans’ needs. VBA provides a  variety of benefits to veterans and their families, including disability  compensation, educational opportunities, assistance with home  ownership, and life insurance. Further, NCA provides burial and memorial  benefits to veterans and their families.
Collectively, the three components rely on approximately 340,000  employees to provide services and benefits. These employees work in  VA’s Washington, D.C. headquarters, as well as 167 medical centers,  approximately 800 community-based outpatient clinics, 300 veterans  centers, 56 regional offices, and 131 national and 90 state or tribal  cemeteries situated throughout the nation.
subsections: section_title: VA Relies Extensively on IT
paragraphs: The use of IT is critically important to VA’s efforts to provide benefits and  services to veterans. As such, the department operates and maintains an  IT infrastructure that is intended to provide the backbone necessary to  meet the day-to-day operational needs of its medical centers, veteran- facing systems, benefits delivery systems, memorial services, and all  other systems supporting the department’s mission. The infrastructure is  to provide for data storage, transmission, and communications  requirements necessary to ensure the delivery of reliable, available, and  responsive support to all VA staff offices and administration customers,  as well as veterans.
Toward this end, the department operates approximately 240 information  systems, manages approximately 314,000 desktop computers and  30,000 laptops, and administers nearly 460,000 network user accounts  for employees and contractors to facilitate providing benefits and health  care to veterans. These systems are used for the determination of  benefits, benefits claims processing, patient admission to hospitals and  clinics, and access to health records, among other services.
VHA’s systems provide capabilities to establish and maintain electronic  health records that health care providers and other clinical staff use to  view patient information in inpatient, outpatient, and long-term care  settings. The department’s health information system— the Veterans  Health Information Systems and Technology Architecture (VistA)—serves  an essential role in helping the department to fulfill its health care delivery  mission. Specifically, VistA is an integrated medical information system  that was developed in-house by the department’s clinicians and IT  personnel, and has been in operation since the early 1980s. The system  consists of 104 separate computer applications, including 56 health  provider applications; 19 management and financial applications; 8  registration, enrollment, and eligibility applications; 5 health data  applications; and 3 information and education applications. Within VistA,  an application called the Computerized Patient Record System enables  the department to create and manage an individual electronic health  record for each VA patient.
VBA relies on VBMS to collect and store information such as military  service records, medical examinations, and treatment records from VA,  DOD, and private medical service providers. In 2014, VA issued its 6-year  strategic plan, which emphasizes the department’s goal of increasing  veterans’ access to benefits and services, eliminating the disability claims  backlog, and ending veteran homelessness. According to the plan, the  department intends to improve access to benefits and services through  the use of enhanced technology to provide veterans with access to more  effective care management. The plan also calls for VA to eliminate the  disability claims backlog by fully implementing an electronic claims  process that is intended to reduce processing time and increase  accuracy. Further, the department has an initiative under way that  provides services, such as health care, housing assistance, and job  training, to end veteran homelessness. Toward this end, VA is working  with other agencies, such as the Department of Health and Human  Services, to implement more coordinated data entry systems to  streamline and facilitate access to appropriate housing and services.
VA reported spending about $3.9 billion to improve and maintain its IT  resources in fiscal year 2015. Specifically, the department reported  spending approximately $548 million on new systems development  efforts, approximately $2.3 billion on maintaining existing systems, and  approximately $1 billion on payroll and administration. For fiscal year  2016, the department received appropriations of about $4.1 billion for  IT—about $505 million on new systems development, about $2.5 billion  on maintaining existing systems, and about $1.1 billion on payroll and  administration.
