Veterans Affairs
Subcommittee Post-Hearing Questions Concerning the Department's Information Technology Management Gao ID: GAO-03-261R November 5, 2002The Department of Veterans Affairs' (VA) has made progress in improving its overall management of information technology, including centralization of information technology functions, programs, and funding under the department-level chief information officer (CIO). The department has also made progress in developing an enterprise architecture, improving information security, and managing important information systems initiatives being pursued by the Veterans Benefits Administration (VBA) and the Veterans Health Administration (VHA). GAO reviewed (1) whether VA's proposed business and enabling functions provide the management tools necessary to start the process for implementing VA's enterprise architecture; (2) how veterans have benefited from the VETSNET Program; (3) what must be done to assure successful implementation of the Federal Health Information Exchange (FHIE); and (4) whether VA can realistically implement HealtheVet-Vista by the end of 2005. GAO found that the Federal CIO's Council's guidance on enterprise architecture advises organizations to develop a set of controls to help them successfully manage the process of creating, changing, and using an enterprise architecture. Although the enterprise business functions and key enabling functions are essential components of the architecture that VA is developing, they cannot be considered a primary tool for managing the enterprise architecture effort. Although VBA has spent more than $40 million since 1996 on developing the VETSNET compensation and pension replacement, veterans have not received measurable benefits from this initiative. Successful implementation of FHIE will largely depend on the extent to which consistent and effective project management and oversight exists to guide the initiative. Beyond FHIE, VA and the Department of Defense (DOD) have envisioned a long-term strategy--HealthePeople--involving the two-way exchange of patient health care information. This exchange is expected to depend on the successful interoperability, and resultant sharing of secure health care data, between DOD's Composite Health Care System II and VA's HealtheVet VISTA, both of which continue under development.
GAO-03-261R, Veterans Affairs: Subcommittee Post-Hearing Questions Concerning the Department's Information Technology Management
This is the accessible text file for GAO report number GAO-03-261R
entitled 'Veterans Affairs: Subcommittee Post-Hearing Questions
Concerning the Department's Information Technology Management' which
was released on November 05, 2002.
This text file was formatted by the U.S. General Accounting Office
(GAO) to be accessible to users with visual impairments, as part of a
longer term project to improve GAO products‘ accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
November 5, 2002:
The Honorable Steve Buyer
Chairman, Subcommittee on Oversight and Investigations
Committee on Veterans‘ Affairs
House of Representatives
Subject: Veterans Affairs: Subcommittee Post-Hearing Questions
Concerning the Department‘s Information Technology Management:
This letter responds to your October 10, 2002, request that we provide
answers to questions relating to our testimony of September 26,
2002.[Footnote 1] At that hearing, we discussed the Department of
Veterans Affairs‘ (VA) progress in improving its overall management of
information technology, including the centralization of information
technology functions, programs, and funding under the department-level
chief information officer (CIO). We also discussed the department‘s
progress since last March in developing an enterprise architecture,
improving information security, and managing important information
systems initiatives being pursued by the Veterans Benefits
Administration (VBA) and the Veterans Health Administration (VHA). Your
questions, along with our responses, follow.
1. On page 19, the GAO testimony stated that VA must also still develop
a program management plan to delineate how it will develop, use, and
maintain the enterprise architecture. GAO stated that such a plan is
integral to providing definitive guidance for effective management of
the enterprise architecture program. According to Dr. Gauss, VA has
developed and will implement version 1.0 of the One-VA Enterprise
Architecture, which establishes ten enterprise business functions and
seven key enabling functions. Does GAO agree that these business and
enabling functions provide the management tools necessary to start the
process for implementing VA‘s enterprise architecture?
The Federal CIO Council‘s guidance on enterprise architecture[Footnote
2] advises organizations to develop a set of controls to help them
successfully manage the process of creating, changing, and using an
enterprise architecture. These controls are intended to promote sound
management of the enterprise architecture project through the use of
plans, products, and requirements, including the program management
plan that we referred to in our testimony. In particular, a program
management plan would articulate critical factors guiding work on the
architecture, including a work breakdown structure detailing the tasks
and subtasks necessary to acquire, develop, and maintain the
architecture; resource estimates for funding, staffing, training,
workspace requirements, and equipment needs; and a roadmap for the
initiation and completion of key project tasks. As our testimony noted,
VA lacked such a management plan to support its enterprise architecture
effort.
