VA plans to implement DSS at 161 of its hospitals. Private sector hospitals already use decision support systems to achieve these objectives. DSS also has the capability to “roll-up” information to the corporate level. Correcting these problems will not be easy because VA’s culture has not traditionally focused on the cost-effectiveness of hospital operations. Our review showed that some clinical data provided to DSS from DHCP and other clinical feeder systems are incomplete or inaccurate. We also suggested that VHA consider selecting a small number of sites to pilot the use of DSS by management before the system is implemented throughout VA. By piloting DSS at selected sites, VHA can (1) document the kinds of benefits that have been gained from using the system and (2) identify the problems that have occurred at the pilot test sites requiring top management’s attention and resolution. A comprehensive, proactive DSS strategy that establishes business goals, leadership, and accountability would provide a framework within which management could improve health care delivery and cost recovery. Recommendations

To increase the likelihood of DSS’ success, we recommend that the Secretary of Veterans Affairs direct the Under Secretary for Health to develop a comprehensive business strategy to identify the specific business goals (for example, reduction of cost in a specific area by a specific percentage), performance measures, and key decisions that DSS will be required to support; give high priority, by allocating appropriate resources, to establishing a complete, consistent, and accurate DSS information infrastructure; and identify data that are needed to support decision-making and ensure that these data are complete, accurate, consistent, and reconciled monthly. Lastly, the VHA Chief Financial Officer did not agree that DSS should not be implemented beyond the 38 sites already begun until (1) defined business goals and a supporting information infrastructure are in place and (2) VA has demonstrated its ability to use DSS effectively.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the Veterans Health Administration's (VHA) efforts to implement a medical decision support system, focusing on: (1) the kinds of benefits that such a system can provide the Department of Veterans Affairs (VA); (2) whether VA is pursuing the comprehensive business strategy needed to achieve these benefits; and (3) whether VA is establishing an adequate information infrastructure for the Decision Support System (DSS).

What GAO Found

GAO found that: (1) DSS has the potential to be an effective tool for improving the quality and cost-effectiveness of VHA health care operations; (2) VA has not formulated business goals or a comprehensive implementation strategy to clearly define how it will use DSS-generated information or prioritize its limited resources to implement DSS; (3) VA also has not established the information infrastructure needed to support DSS; (4) some of the data provided to DSS from other VA information systems are incomplete and inaccurate, limiting VA ability to make sound business decisions; and (5) sustaining top management leadership and commitment within VHA is critical to the successful implementation and use of DSS.