For fiscal year 2017, the department’s budget request included nearly  $4.3 billion for IT. The department requested approximately $471 million  for new systems development efforts, approximately $2.5 billion for  maintaining existing systems, and approximately $1.3 billion for payroll  and administration. In addition, in its 2017 budget submission, the  department requested appropriations to make improvements in a number  of areas, including:  veterans’ access to health care, to include enhancing health care- related systems, standardizing immunization data, and expanding  telehealth services ($186.7 million);  veterans’ access to benefits by modernizing systems supporting  benefits delivery, such as VBMS and the Veterans Services Network  ($236.3 million);  veterans’ experiences with VA by focusing on integrated service  delivery and streamlined identification processes ($171.3 million);
VA employees’ experiences by enhancing internal IT systems ($13  information security, including implementing strong authentication,  ensuring repeatable processes and procedures, adopting modern  technology, and enhancing the detection of cyber vulnerabilities and  protection from cyber threats ($370.1 million).
section_title: VA Has a Long History of Working to Share Electronic Health Records with DOD
paragraphs: Electronic health records are particularly crucial for optimizing the health  care provided to veterans, many of whom may have health records  residing at multiple medical facilities within and outside the United States.  Taking steps toward interoperability—that is, collecting, storing, retrieving,  and transferring veterans’ health records electronically—is significant to  improving the quality and efficiency of care. One of the goals of  interoperability is to ensure that patients’ electronic health information is  available from provider to provider, regardless of where it originated or  resides.
Since 1998, VA has undertaken a patchwork of initiatives with DOD to  allow the departments’ health information systems to exchange  information and increase interoperability. Among others, these have  included initiatives to share viewable data in the two departments’ existing  (legacy) systems, link and share computable data between the  departments’ updated heath data repositories, and jointly develop a single  integrated system that would be used by both departments. Table 1  summarizes a number of these key initiatives.
In addition to the initiatives mentioned in table 1, VA has worked in  conjunction with DOD to respond to provisions in the National Defense  Authorization Act for Fiscal Year 2008. This act required the departments  to jointly develop and implement fully interoperable electronic health  record systems or capabilities in 2009. Yet, even as the departments  undertook numerous interoperability and modernization initiatives, they  faced significant challenges and slow progress. We have reported, for  example, that the two departments’ success in identifying and  implementing joint IT solutions has been hindered by an inability to  articulate explicit plans, goals, and time frames for meeting their common  health IT needs.
In March 2011, the secretaries of VA and DOD announced that they  would develop a new, joint integrated electronic health record system  (referred to as iEHR). This was intended to replace the departments’  separate systems with a single common system, thus, sidestepping many  of the challenges they had previously encountered in trying to achieve  interoperability. However, in February 2013, about 2 years after initiating  iEHR, the secretaries announced that the departments were abandoning  plans to develop a joint system, due to concerns about the program’s  cost, schedule, and ability to meet deadlines. The Interagency Program  Office (IPO), put in place to be accountable for VA’s and DOD’s efforts to  achieve interoperability, reported spending about $564 million on iEHR  between October 2011 and June 2013. Following the termination of the  iEHR initiative, VA and DOD moved forward with plans to separately  modernize their respective electronic health record systems.
In light of VA and DOD not implementing a solution that allowed for the  seamless electronic sharing of health care data, the National Defense  Authorization Act for Fiscal Year 2014 included requirements pertaining  to the implementation, design, and planning for interoperability between  the departments’ electronic health record systems. Among other actions,  provisions in the act directed each department to (1) ensure that all health  care data contained in their systems (VA’s VistA and DOD’s Armed  Forces Health Longitudinal Technology Application, referred to as  AHLTA) complied with national standards and were computable in real  time by October 1, 2014; and (2) deploy modernized electronic health  record software to support clinicians while ensuring full standards-based  interoperability by December 31, 2016.
In August 2015, we reported that VA, in conjunction with DOD, had  engaged in several near-term efforts focused on expanding  interoperability between their existing electronic health record systems.  For example, the departments had analyzed data related to 25 “domains”  identified by the Interagency Clinical Informatics Board and mapped  health data in their existing systems to standards identified by the IPO.  The departments also had expanded the functionality of their Joint  Legacy Viewer—a tool that allows clinicians to view certain health care  data from both departments.