While the enterprise business functions and key enabling functions are
essential components of the architecture that VA is developing, they
cannot be considered a primary tool for managing the enterprise
architecture effort. Rather, these business and enabling functions are
the products of VA‘s efforts to develop the baseline, or ’as-is,“ and
identify the target, or ’to-be,“ components of its enterprise
architecture. Specifically, enterprise business functions are
externally focused functions involving direct interactions with
veterans across the enterprise, such as providing medical care
benefits, vocational rehabilitation, and employment benefits. Key
enabling functions are those necessary to support the enterprise
business functions, such as eligibility and registration, and enable
smooth operation of the overall enterprise both internally and
externally.
As the CIO Council‘s guidance notes, one of the initial steps in
developing an enterprise architecture is describing the enterprise as
it currently exists, including business functions and information
flows. By identifying the business and enabling functions, VA has set
the stage for moving toward and measuring progress against its target
architecture. Nonetheless, while these functions represent an important
accomplishment in VA‘s development of its enterprise architecture, they
do not satisfy the department‘s need for a program management plan to
help provide a sound foundation for managing the development,
implementation, and use of the architecture.
2. Concerning VETSNET, GAO testified that ’after six years the VA still
has significant work to accomplish, and could be several years from
fully implementing the system.“ In GAO‘s opinion, how have veterans
benefited from this program, considering the significant capital that
has been dedicated to this program?
Although VBA has spent more than $40 million on developing the VETSNET
compensation and pension replacement system since 1996, veterans have
not yet received measurable benefits from this initiative. At the time
of our testimony, VBA was using its new software products to deliver
benefits payments to only 9 of the more than 3 million compensation and
pension benefits recipients on its rolls.[Footnote 3] Benefits payments
to all other recipients continued to be made via the department‘s aging
Benefits Delivery Network. Moreover, subsequent to our testimony, VBA
officials told us that at the beginning of this month they intended to
convert the processing of the nine benefits payments being made with
the new software to the Benefits Delivery Network. An official
explained that the February 2001 pilot test using the new VETSNET
software had in essence been a proof of concept exercise to demonstrate
that the software could deliver benefits payments. He stated that this
exercise has now been completed.
VBA still has numerous tasks to accomplish before its software
applications comprising the compensation and pension replacement system
can be fully implemented and capitalized upon. As our testimony noted,
all but one of the six software applications constituting the new
system
[Footnote 4] still need to be fully deployed or developed.
Specifically, two applications--Share, which is used to establish a
claim, and Modern Award Processing-Development, which is used to help
develop a claim--still need to be implemented in the majority of VBA‘s
57 regional offices.[Footnote 5] In addition, three applications
continue to require development and, according to VBA officials, are
not expected to be fully deployed until December 2004. At that time,
Award Processing will be expected to record award decisions; generate,
authorize, and validate on-line awards; and interface with a
correspondence application to develop notification letters to veterans.
The Finance and Accounting System will be expected to perform
accounting and benefits payments functions and interface with the
Department of the Treasury.
Beyond these applications that VBA must still deploy and/or develop, it
faces the more immediate task of ensuring that the one application
already deployed--Rating Board Automation 2000--is utilized to its full
potential. When implemented in November 2000, this application was
expected to assist veterans service representatives in rating benefits
claims. However, according to a VBA official, some regional offices
indicated that rather than improve service delivery, use of the
software tool actually resulted in longer processing times. Given the
department‘s backlog of compensation and pension benefits claims, the
undersecretary for benefits subsequently suspended the requirement for
regional offices to use the software until its backlog had been
reduced. At the time of our testimony, VBA did not plan to require its
regional offices to fully utilize this software until July 2003.
3.Since VA has been given the lead in making the renamed Federal Health
Information Exchange (FHIE) a reality, what must be done to assure
successful implementation?
