VA’s mission is to promote the health, welfare, and dignity of all veterans in recognition of their service to the nation by ensuring they receive medical care, benefits, social support, and lasting memorials. It 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 Benefits Administration (VBA), the Veterans Health Administration (VHA), and the National Cemetery Administration (NCA)—are primarily responsible for carrying out its mission. More specifically, VBA provides a variety of benefits to veterans and their families, including disability compensation, educational opportunities, assistance with home ownership, and life insurance. VHA provides health care services, including primary care and specialized care, and it performs research and development to improve veterans’ needs. Lastly, 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 167 VA medical centers, approximately 1,200 community-based outpatient clinics, 300 veterans centers, 56 regional offices, and 131 national and 90 state or tribal cemeteries situated throughout the nation. VA 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 IT systems supporting the department’s mission. The infrastructure is to provide for data storage, transmission, and communications requirements necessary to ensure delivery of reliable, available, and responsive support to all VA staff offices and administration customers, as well as veterans. In this regard, the department operates approximately 240 information systems, manages 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, patient care through telehealth, and access to health records, among other services. For example, VBA relies on its disability benefits claims processing system—the Veterans Benefits Management System—to collect and store information such as military service records, medical examinations, and treatment records from VA, the Department of Defense, and private medical service providers. Information technology is widely used and critically important to supporting the department in delivering health care to veterans. 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. Specifically, the Veterans Health Information Systems and Technology Architecture, known as VistA, consists of many computer applications and modules that collect, among other things, information about a veteran’s demographics, allergies, procedures, immunizations, and medical diagnoses. In 2014, VA issued its 6-year strategic plan, which emphasizes the agency’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 improved 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. To 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 approximately $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 approximately $4.1 billion for IT. The department had requested approximately $505 million for new systems development efforts, approximately $2.5 billion for maintaining existing systems, and approximately $1.1 billion for payroll and administration. In addition, in its 2016 budget submission the department requested appropriations for the following purposes, among others: improving veteran access to benefits and services ($378.1 million); reducing the time it takes to process disability claims and increase accuracy ($295.1 million); expanding information security ($180.3 million); implementing the Veterans Access, Choice, and Accountability Act of 2014 (the Veterans Choice Act) ($440.6 million); maintaining the IT infrastructure ($1.828 billion); and improving VistA ($182.6 million). Further, 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 the following: 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 the Veterans Benefits Management System 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). Even as the department has engaged in various attempts to improve its IT management capabilities, we have issued numerous reports that highlighted challenges facing its efforts. In February 2014, we reported that about 2 years after taking actions toward developing a single interoperable electronic health record system with the Department of Defense (DOD), VA and DOD announced that they would instead work toward modernizing their separate existing health information systems and work to ensure those systems could share information. However, VA proceeded with this plan without developing a cost and schedule analysis to support the assertion that pursuing a separate modernized system while enabling interoperability with DOD’s system would be less expensive and could be achieved faster than developing a single system, which is contrary to best practice. We recommended that VA work with DOD to develop a cost and schedule estimate for their modernization approach, as well as their joint effort, and compare the estimates to determine which approach would cost less and take less time. VA concurred with our recommendation, but had not completed actions to address it. In addition, we reported in May 2010 that after spending an estimated $127 million over 9 years on its outpatient scheduling system 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 application. 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 completed actions to implement four of the six recommendations. Effectively managing IT needs depends on federal departments and agencies, including VA, having key functions in place. Toward this end, we have identified and reported on a set of essential and complementary functions that serve as a sound foundation for IT management. These include the following: Leadership: Effective leadership, such as that of a CIO, can drive change, provide oversight, and ensure accountability for results. Congress has also recognized the importance of having a strong agency CIO. For example, as part of the Clinger-Cohen Act, Congress required executive branch agencies to establish the position of agency CIO. The act also gave these officials responsibility and accountability for IT investments, including IT acquisitions, monitoring the performance of IT programs, and advising the agency head on whether to continue, modify, or terminate such programs. More recently, in December 2014, Congress passed federal information technology acquisition reform legislation (commonly referred to as FITARA), which strengthened the role that agency CIOs are to play in managing IT. For instance, the law requires the head of covered agencies to ensure that the CIO has a significant role in the decision process for IT budgeting, as well as the management, governance, and oversight processes related to IT. Strategic planning: Strategic planning defines what an organization seeks to accomplish and identifies the strategies it will use to achieve desired results. A defined strategic planning process allows an agency to clearly articulate its strategic direction and to establish linkages among planning elements such as goals, objectives, and strategies. A well-defined IT strategic planning process helps ensure that an agency’s IT goals are aligned with its strategic goals. Also, as part of its strategic planning efforts, an organization should develop an enterprise architecture, which is an important tool to help guide the organization toward achieving the goals and objectives in its IT strategic plan. In addition, the organization should implement human capital management practices to sustain a workforce with the skills necessary to execute its strategic plan. Systems development and acquisition: Agencies should follow disciplined processes for developing or acquiring IT systems.