More recently, in April 2016, VA and DOD certified that all health care  data in their systems complied with national standards and were  computable in real time. However, VA acknowledged that it did not expect  to complete a number of key activities related to its electronic health  record system until sometime after the December 31, 2016, statutory  deadline for deploying modernized electronic health record software with  interoperability. Specifically, the department stated that deployment of a  modernized VistA system at all locations and for all users is not planned  until 2018.
section_title: VA’s IT Organization Has Undergone Recent Changes
paragraphs: VA’s recently departed Chief Information Officer (CIO) initiated an effort to  transform the focus and functions of the Office of Information and  Technology (OI&T), which is responsible for providing IT services across  VA and managing the department’s IT assets and resources. The CIO’s  transformation strategy, initiated in January 2016, called for OI&T to focus  on stabilizing and streamlining processes, mitigating weaknesses  highlighted in GAO assessments, and improving outcomes by  institutionalizing a new set of IT management capabilities.
As part of this transformation, the CIO began transitioning the oversight of  and accountability for IT projects to a new project management process  called the Veteran-focused Integration Process in January 2016, in an  effort to streamline systems development and the delivery of new IT  capabilities. The CIO established five new functions within OI&T:
The enterprise program management office is to serve as OI&T’s  portfolio management and project tracking organization.
The account management function is to be responsible for managing  the IT needs of VA’s major components.
The quality and compliance function is to be responsible for  establishing policy governance and standards and ensuring  adherence to them.
The data management organization is expected to improve both  service delivery and the veteran experience by engaging with data  stewards to ensure the accuracy and security of the information  collected by VA.
The strategic sourcing function is to be responsible for establishing an  approach to fulfilling the department’s requirements with vendors that  provide solutions for those requirements, managing vendor selection,  tracking vendor performance and contract deliverables, and sharing  insights on new technologies and capabilities to improve the  workforce knowledge base.
According to the former CIO, the transformation strategy was completed  in the first quarter of fiscal year 2017.
section_title: FITARA Requires VA to Address Data Center Consolidation
paragraphs: Recognizing the importance of reforming the government-wide  management of IT, Federal Information Technology Acquisition Reform  provisions (commonly referred to as FITARA) were enacted in December  2014 as part of the Carl Levin and Howard P. “Buck” McKeon National  Defense Authorization Act for Fiscal Year 2015. The law was intended  to improve covered agencies’ acquisitions of IT and further enable  Congress to monitor agencies’ progress and hold them accountable for  reducing duplication and achieving cost savings. FITARA includes  specific requirements related to seven areas, including data center  consolidation.
Under FITARA, VA and other covered agencies are required to provide  OMB with a data center inventory, a strategy for consolidating and  optimizing the data centers (to include planned cost savings), and  quarterly updates on progress made. FITARA also requires OMB to  develop a goal for how much is to be saved through this initiative, and  provide annual reports on cost savings achieved.
In addition, in August 2016, OMB released guidance intended to, among  other things, define a framework for achieving the data center  consolidation and optimization requirements of FITARA. The guidance  includes requirements for covered agencies such as VA to: maintain complete inventories of all data center facilities owned,  operated, or maintained by or on behalf of the agency; develop cost savings targets due to consolidation and optimization for  fiscal years 2016 through 2018 and report any actual realized cost  savings; and measure progress toward meeting optimization metrics on a quarterly  basis.
The guidance also directs each covered agency to develop a data center  consolidation and optimization strategic plan that defines the agency’s  data center strategy for fiscal years 2016, 2017, and 2018. This strategy  is to include, among other things, a statement from the agency CIO  stating whether the agency has complied with all data center reporting  requirements in FITARA. Further, the guidance indicates that OMB is to  maintain a public dashboard that will display consolidation-related costs  savings and optimization performance information for the agencies.
section_title: VA Has Begun to Implement VistA Modernization Plans amid Concerns about Its Long-term Approach, Metrics, and Duplication
paragraphs: Although VA has proceeded with its program to modernize VistA (known  as VistA Evolution), the department’s long-term plan for meeting its  electronic health record system needs beyond fiscal year 2018 is  uncertain. The department’s current VistA modernization approach is  reflected in an interoperability plan and a roadmap describing functional  capabilities to be deployed through fiscal year 2018. Specifically, these  documents describe the department’s approach for modernizing its  existing electronic health record system through the VistA Evolution  program, while helping to facilitate interoperability with DOD’s system and  the private sector. For example, the VA Interoperability Plan, issued in  June 2014, describes activities intended to improve VistA’s technical  interoperability, such as standardizing the VistA software across the  department to simplify sharing data.
