Grim prognosis

Report finds e-health IT problems at VA

The Department of Veterans Affairs’ ambitious HealtheVet project was poorly planned and faces a high risk of failure, an independent report has concluded. And members of Congress are now recommending withholding $311 million from the electronic health records system until the flaws are fixed.

In an unprecedented move, the House Veterans’ Affairs Committee last month recommended cutting $400 million from the VA’s proposed information technology budget for 2006, including start-up funds for HealtheVet.

Lawmakers expressed their skepticism last week after learning about the Carnegie Mellon University study that gave the modernization project failing grades.

Rep. Steve Buyer (R-Ind.), the commitee’s chairman, said Congress did not want another VA disaster like last year’s failure of the $372 million Core Financial and Logistics System program, which succumbed to poor project management.

Veterans “deserve a system that works reliably,” he said.

The committee chairman said HealtheVet should not be funded until questions about its operability problems are answered. IT at the VA is “not centrally managed, and the results are poor service to veterans, inefficiency and wasted tax dollars,” Buyer said.

The study, first reported by the St. Petersburg (Fla.) Times April 13, states that the agency has not adequately addressed the risks of the project, is letting deadlines drive it and has no viable architecture or a documented road map to get an operational system in place by the 2010 deadline.

“Current plans are not realistic given the complexity and magnitude of [HealtheVet] and the VA’s ability to carry them out,” the report states.

The VA commissioned the internal report, which is still in draft form, to find the holes in the project, which is still on the drawing board, said Robert McFarland, the department’s chief information officer.

“This is good news that the VA is taking the time and energy to look at large-scale programs upfront instead of after it becomes a disaster,” McFarland said in a telephone interview with Federal Computer Week. “I’m happy we found these holes.”

Despite the firestorm over the study’s conclusions, he said the many problems outlined will help guide the department in fixing the computer modernization program for the 5 million veterans in the VA’s health care system.

“What we tried to do is be proactive by getting experts to come in and look at this large proposal and look at where our holes are,” McFarland said. “It showed us the holes. It showed us the risks…[and] a lot of things we [can] now go and fix before we move forward.”

McFarland said he would take a similar approach “on most of our major projects, and I’m going to try to do them in advance rather than trying to do them when things aren’t looking good.”

HealtheVet would build on the Veterans Health Information Systems and Technology Architecture program, a 20-year-old program that runs on antiquated software and does not scale or provide the needed maturity, according to the report.

In addition, officials do not know enough about the necessary large-scale system integration or proposed technology products and standards to make a new system work, according to the report.

The report, delivered to top VA executives in February, could be a major blow to the department’s plan to modernize its computer system nationwide and develop e-health records for every veteran in the system. Maintaining the current course will lead to failure, the report states.

Intended to upgrade information technology for the VA’s 158-hospital system, the program lacks a clear vision, Carnegie Mellon researchers found.

The study also blamed VA officials for ineffective decision-making and poor communication. “Many decisions are driven by unrealistic, subjective information,” the report states.

But McFarland said he would not be deterred. He talked with lawmakers to help persuade them that the project is, indeed, viable.

“It is not a failed project,” he said. “We shouldn’t be crucified for doing the right thing.”

HealtheVet has a fever

Department of Veterans Affairs officials are planning to build a Web-based system called HealtheVet to provide electronic access to records for the 5 million veterans in the VA’s health system. It would replace the 20-year-old Veterans Health Information Systems and Technology Architecture program, which stores electronic health records in a database that does not offer universal access for veterans or health providers. An independent study found many problems in plans for the new system.

Among the findings:

  • Officials lack an integrated HealtheVet program vision.
  • Critical processes and procedures are frequently eliminated to meet deadlines.
  • Management, technical and operational baselines are missing.
  • Officials do not understand how much change management and training will be needed.
  • The Program Management Office does not have staff or operational procedures for a large-scale systems integration project.
  • Officials must develop an enterprise architecture and a road map before starting to build HealtheVet.
  • Existing systems are inadequate to fold into HealtheVet.
  • Officials have not properly considered security, and HealtheVet could inherit many of the VA infrastructure’s security headaches.
  • Engineering standards are insufficient.
  • Common terminology for stakeholders is lacking.

    Source: Carnegie Mellon University Software Engineering Institute

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