As part of VA’s mission, VHA is to serve the needs of America’s veterans and their families (spouses and children) by providing primary care, specialized care, and related medical and social support services. VHA provides health services through more than 1,500 sites of care, including 153 hospitals, 995 outpatient clinics, 135 community living centers, and 232 Vet Centers. It employs more than 15,000 physicians and serves more than 5 million patients at these sites of care each year. To carry out its daily operations in providing health care to veterans and their families, VHA relies on an outpatient appointment scheduling system that is part of the department’s current electronic health information system, known as VistA. However, according to the department, the current scheduling system has a number of limitations that impede its effectiveness, including: Appointment activity resides at multiple medical centers, making it difficult to retrieve all of a patient’s health care history. Clinicians must maintain multiple calendars to account for the various services they provide. Appointments and ancillary services are not linked, resulting in the inability to associate medical data with appointments. Access to multiple sites is required to make appointments, resulting in inefficient coordination of care between facilities. Accordingly, in 2000, VHA initiated a project to replace the existing scheduling system. In doing so, it envisioned that the new scheduling system would provide benefits for the department, including: a single enterprise database that would allow all appointments to be viewed, regardless of the point of care; calendars that would include sequential appointment settings; long-term appointment lists that would track and remind staff of future appointments; and ancillary service links that would allow for automated updates to appointment cancellations. VA originally planned to deploy the new outpatient scheduling system to an initial site by December 2004 and nationally by June 2006. In August 2002, the department had estimated that the total cost to develop and deploy the new system across all VHA facilities would be about $59 million. VHA began the scheduling replacement initiative in October 2000, at which time it began to identify business requirements for the new system. It also issued a request for proposals, seeking interested Veterans Integrated Service Networks (VISN) to partner with its Office of Information to conduct a business process reengineering effort and replace the VistA scheduling system with a commercial off-the-shelf (COTS) application. In January 2001, VHA selected VISNs 16 and 17, representing Texas and the south-central United States, respectively, to perform these tasks. Additionally, the Muskogee, Oklahoma medical center, part of VISN 16, was the planned location for the initial deployment of the new scheduling system. The VISNs used a pre-existing Cooperative Administrative Support Units (CASU) contract to obtain the services of the Southwest Research Institute (SwRI) to support the project. The statement of work included tasks to develop business information flow models and information system technical documents, and to select a COTS product to integrate into the system. However, according to project officials, in April 2002, VHA’s Chief Information Officer (CIO) determined that using a COTS solution would result in excessive costs and make the department dependent on a vendor for a core business function. Thus, the CIO directed the VISNs to redirect their efforts and funding to develop a scheduling application instead of purchasing a COTS application. VA issued a new statement of work for SwRI to design, build, and test the scheduling application. The department planned to deliver the new outpatient scheduling system first to the location in Muskogee, referred to as the alpha deployment, by December 2004. Once successfully tested and deployed at this location, the system was to be deployed within VISN 16 and 17 for testing, then nationally to all VHA facilities. In 2004, issues integrating the application with HealtheVet components and funding reductions led to a delay in the alpha deployment date, pushing it back to October 2006. In an effort to meet the new date, VA decided in April 2005 to descope the alpha version of the scheduling application by removing certain planned capabilities. Simultaneously, the department and SwRI began treating a separate version that was to retain all planned capabilities as a distinct development effort, referred to as the beta version. Nevertheless, delays in correcting defects, conducting tests, and changing the code in response to infrastructure modifications, resulted in six more extensions of the target alpha deployment date (over 2 ½ years beyond the October 2006 planned date). Further, in an attempt to expedite the project, in September 2008, the Principal Deputy Under Secretary for Health directed the project team to focus its efforts on a national deployment of the new scheduling system by the end of 2009, rather than on the single-site alpha deployment. However, in January 2009, the project team determined that the product that had been developed for alpha deployment would not be suitable for national deployment by the end of 2009; thus, in February 2009, the department terminated its contract for the replacement scheduling application. VA subsequently ended the entire Scheduling Replacement Project in September 2009. Figure 1 depicts