Veterans Affairs

VA tells Congress that key Mission Act IT tool will work

VA headquarters in Wash., DC 

Officials at the Department of Veterans Affairs pushed back on a U.S. Digital Services report that was highly critical of an application set to be fielded in early June to determine eligibility for VA-covered benefits outside of the Veterans Health Administration.

The Decision Support Tool is intended to help clinicians and staff determine patient eligibility for community care within the regulations set up under the Mission Act, which takes effect June 6, 2019. Eligibility is determined by wait times for appointments with primary care clinicians and specialists, as well as patient drive times.

DST itself is "pretty simple," VA CIO Jim Gfrerer said in an April 2 House hearing.

"It looks at the Master Veteran Index, it then establishes some level of eligibility, [and] it looks at the provider database and makes a determination around drive- and wait-time eligibility."

In their report, which was not intended to become public but was obtained and published by ProPublica, USDS personnel "identified significant risks surrounding software development timing, integration dependencies, and usability."

USDS recommended that VA stop development of DST. While USDS said that the contractor, AbleVets, is "motivated and capable," the problems of interoperability with the legacy VA systems the tool has to interface with are daunting. It interacts with six legacy systems, and each requires an interface agreement, but as of the submission of the report, only one had been finalized. In addition, USDS was not optimistic that the development environment could adequately forecast the demands on DST once it goes into production.

"DST calls the various services in a cascading, serialized fashion. The continued inability to test these service integrations with regard to response times and error rates at scale could lead to severe latency, errors, or system crashes," the report stated.

Gfrerer pushed back on this assertion at the hearing, saying that VA "has done sufficient stress testing" and that the tool and the backend systems it connects with are "orders of magnitude more capable of handling that increased load." He indicated that meant adding between 50,000 and 70,000 calls per day as could occur would not be an issue.

Gfrerer also said the tool was designed to "fail elegantly," meaning that a failure in any single backend system call wouldn't disrupt the entire process. "It's not an all-or-nothing proposition," he said.

The accelerated rollout of DST means that clinicians and patients will find out if it works one way or the other fairly soon. The Choice Act expires and the Mission Act takes effect on June 6, and the new system is scheduled to be in place by then. According to the schedule cited in the USDS report, the code will be finalized and submitted for authorization to operate in late April, with rollout and initial operation capability testing taking place throughout May.

The USDS report predicted that deployment of DST as currently configured could add five to 10 minutes to clinician appointments and diminish overall capacity by 75,000 appointments per day.

The report's authors also recommended a slew of policy changes be implemented in advance of the development of a new tool. They'd like to see a tool be veteran-facing, so that patients can get an idea of their own eligibility for community care before contacting VA for an appointment, and they want VA to restructure contracts with health care networks to guarantee continuity of coverage for patients in the midst of treatment. USDS said it also wants VA to partner with a government payer -- Medicare or the Defense Department's Tricare -- to handle the settlement side.

VA Secretary Robert Wilkie, in an interview with Colorado Public Radio, said that USDS ought to stay in its lane.

"For an outfit that’s supposed to be all about technology, about 90% of that report was about policy, which I think if you look at their charter, they were not competent to do," Wilkie said.

Former USDS staffer Emily Tavoulareas weighed in on Twitter noting that "institutional problems are at the heart of government's IT problems. That's mostly (1) policies, (2) people, (3) processes. People at USDS spend an unbelievable amount of time untangling that mess in order to deliver what is actually not very complicated tech."

According to Gfrerer, the VA is moving on a separate track to improve feeds from the systems tapped by DST as part of the agency's overall move to cloud and to build application programming interfaces.

"We couldn't get there fast enough from January to June 6," Gfrerer said. "There is a parallel development team that is taking those requirements around legacy architecture and developing it on an API basis."

About the Author

Adam Mazmanian is executive editor of FCW.

Before joining the editing team, Mazmanian was an FCW staff writer covering Congress, government-wide technology policy and the Department of Veterans Affairs. Prior to joining FCW, Mazmanian was technology correspondent for National Journal and served in a variety of editorial roles at B2B news service SmartBrief. Mazmanian has contributed reviews and articles to the Washington Post, the Washington City Paper, Newsday, New York Press, Architect Magazine and other publications.

Click here for previous articles by Mazmanian. Connect with him on Twitter at @thisismaz.


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