Successful implementation of FHIE will largely depend on the extent to
which consistent and effective project management and oversight exists
to guide the initiative. In April 2001,[Footnote 6] we recommended that
the participating agencies--VA, the Department of Defense (DOD), and
the Indian Health Service--take various actions to strengthen the
management and oversight of the government computer-based patient
record (GCPR) project (the predecessor strategy). These steps included
(1) designating a lead entity with final decision-making authority and
(2) creating comprehensive and coordinated plans that included an
agreed-upon mission and clear goals, objectives, and performance
measures to ensure that the agencies could share comprehensive,
meaningful, accurate, and secure patient health care data. We
reiterated the need for VA to implement these recommendations in our
June 2002 report,[Footnote 7] and also made additional recommendations
that the participating agencies (1) revisit the original goals and
objectives of the GCPR initiative to determine if they remained valid
and, where necessary, revise the goals and objectives to be aligned
with the current strategy and direction of the project; and (2) commit
the executive support necessary for adequately managing the project and
ensure that sound project management principles are followed in
carrying out the initiative. VA concurred with these recommendations.
The actions that VA and DOD took in response to the recommendations
resulted in a revised strategy whereby patient data would be exchanged
and a common health information infrastructure and architecture
comprised of standardized data, communications, security, and high-
performance health information systems would be developed. VA and DOD
intend to accomplish this with two initiatives. The first, FHIE, is
focused on DOD providing information to VA clinicians. A second
initiative, referred to as HealthePeople (Federal), is intended to
allow the two-way exchange of clinical information, with an emphasis on
establishing a common health information infrastructure and
architecture. VA and DOD have stated that they plan to complete this
initiative by the end of 2005.
Along with designating VA as the lead agency for FHIE, VA and DOD took
actions to improve project management that should continue to help
guide this initiative to a successful outcome. For example,
goals and objectives have been revised and aligned with the new FHIE
strategy;
² a permanent project manager has been assigned to the initiative, and
he is using project management software to facilitate the monitoring of
assigned tasks;
² executive-level reviews are being conducted for systems development
and deployment approval;
² weekly testing and technical meetings are being held; and:
² monthly interagency in-process reviews are being conducted by VA‘s
Deputy CIO for Health and DOD‘s CIO for Military Health Systems.
VA and DOD officials reported that the nationwide deployment and
implementation of the first phase of FHIE was successfully completed in
July. The first phase has enabled the one-way transfer of demographic
information,[Footnote 8] laboratory results, outpatient pharmacy data,
and radiology reports for separated service members from DOD‘s Military
Health System Composite Health Care System to VA‘s FHIE repository.
Clinicians throughout VHA now have access to over 14 million lab
messages, almost 14 million pharmacy messages, and over 2 million
radiology messages on over 1 million service personnel who separated
between 1987 and 2001.
A second, final phase of FHIE began in October and is intended to make
additional health information--in-patient histories, diagnoses, and
procedures; allergy information; admission, disposition, and transfer
information; and consult results--available to VA clinicians. This
phase will rely on the existing technology supporting phase 1, and thus
will only involve adding data to the existing repository. Completion of
the final phase is scheduled for September 2003.
As VA and DOD proceed with implementing the final phase of FHIE and
move forward with HealthePeople (Federal), providing consistent project
management and oversight will continue to be essential for successful
project completion. As such, sustained adherence to the program
management structure that VA and DOD have already put in place will be
critical. Moreover, these agencies can further strengthen their
management and oversight through the use of performance measures to
gauge the progress and effectiveness of their efforts.
4. The VA testified that HealtheVet-Vista should be implemented by the
end of 2005. In GAO‘s opinion, is this timetable realistic? Please
elaborate.
As noted, beyond FHIE, VA and DOD have envisioned a long-term strategy-
-HealthePeople (Federal)--involving the two-way exchange of patient
health care information. This exchange is expected to depend on the
successful interoperability, and resultant sharing of secure health
care data, between DOD‘s Composite Health Care System (CHCS) II and
VA‘s HealtheVet VISTA, both of which continue under development.
At this time, we are unable to determine whether plans for implementing
this long-term strategy are realistic. When our review concluded, VA
and DOD had just begun this initiative, and program officials stated
that they had not completed an implementation plan. Until DOD‘s CHCS II
and VA‘s HealtheVet VISTA have been fully developed and a plan
detailing the work tasks, resources, and completion milestones for
HealthePeople (Federal) has been developed and made available for our
review, we will not have a basis for assessing VA‘s potential for
implementing this initiative by the end of 2005.
