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VA faces another computer problem

A report done for the administration suggests that the VA's multibillion-dollar plan to upgrade its system is "not realistic."

By PAUL DE LA GARZA and STEPHEN NOHLGREN
Published April 13, 2005

A $3.5-billion computer overhaul at veterans hospitals across the country is poised to fail unless the Department of Veterans Affairs makes drastic changes, according to a closely guarded government study obtained by the St. Petersburg Times .

The multiyear project is designed to modernize almost all phases of hospital computing at the VA, including appointment schedules, lab reports, drug prescriptions and a clinical record system already widely admired as one of the best in the world.

But a February report by Carnegie Mellon University, which the VA hired to evaluate the computer conversion, says the ambitious undertaking - known as HealtheVet, or HeV - is "not viable" and an "unacceptably high risk."

And if the project fails, the VA could not deliver timely medical care to 5-million veterans, another internal VA document says. The result would be "gridlock."

"The VA must rethink HealtheVet," says the Carnegie Mellon report . "Current plans are not realistic given the complexity and magnitude of HeV and the VA's ability" to carry out those plans.

As of Tuesday, the VA had not shared the Carnegie Mellon report with Congress, said Rep. C.W. Bill Young, R-Indian Shores. After receiving a copy from the Times, Young said the House Appropriations Committee will launch a formal investigation.

The Bush administration has submitted a $311-million budget request for HeV development in 2006, the first year the program would be fully funded.

Young, a member of the Military Quality of Life and Veterans Affairs Subcommittee and one of the most powerful members in Congress, said that funding will now receive "extra scrutiny."

Last year, a much smaller computer overhaul known as the Core Financial and Logistics System, or CoreFLS, seriously disrupted operations at Bay Pines VA Medical Center in St. Petersburg.

The VA killed CoreFLS after another Carnegie study said it did not work.

CoreFLS cost taxpayers around $300-million.

"We're determined that we're not going to have another CoreFLS fiasco," Young said. "Veterans are too important."

VA spokeswoman Cynthia Church characterized the Carnegie study on HeV as a draft, and declined further comment. A Carnegie spokeswoman also declined comment.

In a conference call with VA staff, information technology manager Nancy Wilck said the VA would address some of Carnegie's concerns, but not all.

Following everything Carnegie Mellon suggested would "choke" the VA and the computer conversion would never get done, Wilck said.

In a letter Tuesday to VA Secretary James Nicholson, Sen. Bill Nelson, the Florida Democrat who serves on the Armed Services Committee, said that in light of the CoreFLS debacle, he wanted answers about the recent Carnegie findings.

"At this time of record-high budget deficits, it makes sense that agencies of the federal government be extra vigilant with taxpayers' money," Nelson wrote. "Not addressing potential problems with a national health-data repository now could lead to another fiscal disaster."

"It's horrifying, billions of dollars at stake and it seems nobody is minding the ship over there."

--KEITH ASHDOWN, Taxpayers for Common Sense

The HeV study was conducted from November 2004 through January by consultants with Carnegie's SoftWare Engineering Institute. They interviewed more than 100 VA employees. The report agreed that the VA needs to replace its current computer system, but cited many technical and managerial problems with the VA's plans:

--Deadlines - not test results - are driving the project. "Critical processes and procedures (are) frequently eliminated to meet end dates."

--The VA has inadequately assessed risks and alternatives.

--Managers at headquarters don't listen to experts, and "many decisions are driven by unrealistic, subjective information."

--VA culture inhibits "raising risks, issues, problems or differing opinions."

--The project management office "does not have the needed staff, authority, responsibility or operational procedures."

VA hospitals, clinics and nursing homes run on a complex web of computer programs known as VistA. It has evolved over 25 years and was created piecemeal by VA doctors, nurses and technology wonks who swapped ideas from hospital to hospital.

VistA's crown jewel is the computerized patient record system, which tells doctors and nurses everything they need to know about each patient's tests and condition. MRIs and lab results pop up on laptop screens seconds after completion.

Patients wear bar-code wrist bands, readable by hand-held scanners, that have reduced medication errors by 70 percent.

"The VA's integrated health information system ... is considered one of the best in the nation," the Institute of Medicine concluded in 2002.

For nearly a decade, however, VA headquarters has told Congress it must replace VistA with a more "modern" system, built on commercial software like Oracle. VistA is great for running individual hospitals, VA managers say, but not a huge health care system.

For example, the VA would like a soldier injured in Iraq to receive treatment in a Department of Defense hospital, transfer to a VA hospital in Michigan, retire to Florida, get simultaneous care from VA and Medicare doctors - all using computers that easily exchange information.

But VistA has quirks that vary from hospital to hospital. Patient records currently transfer electronically between hospitals, but it can take hours.

VistA also was written in a computer language called MUMPS, which is rarely taught. Finding programmers to maintain and upgrade VistA has proven expensive, the VA says.

HealtheVet would be written in more common languages, which would allow the VA to communicate more easily with the broader health care universe. More vendors also could compete for VA business and VA computers could easily swap out programs as new commercial software came online.

According to the VA's timetable, the HealtheVet system will be developed and installed over the next five years. Work is under way on a few applications, like patient scheduling and pharmacy operations.

Development costs are expected to fall between $1-billion and $2-billion, according to documents the VA submitted to the Office of Management and Budget. Total maintenance and development costs over 10 years are pegged at $3.5-billion.

At least, that's the theory.

In November, senior VA engineer John Beaufait also evaluated HeV's risks. The primary risk, he wrote in an internal report, obtained by the Times, was that the VA lacked performance goals to monitor progress while changing from the old system to the new.

How would managers know if the new system was on track?

Beaufait noted that "there is a risk that the projected, budgeted, or purchased systems will be insufficient to meet our actual requirements."

The proposed HeV hardware, operating system and database programs were based only on paper evaluation, not real testing, Beaufait wrote.

"We don't have an opportunity to do extensive lab and field tests before purchasing first HeV systems, and don't have time for an acceptance test of what is purchased. ... We don't even have an application we can use in a test lab environment."

Those concerns dovetailed with Carnegie Mellon's recommendations:

--The VA needs a better grasp of how people use its current system, including local variations, the report says. "The VA cannot gauge forward progress until it knows where it is."

--The VA needs a better vision of how the new system will work, with a road map of how each change will be staged, along with contingency plans if things turn sour.

--Tradeoffs must be considered. The current system has thousands of wrinkles. If the VA changes one feature, how will that affect every other feature?

In Washington, Keith Ashdown of Taxpayers for Common Sense welcomed the study and the congressional investigation. Ashdown said the VA lacks competent leadership in information technology.

"It's horrifying," Ashdown said, "billions of dollars at stake and it seems nobody is minding the ship over there."

Ashdown praised members of Congress for taking an early interest in the program.

"A lot of the time hearings are done retroactive when the waste has already occurred," he said, "and there's an opportunity here to save a lot of money and I hope that's a parade that a lot of lawmakers want to be a part of."

[Last modified April 13, 2005, 01:31:06]