However, a number of VA’s systems are old. VA concurred with our  recommendation and stated that it is planning to retire PAID and BDN in  2017 and 2018, respectively. IT Challenges Contributed to Designation of VA Health Care as High Risk

In February 2015, we designated VA health care as a high-risk area. Among the five broad areas contributing to our determination was the  department’s IT challenges. Of particular concern was the failed  modernization of a system, suspended development of another system,  and the extent of system interoperability—the ability to exchange  information—with DOD, which present risks to the timeliness, quality, and  safety of VA health care. We have reported on the department’s failed attempts to modernize its  outpatient appointment scheduling system, which is about 30 years old. Additionally, we reported in February 2014 that VA and DOD lacked  electronic health record systems that permit the efficient electronic  exchange of patient health information as military service members  transition from DOD to VA health care systems. VA and DOD agreed with our prior recommendations and stated that  initial comparison indicated that the current approach would be more cost  effective. Recent Evaluations Have Identified Additional IT Challenges

To further highlight the department’s IT challenges, our most recent report  in August 2015 on VA’s efforts to achieve electronic health record  interoperability with DOD noted that the departments have engaged in  several near-term efforts focused on expanding interoperability between  their existing electronic health record systems. In addition, VA and DOD have moved forward with plans to modernize  their respective electronic health record systems. Nevertheless, a significant concern that we identified is that VA (and  DOD) had not identified outcome-oriented goals and metrics that would  more clearly define what they aim to achieve from their interoperability  efforts and the value and benefits these efforts are intended to yield. Accordingly, we recommended that the departments,  working with the IPO, establish a time frame for identifying outcome- oriented metrics, define related goals as a basis for determining the  extent to which the departments’ modernized electronic health record  systems are achieving interoperability, and update IPO guidance  accordingly. VA concurred with our recommendations and has told us that  it has initiated actions in response to them. Efforts to Develop and Use the Veterans Benefits Management System Can Be Improved

In September 2015, we reported that VBA had made progress in  developing and implementing VBMS, its system that is to be used for  processing disability benefit claims. Specifically, it had deployed the  initial version of the system to all of its regional offices as of June 2013. As VA continues its efforts to complete the development and  implementation of VBMS, we reported in September 2015 that three  areas could benefit from increased management attention. We also found in our September 2015 report that VA had not conducted a  customer satisfaction survey that would allow the department to compile  data on how users view the system’s performance, and ultimately, to  develop goals for improving the system. In our September 2015 report, we recommended that VA develop a plan  with a time frame and a reliable cost estimate for completing VBMS,  establish goals for system response time, minimize the incidence of high  and medium severity system defects for future VBMS releases, assess  user satisfaction, and establish satisfaction goals to promote  improvement. Modernization of Health Care Claims Processing System Requires Additional Planning to Ensure Weaknesses Are Addressed

As we reported in May 2016, VA’s expenditures for its care in the  community programs, the number of veterans for whom VA has  purchased care, and the number of claims processed by VHA have all  grown considerably in recent years. The substantial increase in  utilization of VA care in the community programs poses staffing and  workload challenges for VHA, which has had ongoing difficulty processing  claims from community providers in a timely manner. Thus, to help provide reasonable  assurance that VHA achieves its long-term goal of modernizing its claims  processing system, we recommended in May 2016 that the Secretary of  Veterans Affairs direct the Under Secretary for Health to ensure that the  agency develops a sound written plan that includes: a detailed schedule for when VHA intends to complete development  and implementation of each major aspect of its new claims processing  system;  the estimated costs for implementing each major aspect of the  system; and  the performance goals, measures, and interim milestones that VHA  will use to evaluate progress, hold staff accountable for achieving  desired results, and report to stakeholders the agency’s progress in  modernizing its claims processing system. The department concurred with our recommendation and said that VHA  plans to address the recommendation when the agency develops an  implementation strategy for the future consolidation of its VA care in the  community programs. In conclusion, effective IT management is critical to the performance of  VA’s mission. The department faces challenges in key areas, including  the development of new systems, modernization of existing systems, and  increasing interoperability with DOD.
Why GAO Did This Study

VA relies on IT to meet its mission and effectively serve the nation's veterans. Over the past several years, the department has expended billions of dollars to manage and modernize its information systems. However, VA has experienced challenges in managing its IT, raising questions about the effectiveness of its IT operations. GAO has previously reported on a number of the department's IT initiatives.
This statement summarizes results from key GAO reports issued between 2010 and 2014 highlighting IT challenges that have contributed to GAO's designation of VA health care as a high risk area. It also describes additional challenges that GAO more recently identified in 2015 and 2016 that are related to increasing the electronic exchange of VA's health records with those of DOD, development and use of VBMS, and the department's modernization of its health care claims processing system.

What GAO Found

In February 2015, GAO designated Veterans Affairs (VA) health care as a high-risk area based on its concerns about the department's ability to ensure the quality and safety of veterans' health care in five broad areas, one of which was information technology (IT) challenges. Of particular concern at that time was the failed modernization of an outpatient appointment scheduling system, suspended development of a system that was to electronically store and retrieve information about surgical implants, and the extent of system interoperability—the ability to exchange information—with the Department of Defense (DOD), which present risks to the timeliness, quality, and safety of VA health care.
Subsequent to the designation of VA health care as high risk, GAO completed evaluations that identified additional IT management challenges at VA.
In August 2015, GAO reported on VA's efforts to achieve electronic health record interoperability with DOD and noted that (1) the two departments had engaged in several near-term efforts to expand interoperability and (2) VA and DOD had moved forward with plans to separately modernize their electronic health record systems. However, of significant concern was that VA (and DOD) had not identified outcome-oriented goals and metrics that would clearly define what it aims to achieve from its efforts. GAO recommended that VA develop goals and metrics, among other things. VA concurred with the recommendations and stated that it has initiated actions in response.
VA had made progress in developing and implementing its Veterans Benefits Management System (VBMS), with deployment of the initial version of the system. However, in September 2015, GAO reported that the development and implementation of the system was ongoing and noted three areas that could benefit from increased management attention: cost estimating, system availability, and system defects. The report also noted that VA had neither conducted a customer satisfaction survey nor developed goals for improving the system. GAO recommended that VA develop a plan with a time frame and a reliable cost estimate for completing VBMS, establish goals for system response time, minimize the incidences of high and medium severity system defects for future VBMS releases, assess user satisfaction, and establish satisfaction goals to promote improvement. VA agreed with the recommendations and noted steps it was taking to address them.
Due to recent increases in utilization of VA care in the community, the department has had difficulty processing claims in a timely manner. In May 2016, GAO reported that VA officials and claims processing staff indicated that IT limitations, manual processes, and staffing challenges had delayed claims processing. The department had implemented interim measures to address some of the system's challenges, but did not expect to deploy solutions to address all challenges, including those related to IT, until fiscal year 2018 or later. Further, VA did not have a sound plan for modernizing its claims processing system, which GAO recommended it develop. The department concurred with this recommendation and stated that it intended to address the recommendation through the planned consolidation of its care in the community programs.

What GAO Recommends

GAO has made numerous recommendations to VA to improve the modernization of its IT systems. Among other things, GAO has recommended that VA address challenges associated with its efforts to modernize its electronic health record system to increase interoperability with DOD, develop goals and metrics as a basis for determining the extent to which VA's and DOD's modernized electronic health records systems are achieving interoperability, address shortcomings with VBMS planning and implementation, and develop a sound written plan for deploying its modernized claims processing system. VA has concurred with these recommendations and has some actions ongoing.