VA program to schedule patient appointments on verge of collapse

Failure of the overdue application, a core piece of a new medical system, angers veterans groups and has officials worried about a reaction from the Hill and White House.

An eight-year-old, $167 million project to develop a core computer application to schedule patient appointments at hospitals run by the Veterans Affairs Department has all but collapsed, and senior executives are worried about the repercussions it could cause on the Hill and in the White House, according to an internal memo obtained by Nextgov.

The Replacement Scheduling Application Development Program, which VA began building in 2001, "still has not developed a single scheduling capability it can provide to the field, nor is there any expectation of delivery in the near future," wrote Dr. Michael Kussman, undersecretary for health at the Veterans Health Administration, in a March 20 memo to Stephen Warren, acting assistant secretary for information and technology.

The scheduling application is a core piece of VA's new HealtheVet, a vast medical platform that will include patient enrollment and scheduling systems, a data repository, electronic health records, a pharmacy system, a workload management system, and a way for patients to manage their medical records and personal information. VA plans to use the system to replace its aging Veterans Health Information System and Technology Architecture (VistA), the Government Accountability Office reported on June 20, 2008.

The botched effort comes on the heels of another scheduling program -- a five-year, $75 million failed project started in 2001. That program, the Scheduling Replacement Project, was started by IT staffs in the VA healthcare regions serving Louisiana, Oklahoma, Mississippi and Texas, but after five years of work they failed to develop a usable product. Top VA management then transferred development in November 2006 to a new centralized VA IT operation. Kussman said the failure of the Scheduling Replacement Project precipitated a decision by then VA Chief Information Officer Robert McFarland to centralize all IT development in the Office of Information and Technology in the department's headquarters.

A pilot version of the scheduling program was supposed to be installed at the VA Medical Center in Muskogee, Okla., in the summer of 2008, Dr. Paul Tibbits, head of the Office of Enterprise Development at the Office of Information and Technology, told a House Veterans Affairs Committee hearing in 2007. He also said he anticipated the program would be in use in all VA hospitals by January 2011.

But Kussman's memo detailed a series of "significant test failures" with a beta version of the scheduling system, which had less functionality than originally envisioned. In February, VA terminated its contract with the schedule application developer, Southwest Research Institute, based in San Antonio. A spokeswoman for the organization did not return a call for comment by deadline.

Kussman added his office was not notified until March 18 that the problems with the scheduling applications were so significant that the program has been suspended.

The suspension is "significant and likely to generate intense congressional and Office of Management of Budget interest," Kussman said. "This is also of concern . . . because of the numerous representations of clear progress we have been making, not only to Congress and OMB, but more importantly to our health care providers, who are eagerly waiting for this capability."

The patient scheduling project has "floundered under VHA's leadership since 1998," Rep. Steve Buyer, R-Ind., the ranking member of the House Veterans Affairs Committee, said in a statement. He added the current failure exemplifies the need for VA to develop a professional cadre of contracting officers and program managers.

Buyer said VA must make significant management changes to improve its effort to centralize IT development. "Stovepiped management within the existing VA organization and hidden pockets of application dollars continue to challenge this consolidation," he said. "Bureaucratic backroom skirmishes that occur on a regular basis are hamstringing successful and disciplined development of new IT systems and applications and wasting taxpayer dollars."

VA needs the scheduling application to manage a forecasted sharp increase in the number of veterans seeking care at its medical facilities during the next several years, said Paul Sullivan, executive director of Veterans for Common Sense. He said VA will soon be hit by a "tidal wave" of veterans and predicted the number of Iraq and Afghanistan veterans will jump from 400,000 in September 2008 to 600,000 in September 2010.

"VA has a decade-long history of initiating IT programs, only to experience extensive delays and major cost overruns," said Gerald Manar, deputy director of the National Veterans Service at the Veterans of Foreign Wars. "The fact that VA has frittered away eight years and millions of dollars in developing the RSA, with no viable results and no end in sight, is extremely disappointing but, based on its track record, not surprising."

Adrian Atizado, assistant national legislative director for the Disabled American Veterans group, urged VHA to take control of its IT programs to avoid problems such as suspension of the scheduling application. VHA "should regain its authority for planning, programming, operating and budgeting information technology matters that directly affect delivery of health care to enrolled veterans in coordination with the VA chief information officer."

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