VA centralization takes hold

Agencies and hospitals are adapting to the CIO’s takeover of IT management and spending

Centralization case study

HealtheVet is an example of an information technology development project that fits into the Veterans Affairs Department’s OneVA enterprise view, said Paul Tibbits, deputy chief information officer at VA’s Office of Enterprise Development.

Earlier this year, the Government Accountability Office said VA had made progress on its effort to upgrade its medical information system but still needed a comprehensive project management plan, independently validated cost estimates and a governance structure for HealtheVet.

“The fact that I’ve now got one group of people working with HealtheVet that know what a life cycle cost model is doesn’t necessarily mean that automatically all 6,000 people inside of [the Office of Information and Technology] now know what a life cycle cost model is,” he said.

VA is incorporating that knowledge in coaching, mentoring and training VA employees on its new IT business processes.

“A lot of energy has to be put in to enlarge that circle from HealtheVet to encompass other programs,” he said.

VA also created a program management division and is in the process of hiring a senior executive to lead it. The division will focus on life cycle costs and management, trade-offs, working with customers, and earned value management, he said.

— Mary Mosquera

The Veterans Affairs Department’s decision to centralize all information technology management, development and budget authority under the chief information officer is affecting the entire organization, including VA hospitals, department officials say.

VA has been mostly decentralized, with local facilities making their own IT spending decisions. But now VA is one of the few large agencies to give total IT authority to its CIO.

That decision, finalized in the aftermath of a well-publicized data breach in May 2006, aims to institutionalize policy and management standards, including information security, said Robert Howard, VA’s CIO.

Authority over IT staff members at the Veterans Health Administration (VHA), Veterans Benefits Administration and National Cemetery Administration was transferred to Howard in 2007, and the department’s new IT development organization was launched in June.

“We received mandates for standardization, interoperability and fiscal discipline,” Howard said, adding that the reorganization occurred in response to numerous complaints about management from Congress, the Government Accountability Office and VA’s inspector general.

With centralization, VA hospitals will no longer have the flexibility to intermingle spending on IT and non-IT medical services. They must now account for IT spending separately, Howard said.

“The IT staff helped at whatever was required, to include the care of medical devices,” he said. “Hospitals are wall-to-wall IT. It’s more complicated than it was before, and [IT spending] will be a source of frustration if you’re trying to run a hospital.”

VA officials are establishing policies and procedures to help facilities identify and account for their IT spending. In the meantime, they have reallocated funds from other areas to cover IT spending for hospitals, Howard said. As a result, hospitals are experiencing a shortage of IT funds, and the effort to standardize VA’s IT systems has introduced more difficult changes for VA hospitals, he added.

“For example, you can’t buy your own server at a hospital anymore,” he said. “The reason we’re trying to get our arms around it is the issue of sending out [software] patches. Change management is a problem in VA because not only are the processes different throughout the VA, but the equipment is different.”

VA officials sought to reduce some of the frustration for hospital directors by requesting more funding from Congress. In fiscal 2008, lawmakers agreed to provide $35 million for medical facilities’ CIOs or directors to buy small IT items, such as keyboards or extra computers. That money was allocated and distributed.

However, in some cases, requests were not approved in a timely manner. For example, a number of hospital directors wanted to use the money to set up kiosks for patients to access their health care information, but VHA officials took a long time to decide on a standard for the kiosks, Howard said.

Separating IT spending from non-IT spending is not always a straightforward process, he added. For example, a medical device might have a computer attached to it, but such devices must be bought with non-IT money.

“If you’re a hospital director and you have money available but you can’t use it to solve some urgent problems in IT, it’s going to be frustrating,” Howard said.

Paul Tibbits, deputy CIO at VA’s Office of Enterprise Development, described the predicament of hospital directors. A device that controls the administration of intravenous fluids is medical equipment even though it has a computer in it and is connected to a network.

Congress dealt with the funding situation by including the fiscal 2009 Military Construction and Veterans Affairs Appropriations Act in the continuing resolution legislation it approved to fund government activities until lawmakers can agree on a budget.

In an accompanying report to the legislation, the Senate Appropriations Committee cited complaints that the VA CIO’s office had not established standardized policies and procedures for requesting and receiving IT services, equipment and development and had not created a clear organizational structure.

“The repeated reprogramming requests from other departmental accounts to the Information Technology Systems account lead the committee to believe the department has not established an effective process for identifying its IT needs, particularly those at the medical center level,” the report states. Also, committee members said the situation raises the question of whether the centralization effort has indeed helped the department become more efficient.

They directed VA officials to report in April 2009 on the extent to which those problems had been corrected and whether centralization had resulted in any efficiencies.

VA needs to improve the way it tracks IT spending, a Senate staff member said. Committee members were concerned that officials overlooked some IT spending in the move to centralization because managers consolidated purchases under medical services, the staff member added.

“There was not a lot of visibility on what programs were requesting and spending,” the staff member said. The exceptions were large systems that have started since centralization began, such as the effort to modernize VA’s medical information system and the program to replace its financial and logistics system. 

Lawmakers hope VA officials will better account for IT spending this year so funds do not have to be taken from elsewhere, the staff member said. VA hospitals are technology-driven, and that reliance will only increase. The idea is to capture IT spending when it is health-driven. “Because their health care is so driven by technology, it is important that it be accurately driven,” the staff member said.

Reinventing the team
The most critical aspect of centralization is creating a high-performing team with an adequate number of IT professionals who are well led and have the resources and skills necessary to do what needs to be done, Howard said.

“That does not exist at this point,” he added.

When VA began to reorganize its IT environment, no one knew what the IT staff would look like and how much money it should have, Howard said.

“What we’ve found is that there’s an awful lot of fixing that needs to be done,” he said. 

VA has training programs to strengthen the skills, abilities and professionalism of its IT workforce, Tibbits said. However, officials  also need to develop mature, standard processes for building the IT organization.

“We’ve moved forward in doing what is necessary to implement those at the speed that we believe that the organization can successfully ingest while trying to get work done,” he said. “It’s not possible to change people overnight.”

In addition, employees are coming together in the central IT development organization who never worked together.

As VA officials devise and document operational processes, they file them in a process asset library and train employees on them. Supervisors are also approving individual development plans for each member of the IT organization, Tibbits said, and they are using those plans to create training programs for the employees. The training includes traditional classroom instruction and coaching and mentoring.

“It’s more of an adult education approach of just-in-time delivery of information to the adult learner when the adult needs it for the task that they have at hand,” Tibbits said. 

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