System Overload

Few people were surprised when the Government Accountability Office added veterans’ health care to its high-risk list of federal programs vulnerable to waste, fraud and abuse in February. The Veterans Affairs Department operates one of the largest nationwide health care systems, serving nearly 9 million veterans through 150 medical centers and more than 800 clinics. As VA’s patient load has grown over the last decade, largely as a result of wars in Iraq and Afghanistan, so too have the department’s well- publicized problems.

GAO notes that the number of annual outpatient medical appointments increased by 39.9 million visits—85 percent—between 2002 and 2013. While the department received substantial budget increases over that period, multiple investigations by GAO and others have shown the quality and especially the timeliness of care have eroded. 

To address those issues, Congress passed the 2014 Veterans Access, Choice and Accountability Act. The law requires VA to offer veterans the option to receive hospital care and medical services from non-VA providers when a VA facility cannot provide an appointment within 30 days or when veterans live more than 40 miles from the nearest VA facility. But the new law could end up exacerbating problems at the department, GAO noted, specifically regarding VA’s struggling computer systems. 

“Of particular concern is the outdated, inefficient nature of certain systems, along with a lack of system interoperability—the ability to exchange information—which presents risks to the timeliness, quality and safety of VA health care,” GAO explained. Auditors specifically cited the severe shortcomings of the department’s 30-year-old scheduling system, as well as long-standing hurdles to sharing patient data between the Defense Department and VA. 

“The ongoing lack of electronic health record interoperability limits VA clinicians’ ability to readily access information from DOD records, potentially impeding their ability to make the most informed decisions on treatment options, and possibly putting veterans’ health at risk,” GAO noted.

Technology failures at VA are nothing new. But the department’s efforts to deal with them have met with mixed results at best. Six years ago, VA launched the Program Management Accountability System, or PMAS, to help officials monitor IT projects’ progress, uncover red flags and deliver functionality in short-term increments. But a recent inspector general report found the system needs some monitoring of its own.

“More than five years after its launch,” department officials have not “fully infused PMAS with the discipline and accountability necessary for effective management and oversight of IT development projects,” Linda Halliday, VA’s assistant inspector general for audits and evaluations, wrote in the Jan. 22 report.

Among the problems the IG found was that officials from the VA’s Office of Information and Technology had not always conducted review sessions to determine whether projects were ready to be moved beyond the planning stages or if  they needed to be re-evaluated or shut down entirely.

The review sessions are a key part of the project management system, and VA Chief Information Officer Stephen Warren has frequently touted his willingness to kill failed programs based on the outcome of the reviews.  

Still, in two particular IT offices, the Office of Product Development and the Enterprise Risk Management Office, planning and compliance reviews were done in only a fraction of cases, according to Halliday.

Even when review sessions were completed, cost information uploaded to the system’s dashboard was not always accurate, IG auditors found. “Project managers continued to struggle with capturing and reporting reliable cost information,” the report noted, and spending on enhancements to existing IT systems was left out entirely.

All told, VA spends $495 million on IT development projects.

The IG uncovered other problems as well. The office that oversees the accountability system—the PMAS business office—is plagued by staff vacancies, and many positions have been filled by contractors. Auditors say the agency could save as much as $6.4 million by hiring federal employees to replace contractors in the office.

This was not the first time the IG assessed the project management tool and found it lacking. In 2011 and again in 2013, auditors in the inspector general’s office found gaps in PMAS’ implementation, although officials have taken steps over the years to implement the watchdog’s recommendations.

In the most recent report, the IG recommends VA modify the PMAS dashboard to maintain a “complete audit trail of baseline data” and establish procedures for ensuring all spending reviews are actually completed.

Warren, the VA CIO, agrees with the IG’s recommendations, except for the one suggesting the agency replace contractor staff in the PMAS office with federal employees.

In a letter to Halliday, Warren notes that contractors are needed to provide support, citing the growing portfolio of IT projects the agency manages. However, Warren did agree to conduct a cost analysis of switching to an all-federal staff.