In addition, the VistA 4 Roadmap, which further describes VA’s plan for  modernizing the system, identifies four sets of functional capabilities that  are expected to be incrementally deployed during fiscal years 2014  through 2018 to modernize the VistA system and enhance  interoperability. According to the roadmap, the first set of capabilities was  delivered by the end of September 2014 and included access to the Joint  Legacy Viewer and a foundation for future functionality, such as an  enhanced graphical user interface.
Another interoperable capability that is expected to be incrementally  delivered over the course of the VistA modernization program is the  enterprise health management platform. The department has stated that  this platform is expected to provide clinicians with a customizable view of  a health record that can integrate data from VA, DOD, and third-party  providers. Also, when fully deployed, VA expects the enterprise health  management platform to replace the Joint Legacy Viewer.
However, an independent assessment of health IT at VA questioned  whether the VistA Evolution program to modernize the electronic health  record system can overcome a variety of risks and technical issues that  have plagued prior VA initiatives of similar size and complexity. For  example, the study raised questions regarding the lack of any clear  advances made during the past decade and the increasing amount of  time needed for VA to release new health IT capabilities. Given the  concerns identified, the study recommended that VA assess the cost  versus benefits of various alternatives for delivering the modernized  capabilities, such as commercially available off-the-shelf electronic health  record systems, open source systems, and the continued development of  VistA.
In speaking about this matter, VA’s former Under Secretary for Health  asserted that the department will follow through on its plans to complete  the VistA Evolution program in fiscal year 2018. However, the former CIO  also indicated that the department would reconsider how best to meet its  electronic health record system needs beyond fiscal year 2018. As such,  VA’s approach to addressing its electronic health record system needs  remains uncertain.
subsections: section_title: VA, Together with DOD and the Interagency Program Office, Have Not Developed Goals and Metrics for Assessing Interoperability
paragraphs: Beyond modernizing VistA, VA has undertaken numerous initiatives with  DOD that were intended to advance electronic health record  interoperability between the two departments. Yet, a significant concern is  that these departments have not identified outcome-oriented goals and  metrics to clearly define what they aim to achieve from their  interoperability efforts, and the value and benefits these efforts are  expected to yield. As we have stressed in our prior work and guidance,  assessing the performance of a program should include measuring its  outcomes in terms of the results of products or services. In this case,  such outcomes could include improvements in the quality of health care  or clinician satisfaction. Establishing outcome-oriented goals and metrics  is essential to determining whether a program is delivering value.
The IPO is responsible for monitoring and reporting on VA’s and DOD’s  progress in achieving interoperability and coordinating with the  departments to ensure that these efforts enhance health care services.  Toward this end, the office issued guidance that identified a variety of  process-oriented metrics to be tracked, such as the percentage of health  data domains that have been mapped to national standards. The  guidance also identified metrics to be reported that relate to tracking the  amounts of certain types of data being exchanged between the  departments, using existing capabilities. This would include, for example,  laboratory reports transferred from DOD to VA via the Federal Health  Information Exchange and patient queries submitted by providers through  the Bidirectional Health Information Exchange.
Nevertheless, in our August 2015 report, we noted that the IPO had not  specified outcome-oriented metrics and goals that could be used to  gauge the impact of the interoperable health record capabilities on the  departments’ health care services. At that time, the acting director of the  IPO stated that the office was working to identify metrics that would be  more meaningful, such as metrics on the quality of a user’s experience or  on improvements in health outcomes. However, the office had not  established a time frame for completing the outcome-oriented metrics and  incorporating them into the office’s guidance.
In the report, we stressed that using an effective outcome-based  approach could provide the two departments with a more accurate picture  of their progress toward achieving interoperability, and the value and  benefits generated. Accordingly, we recommended that the departments,  working with the IPO, establish a time frame for identifying outcome- oriented metrics; define related goals as a basis for determining the  extent to which the departments’ modernized electronic health record  systems are achieving interoperability; and update IPO guidance  accordingly.
