Five are applications development projects, of which  four are health care applications currently in development and one is a  financial application in the planning stage. The remaining two projects are  to enhance current VistA systems, prepare them for transition to  HealtheVet, and develop new applications. However, since 2003, the time  frames for completing the projects and the HealtheVet system as a whole  have been extended from 2012 to 2018. Of the eight projects in progress, one is currently operational though not  yet completed. The Health Data Repository (HDR) database, which  became operational in 2006, currently contains standardized health data in  three areas: vital signs, allergies, and outpatient pharmacy. This  work is expected to be ongoing until the completion of the HealtheVet  initiative. From the inception of the initiative in 2001 through fiscal year 2007, VA  reported spending almost $600 million for the development of these eight  projects. VA Has Developed an Overall Strategy for HealtheVet, but It Lacks a Project Management Plan

Under VA’s current strategy for HealtheVet, developed in August 2006, the  department is taking an incremental approach to the remainder of the  initiative, based on six phases (referred to as “blocks”) that are to be  completed in 2018. III) with 67  applications, 3 databases, and 10 common services. Further, although the department has  established interim dates for completing projects that are under way, as of  mid-June 2008, the department had not developed a detailed schedule or  approach for completing the HealtheVet initiative, including the remaining  62 software applications, other than to state that it intends to complete all  six blocks of the initiative by 2018. Such a plan also includes an integrated schedule that considers  all dependencies and includes subtasks so that deadlines are realistic, and  it incorporates reviews to allow oversight and approval by high-level  managers. A key component of planning is determining the resources necessary to  accomplish the myriad tasks needed throughout the life cycle of the  initiative. In April 2008, VA provided an $11 billion cost estimate to  complete HealtheVet; however, it has not yet independently validated  these estimates. We stress in our Cost Assessment Guide that having a  validated cost estimate is essential to improve the accuracy of cost,  schedule, and performance management. Without an integrated plan that includes independently validated cost  estimates, VA increases the risk that HealtheVet could incur schedule  slippages and cost increases and not achieve what it intends to achieve. For the HealtheVet initiative, various levels and types of oversight are  currently provided by the business owner (the Veterans Health  Administration), the developers (the Office of Enterprise Development  within the department’s CIO organization), and departmental IT  governance boards. However, the business unit has not yet finalized a  governance plan or implemented a complete governance structure, several  key leadership positions within the developers’ organization are either  vacant or filled with acting personnel, and the IT governance boards have  not yet scheduled critical reviews of HealtheVet projects. Until all  elements of governance and oversight are in place, the risk is increased  that the HealtheVet initiative may experience cost overruns and continued  schedule slippages and may not achieve what it intends to achieve. Appendix I: Objectives, Scope, and Methodology

As requested, the objectives of our review were to determine (1) the status  of the HealtheVet initiative, (2) VA’s overall plan for completing the  initiative, and (3) how VA is providing oversight to ensure the success of  the initiative.
Why GAO Did This Study

The Department of Veterans Affairs (VA), through its Veterans Health Administration (VHA), provides health care for more than 5 million veterans each year. In 2001, VHA began an initiative, HealtheVet, to modernize its current medical information system. GAO's objectives were to determine the status of the modernization, VA's overall plan for completing it, and how VA is providing oversight to ensure the success of the initiative. To conduct this review, GAO analyzed project documentation and interviewed officials responsible for the development and implementation of the new system.

What GAO Found

As of June 2008, the HealtheVet initiative has these eight major software development projects under way. One project is to further develop the Health Data Repository, a database of standardized health data. This database, which is currently operational, is not yet complete; additional types of health data remain to be standardized and added to the repository. Four application projects are currently in development. One application project is in the planning stage. Two projects are being pursued to enhance current systems, prepare them for transition to HealtheVet, and develop new applications. From 2001 through fiscal year 2007, VA reported spending almost $600 million for these eight projects. The time frame for completing the projects and the HealtheVet system as a whole was 2012, but the projected completion date has now been delayed until 2018. The department has a high-level strategy for HealtheVet, in which the remainder of the initiative is to be completed incrementally in phases (referred to as "blocks"), but it does not have a comprehensive project management plan to guide the remaining work. This work is considerable: the department plans to replace the 104 applications in its current medical information system with 67 modernized applications (of which 5 are currently in development, as described), 3 databases, and 10 common services (general software functions, such as messaging and security, on which application software can call as needed). In view of this scope, the importance is increased of developing a comprehensive project management plan that includes, among other things, an integrated schedule that considers all dependencies and defines subtasks to ensure that deadlines are realistic. Another important component of such planning is determining the resources necessary to accomplish tasks throughout the life cycle of the initiative. In April 2008, VA provided an $11 billion cost estimate for completion of HealtheVet; however, it has not yet independently validated this estimate. Having a validated cost estimate is essential to improve the accuracy of cost, schedule, and performance management. Without an integrated plan that includes independently validated cost estimates, VA increases the risk that HealtheVet could incur cost increases and continued schedule slippages and not achieve its intended outcomes. Various levels and types of oversight are currently being provided for the HealtheVet initiative by business owners, developers, and departmental information technology governance boards. However, the business owners have not yet implemented a complete governance structure, several key leadership positions within the developers' organization are either vacant or filled with acting personnel, and the governance boards have not yet scheduled critical reviews of HealtheVet projects. Until all elements of governance and oversight are in place, the risk to the success of the HealtheVet initiative is increased.