----------:
We requested comments on a draft of this letter from the Department of
Veterans Affairs, but none were provided.
We are sending copies of this letter to the Secretary of Veterans
Affairs; copies will also be available on our Web site at www.gao.gov.
Should you or your office have any questions on matters discussed in
the letter, please contact me at (202) 512-6253. I can also be reached
by e-mail at willemssenj@gao.gov.
Sincerely yours,
Signed by Joel C. Willemssen:
Joel C. Willemssen
Managing Director, Information Technology Issues:
FOOTNOTES
[1] U.S. General Accounting Office, VA Information Technology:
Management Making Important Progress in Addressing Key Challenges, GAO-
02-1054T (Washington, D.C.: Sept. 26, 2002).
[2] Chief Information Officer Council, A Practical Guide to Federal
Enterprise Architecture, Version 1.0 (Washington, D.C.: February 2001).
[3] As part of a pilot test in February 2001, VBA began processing ten
original benefits claims using its new software. However, according to
VBA, one of the ten veterans subsequently moved outside of the area
covered by the pilot test and now receives his payments via the
Benefits Delivery Network.
[4] The six software applications constituting the replacement system
are Share, Modern Award Processing-Development, Rating Board Automation
2000, Award Processing, Finance and Accounting System, and
Correspondence.
[5] Among the 57 regional offices that are expected to benefit from the
replacement system, only 6 currently use Share to establish a claim;
only 2 offices (Salt Lake and Little Rock) have pilot-tested and
currently use Modern Award Processing-Development to assist in
developing most compensation claims.
[6] U.S. General Accounting Office, Computer-Based Patient Records:
Better Planning and Oversight by VA, DOD, and IHS Would Enhance Data
Sharing, GAO-01-459 (Washington, D.C.: Apr. 30, 2001).
[7] U.S. General Accounting Office, Veterans Affairs: Sustained
Management Attention Is Key to Achieving Information Technology
Results, GAO-02-703 (Washington, D.C.: June 12, 2002).
[8] The demographic information consists of patient name, DOD
eligibility category, Social Security number, address, date of birth,
religion, primary language, sex, race, and marital status.
GAO‘s Mission:
The General Accounting Office, the investigative arm of Congress,
exists to support Congress in meeting its constitutional
responsibilities and to help improve the performance and accountability
of the federal government for the American people. GAO examines the use
of public funds; evaluates federal programs and policies; and provides
analyses, recommendations, and other assistance to help Congress make
informed oversight, policy, and funding decisions. GAO‘s commitment to
good government is reflected in its core values of accountability,
integrity, and reliability.
Obtaining Copies of GAO Reports and Testimony:
The fastest and easiest way to obtain copies of GAO documents at no
cost is through the Internet. GAO‘s Web site ( www.gao.gov ) contains
abstracts and full-text files of current reports and testimony and an
expanding archive of older products. The Web site features a search
engine to help you locate documents using key words and phrases. You
can print these documents in their entirety, including charts and other
graphics.
Each day, GAO issues a list of newly released reports, testimony, and
correspondence. GAO posts this list, known as ’Today‘s Reports,“ on its
Web site daily. The list contains links to the full-text document
files. To have GAO e-mail this list to you every afternoon, go to
www.gao.gov and select ’Subscribe to daily E-mail alert for newly
released products“ under the GAO Reports heading.
Order by Mail or Phone:
The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent
of Documents. GAO also accepts VISA and Mastercard. Orders for 100 or
more copies mailed to a single address are discounted 25 percent.
Orders should be sent to:
U.S. General Accounting Office
441 G Street NW,
Room LM Washington,
D.C. 20548:
To order by Phone:
Voice: (202) 512-6000:
TDD: (202) 512-2537:
Fax: (202) 512-6061:
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: www.gao.gov/fraudnet/fraudnet.htm E-mail: fraudnet@gao.gov
Automated answering system: (800) 424-5454 or (202) 512-7470:
Public Affairs:
Jeff Nelligan, managing director, NelliganJ@gao.gov (202) 512-4800 U.S.
General Accounting Office, 441 G Street NW, Room 7149 Washington, D.C.
20548:
