More specifically,  VHA provides health care services, including primary care and  specialized care, and it performs research and development to improve  veterans’ needs. This program office is  responsible for providing organizational guidance on a broad range of  pharmacy activities to the 260 pharmacies located in VA’s medical  centers and outpatient clinics. Key IT Management Processes Are Partially Consistent with Leading Practices

VA has established IT management processes that are partially  consistent with leading practices. The HISP identifies strategic goals and objectives related to health  IT within VHA. VHA’s IT Investment Management Process Is Consistent with Leading Practices, but a Department-level Board Has Been Inactive and Clear Investment Selection Criteria Have Not Been Defined

According to leading practices for IT investment management,  establishing and following a systematic and organized approach to  investment management helps lay the foundation for successful,  predictable, and repeatable investment decisions. One of these boards—the Portfolio Investment  Management Board—has been identified by its charter as the  department-level IT investment review board to be responsible for  integrating IT investment decisions with VA’s mission, strategic plan,  budget, and enterprise architecture. This framework defines a  total of 262 core business functions as part of the VHA business  architecture. VHA’s Core Business Functions Are Not Fully Supported by Current IT Systems

VA’s IT systems are generally aligned to VHA core business functions,  but the administration has unaddressed needs that indicate current IT  systems do not fully support the functions. However, our review of new service requests, which are requests in the  NSR database for identified IT needs submitted by VHA programs and  business owners, determined that VHA’s core business functions are not  fully supported by systems. In this regard, as of October 2016, VHA had 2,772 requests for  IT needs documented in the NSR database since 1998. Of these,  approximately 817 were open requests—IT needs identified throughout  VHA that had not been met. Further, 316, or about 39 percent, of these  open needs are long-standing—they have been open for more than 5  years. The fact that business functions are not fully supported is further  illustrated when reviewing needs associated with three program areas— pharmacy benefits management, scheduling, and community care— which all have open requests that represent long-standing, unmet IT  needs. Veterans Access to Care (scheduling and consults). However, VA’s partial implementation of effective IT strategic planning,  investment management, and enterprise architecture has put the  department at risk of being unable to fully support VHA with the  information systems it needs to perform its mission of providing high- quality health care to veterans. Recommendations for Executive Action

To assist VA in improving key IT management processes to ensure that  investments support the delivery of health care services, we recommend  that the Secretary of Veterans Affairs direct the Under Secretary for  Health and the Chief Information Officer to take the following four actions:  Identify performance metrics and associated targets for the goals and  objectives in the department’s IT strategic plans, including the  Information Resources Management strategic plan and the Health  Information Strategic Plan, as they relate to the delivery of health IT  and the VHA mission. In  addition, the department stated that it plans to include the outstanding  needs of these key program areas in its VHA IT Requirements  Governance Process during fiscal year 2018 to ensure the needs are  addressed in this multi-year planning review. Appendix I: Objectives, Scope, and Methodology

The objectives of this study were to determine the extent to which the  Department of Veterans Affairs’ (VA) (1) information technology (IT)  management processes are consistent with leading practices and (2)  current IT systems support the Veterans Health Administration’s (VHA)  core business functions. We compared our analysis to critical processes related to  investment selection described in GAO’s framework.
Why GAO Did This Study

VHA, an administration within VA, provides a broad range of primary care, specialized care, and related medical and social support services to veterans. In doing so, VHA operates one of the nation's largest health care systems through 168 VA medical centers and more than 1,000 outpatient facilities. The administration managed total budget resources reported at nearly $91 billion in fiscal year 2016. Based on interest in VHA's ability to oversee its health care system and provide timely care, GAO reviewed IT management at VHA. Specifically, GAO determined the extent to which VA's (1) IT management processes are consistent with leading practices and (2) current IT systems support VHA's core business functions. To do so, GAO analyzed documentation and interviewed officials about VA's approach to IT management processes related to strategic planning, investment management, and enterprise architecture, and compared VA's processes to leading practices. In addition, GAO reviewed data related to VA's IT systems and VHA's IT business needs. GAO further reviewed IT needs from three key VHA program areas.

What GAO Found

The Department of Veterans Affairs (VA) has established information technology (IT) management processes that are partially consistent with leading practices. VA has issued strategic plans that identify goals and objectives related to health IT; established investment review boards at the department-level and within the Veterans Health Administration (VHA) that are responsible for selecting IT investments aligned to VHA priorities; and documented VHA's core business functions within an enterprise architecture. However, the IT strategic plans do not include performance measures and targets for their defined objectives, VA's department-level IT investment board has been inactive and its investment selection guidance lacks criteria, and the department has not fully identified metrics aligned to core business functions to inform investment decisions. Until VA can improve these processes, it risks having IT systems that may not fully support VHA's mission.
IT systems at VA are generally aligned to core business functions defined by VHA; however, among new service requests, which identify unmet needs of business owners, 817 out of a total of 2,772 IT needs identified for VHA since 1998 had not been met as of October 2016. About 39 percent of these open requests had been open for more than 5 years.
GAO's review of the business needs identified in three key program areas—Pharmacy Benefits Management, Veterans Access to Care, and Community Care—showed a number of long-standing needs. According to VA officials, their need to balance the resources for IT needs across the department is a reason that business needs have remained unresolved. Until VA prioritizes resources to address these needs, VHA's programs may not be well supported by IT systems capable of delivering health care services consistent with its objectives.

What GAO Recommends

GAO is recommending that VA address the deficiencies identified with IT strategic planning, investment management, and enterprise architecture; and ensure that the three programs' IT needs are addressed. VA agreed with GAO's recommendations and described actions planned to address them by the end of fiscal year 2018.