Both departments concurred with our recommendations. Further, since  that time, VA has established a performance architecture program that  has begun to define an approach for identifying outcome-oriented metrics  focused on health outcomes in selected clinical areas, and it also has  begun to establish baseline measurements. We intend to continue  monitoring the departments’ efforts to determine how these metrics define  and measure the results achieved by interoperability between the  departments.
section_title: VA’s Plan to Modernize VistA Raises Concern about Duplication with DOD’s Electronic Health Record System Acquisition
paragraphs: VA has moved forward with modernizing VistA despite concerns that  doing so is potentially duplicative with DOD’s acquisition of a  commercially available electronic health record system. Specifically, VA  took this course of action even though it has many health care business  needs in common with DOD. For example, in May 2010, both  departments issued a report on medical IT to congressional committees  that identified 10 areas—inpatient documentation, outpatient  documentation, pharmacy, laboratory, order entry and management,  scheduling, imaging and radiology, third-party billing, registration, and  data sharing—in which the departments have common business needs.  Further, the results of a 2008 consultant’s study pointed out that over 97  percent of inpatient requirements for electronic health record systems are  common to both departments.
We also issued several prior reports regarding the plans for separate  systems, in which we noted that the two departments did not substantiate  their claims that VA’s VistA modernization, together with DOD’s  acquisition of a new system, would be achieved faster and at less cost  than developing a single, joint electronic health record system. Moreover,  we noted that the departments’ plans to modernize their two separate  systems were duplicative and stressed that their decisions to do so  should be justified by comparing the costs and schedules of alternate  approaches.
We recommended that VA and DOD develop cost and schedule  estimates that would include all elements of their approach (i.e., to  modernize both departments’ health information systems and establish  interoperability between them) and compare them with estimates of the  cost and schedule for developing a single, integrated system. If the  planned approach for separate systems was projected to cost more or  take longer, we recommended that the departments provide a rationale  for pursuing such an approach.
VA, as well as DOD, agreed with our recommendations and stated that  an initial comparison had indicated that the approach involving separate  systems would be more cost effective. However, as of January 2017, the  departments had not provided us with a comparison of the estimated  costs of their current and previous approaches. Further, with respect to  their assertions that separate systems could be achieved faster, both  departments had developed schedules which indicated that their separate  modernization efforts are not expected to be completed until after the  2017 planned completion date for the previous single-system approach.
section_title: Scheduling System Challenges Contributed to Designation of VA Health Care as High Risk
paragraphs: In February 2015, we designated VA health care as a high-risk area.  Among the five broad areas contributing to our determination was the  department’s IT challenges. Of particular concern was the failed  modernization of a system to support the department’s outpatient  appointment scheduling.
We have previously reported on the department’s outpatient appointment  scheduling system, which is about 30 years old. Among the problems that  VA employees responsible for scheduling appointments have cited, are  that the system’s commands require the use of many keystrokes, and that  it does not allow them to view multiple screens at once. Thus, schedulers  must open and close multiple screens to check a provider’s or a clinic’s  full availability when setting up a medical appointment, which is time- consuming and can lead to errors.
In May 2010, we reported that, after spending an estimated $127 million  over 9 years on its outpatient scheduling system modernization project,  VA had not implemented any of the planned system’s capabilities and  was essentially starting over by beginning a new initiative to build or  purchase another scheduling system. We also noted that VA had not  developed a project plan or schedule for the new initiative, stating that it  intended to do so after determining whether to build or purchase the new  system.
We recommended that the department take six actions to improve key  systems development and acquisition processes essential to the second  outpatient scheduling system effort. The department generally concurred  with our recommendations, but as of May 2016, had not addressed four  of the six recommendations. Addressing our recommendations should  better position VA to effectively modernize its outpatient scheduling  system, and ultimately, improve the quality of care that veterans receive.
subsections: section_title: Efforts to Develop and Use the Veterans Benefits Management System Can Be Improved
paragraphs: In September 2015, we reported that VBA had made progress in  developing and implementing VBMS, its system that is to be used for  processing disability benefit claims. Specifically, it had deployed the  initial version of the system to all of its regional offices as of June 2013.  Further, after initial deployment, VBA continued developing and  implementing additional system functionality and enhancements to  support the electronic processing of disability compensation claims. As a  result, 95 percent of records related to veterans’ disability claims were  electronic and resided in the system.