a timeline of key project events from its initiation through its termination. Several organizations within VA were responsible for governance of the Scheduling Replacement Project: In July 2000, VHA established a project management office to coordinate all efforts and monitor project activities to ensure success of the Scheduling Replacement Project. The project management office was to ensure achievement of milestones, evaluate project success, and report to VHA senior level executives. In June 2001, VHA established the Scheduling Replacement Board of Directors to guide the overall direction of the project. According to its charter, the board was to review project activities on a quarterly basis, provide key decisions at major project milestones, confirm the achievement of project milestones, and evaluate project success. In February 2003, VA established an Enterprise Information Board as its executive decision-making body for information technology (IT) capital planning and investment control. The board was to provide oversight in the selection, management, and control of IT investments such as the scheduling system. In February 2007, the Secretary of Veterans Affairs approved a centralized IT management structure for the department. As part of this realignment, staff from the project management office with responsibility for the Scheduling Replacement Project were transferred from VHA to the Office of Enterprise Development (OED) within VA’s Office of Information and Technology (OI&T). Also in 2007, VA issued a governance plan to enable the department to better align its IT strategy to its business strategy, manage investments, and reconcile disputes regarding IT. The governance structure established by the plan included three governance boards for IT projects, such as the Scheduling Replacement Project: The Budgeting and Near-Term Issues Board is to identify, review, recommend, and advocate projects and programs across the department. The board’s responsibilities include monitoring projects’ achievement of results. The Programming and Long-Term Issues Board is to oversee portfolio development and evaluate program execution by conducting milestone reviews and program management reviews of IT investments. The Information Technology Leadership Board is responsible for adjudicating all unresolved resource issues forwarded by the Budgeting and Near-Term Issues Board and forwarding recommendations to the department’s Strategic Management Council. We and VA’s Office of Inspector General have both issued reports concerning the HealtheVet initiative and the Scheduling Replacement Project. Specifically, in a June 2008 report, we raised concerns about VA’s HealtheVet initiative. We noted that the eight major software development projects comprising the initiative (which included the Scheduling Replacement Project) were in various stages of development, and that none had yet been completed. We noted that while VA had established interim dates for completing the component projects, it had not developed a detailed schedule or approach for completing the overall HealtheVet initiative. Further, the department had not yet implemented a complete governance structure; several key leadership positions within the development organization had not been filled or were filled with acting personnel; and the departmental governance boards had not scheduled critical reviews of HealtheVet projects. We concluded that, without all elements of governance and oversight in place, the risk to the success of the HealtheVet initiative and, therefore, its component initiatives (such as the Scheduling Replacement Project) was increased. Accordingly, we recommended that VA develop a comprehensive project management plan and schedule, as well as a governance structure, to guide the development and integration of the many projects under this complex initiative. Subsequent to our 2008 report, VA reported that it had begun to formulate a project management plan, an integrated schedule of projects, and a governance plan for the HealtheVet initiative. Further, in reporting on the development of the replacement scheduling application in August 2009, the Office of Inspector General noted, among other things, that VA did not have staff with the necessary expertise to execute large-scale IT projects. The report also noted that there was minimal oversight of the contracting processes on the project and that the department had made no attempt to find a contracting officer with experience for this multi-year, complex project. The Inspector General suggested that VA develop effective oversight processes, develop in-house staff with the expertise to manage and execute complex integrated IT programs, and expand the number of contracting officers with experience on large projects. In response, the department consolidated IT procurements under the Office of Acquisition, Logistics, and Construction and established the Technology Acquisition Center to administer future OI&T contracts. After spending an estimated $127 million over 9 years (from fiscal years 2001 through 2009) on its outpatient scheduling system project, VA has not yet implemented any of the system’s expected capabilities. According to the department, of the total amount, $62 million was expended for, among other things, project planning, management support, a development environment, and equipment. In addition, the department paid an estimated $65 million to SwRI to develop the replacement scheduling application.