Nevertheless, we found that VBMS was not able to fully support disability  and pension claims, as well as appeals processing. While the Under  Secretary for Benefits stated in March 2013 that the development of the  system was expected to be completed in 2015, implementation of  functionality to fully support electronic claims processing was delayed  beyond 2015. In addition, VBA had not produced a plan that identified  when the system would be completed. Accordingly, holding VBA  management accountable for meeting a time frame and demonstrating  progress was difficult.
Our report further noted that, even as VBA continued its efforts to  complete the development and implementation of VBMS, three areas  were in need of increased management attention.
Cost estimating: The program office did not have a reliable estimate of  the cost for completing the system. Without such an estimate, VBA  management and the department’s stakeholders had a limited view of  the system’s future resource needs, and the program risked not  having sufficient funding to complete development and  implementation of the system.
System availability: Although VBA had improved its performance  regarding system availability to users, it had not established system  response time goals. Without such goals, users did not have an  expectation of the system response times they could anticipate and  management did not have an indication of how well the system  performed relative to performance goals.
System defects: While the program had actively managed system  defects, a recent system release had included unresolved defects that  impacted system performance and users’ experiences. Continuing to  deploy releases with large numbers of defects that reduced system  functionality could have adversely affected users’ ability to process  disability claims in an efficient manner.
We also noted in the report that VBA had not conducted a customer  satisfaction survey that would allow the department to compile data on  how users viewed the system’s performance, and ultimately, to develop  goals for improving the system. Our survey of VBMS users in 2014 found  that a majority of them were satisfied with the system, but that decision  review officers were considerably less satisfied.
However, while the results of our survey provided VBA with data about  users’ satisfaction with the system, the absence of user satisfaction goals  limited the utility of the survey results. Specifically, without having  established goals to define user satisfaction, VBA did not have a basis for  gauging the success of its efforts to promote satisfaction with the system,  or for identifying areas where its efforts to complete development and  implementation of the system might need attention.
We recommended, among other actions, that the department develop a  plan with a time frame and a reliable cost estimate for completing VBMS,  establish goals for system response time, assess user satisfaction, and  establish satisfaction goals to promote improvement. While all of our  recommendations currently remain open, the department indicated that it  has begun taking steps to address them. For example, the department  informed us of its plans to distribute its own survey to measure users’  satisfaction with VBMS and to have the results of this survey analyzed by  May 2017. In addition, the department has developed draft metrics for  measuring the performance of the most commonly executed transactions  within VBMS. Continued attention to these important areas can improve  VA’s efforts to effectively complete the development and implementation  of VBMS and, in turn, more effectively support the department’s  processing of disability benefit claims.
section_title: VA’s Progress on Data Center Consolidation Lags Behind Other Agencies
paragraphs: We previously reported that VA was among the agencies that had  collectively made progress on their data center closure efforts;  nevertheless, it had fallen short of OMB’s goal for agencies to close 40  percent of all non-core centers by the end of fiscal year 2015.
VA’s progress toward closing data centers, and realizing the associated  cost savings, lagged behind that of most other covered agencies.  Specifically, we reported that VA’s closure of 20 out of its total of 356 data  centers gave the department a 6 percent closure rate through fiscal year  2015—ranking its closure rate 19th lowest out of the 24 agencies we  studied. Further, when we took into account the data centers that the  department planned to close through fiscal year 2019, VA’s 8 percent  closure rate ranked 21st lowest out of 24.
With regard to cost savings and avoidance resulting from data center  consolidation, our analysis of the department’s data identified a total of  $19.1 million in reported cost savings or avoidances from fiscal year 2011  though fiscal year 2015. This equated to only about 0.7 percent of the  total of approximately $2.8 billion that all 24 agencies reported saving or  avoiding during the same time period. Also, when we reported on this  matter in March 2016, the department had not yet estimated any planned  cost savings or avoidances from further data center consolidation during  fiscal years 2017 through 2019.
VA also lagged behind other agencies in making progress toward  addressing data center optimization metrics established by OMB in  2014. These metrics, which applied only to core data centers,  addressed several data center optimization areas, including cost per  operating system, energy, facility, labor, storage, and virtualization.  Further, OMB established a target value for nine metrics that agencies  were expected to achieve by the end of fiscal year 2015. As we  previously reported, 20 of 22 agencies with core data centers met at least  one of OMB’s optimization targets. VA was the only agency that reported  meeting none of the nine targets.
Accordingly, we recommended that VA take action to improve its  progress in the data center optimization areas that we reported as not  meeting OMB’s established targets. The department agreed with our  recommendation and has since stated that approximately 70 data centers  have been tentatively identified for potential consolidation by the end of  fiscal year 2019. VA is anticipating that, upon completion, these  consolidations will improve its performance on OMB’s optimization  metrics.
section_title: VA Plans to Retire Two Legacy Systems That Are Over 50 Years Old
paragraphs: The federal government spent more than 75 percent of the total amount  budgeted for IT for fiscal year 2015 on operations and maintenance,  including for the use of legacy IT systems that are becoming increasingly  obsolete. VA is among a handful of departments with one or more archaic  legacy systems. Specifically, our recent report on legacy systems used by  federal agencies identified 2 of the department’s systems as being over  50 years old, and among the 10 oldest investments and/or systems that  were reported by 12 selected agencies.
Personnel and Accounting Integrated Data (PAID)—This 53-year old  system automates time and attendance for employees, timekeepers,  payroll, and supervisors. It is written in Common Business Oriented  Language (COBOL), a programming language developed in the late  1950s and early 1960s, and runs on IBM mainframes. VA plans to  replace this system with the Human Resources Information System  Shared Service Center in 2017.
Benefits Delivery Network (BDN)—This 51-year old system tracks  claims filed by veterans for benefits, eligibility, and dates of death. It is  a suite of COBOL mainframe applications. VA has general plans to  roll the capabilities of BDN into another system, but has not  established a firm date doing so.
Ongoing use of antiquated systems such as PAID and BDN contributes to  agencies spending a large, and increasing, proportion of their IT budgets  on operations and maintenance of systems that have outlived their  effectiveness and are consuming resources that outweigh their benefits.  Accordingly, we recommended that VA identify and plan to modernize or  replace its legacy systems. VA concurred with our recommendation and  stated that it plans to retire PAID in 2017 and to retire BDN in 2018.
In conclusion, effective IT management is critical to the performance of  VA’s mission. However, the department faces challenges in several key  areas, including its approach to pursuing electronic health record  interoperability with DOD. Specifically, VA’s reconsideration of its  approach to modernizing VistA raises uncertainty about how it intends to  accomplish this important endeavor. VA has not yet defined the extent of  interoperability it needs to provide the highest possible quality of care to  its patients, as well as how and when the department intends to achieve  this extent of interoperability with DOD. Further, VA has not justified the  development and operation of an electronic health record system that is  separate from DOD’s system, even though the departments have  common system needs.
The department also faces challenges in modernizing its approximately  30-year old outpatient appointment scheduling system and improving its  development and implementation of VBMS. Further, the department has  not yet demonstrated expected progress toward consolidating and  optimizing the performance of its data centers. In addition, VA’s continued  operation of two of the oldest legacy IT systems in the federal  government raises concern about the extent to which the department  continues to spend funds on IT systems that are no longer effective or  cost beneficial. While we recognize that VA has initiated steps to mitigate  the IT management weaknesses we have identified, sustained  management attention and organizational commitment will be essential to  ensuring that the transformation is successful and that the weaknesses  are fully addressed.
Chairman Roe, Ranking Member Walz, and Members of the Committee,  this completes my prepared statement. I would be pleased to respond to  any questions that you may have.
section_title: GAO Contact and Staff Acknowledgments
paragraphs: If you or your staffs have any questions about this testimony, please  contact David A. Powner at (202) 512-9286 or pownerd@gao.gov  . Contact points for our Offices of Congressional Relations and Public  Affairs may be found on the last page of this testimony statement. GAO  staff who made key contributions to this statement are Mark Bird  (Assistant Director), Eric Trout (Analyst in Charge), Rebecca Eyler, Scott  Pettis, Priscilla Smith, and Christy Tyson.
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