The department’s health information system— the Veterans  Health Information Systems and Technology Architecture (VistA)—serves  an essential role in helping the department to fulfill its health care delivery  mission. VA reported spending about $3.9 billion to improve and maintain its IT  resources in fiscal year 2015. In addition, in its 2017 budget submission, the  department requested appropriations to make improvements in a number  of areas, including:  veterans’ access to health care, to include enhancing health care- related systems, standardizing immunization data, and expanding  telehealth services ($186.7 million);  veterans’ access to benefits by modernizing systems supporting  benefits delivery, such as VBMS and the Veterans Services Network  ($236.3 million);  veterans’ experiences with VA by focusing on integrated service  delivery and streamlined identification processes ($171.3 million);
VA employees’ experiences by enhancing internal IT systems ($13  information security, including implementing strong authentication,  ensuring repeatable processes and procedures, adopting modern  technology, and enhancing the detection of cyber vulnerabilities and  protection from cyber threats ($370.1 million). VA Has Begun to Implement VistA Modernization Plans amid Concerns about Its Long-term Approach, Metrics, and Duplication

Although VA has proceeded with its program to modernize VistA (known  as VistA Evolution), the department’s long-term plan for meeting its  electronic health record system needs beyond fiscal year 2018 is  uncertain. VA, Together with DOD and the Interagency Program Office, Have Not Developed Goals and Metrics for Assessing Interoperability

Beyond modernizing VistA, VA has undertaken numerous initiatives with  DOD that were intended to advance electronic health record  interoperability between the two departments. Yet, a significant concern is  that these departments have not identified outcome-oriented goals and  metrics to clearly define what they aim to achieve from their  interoperability efforts, and the value and benefits these efforts are  expected to yield. VA’s Plan to Modernize VistA Raises Concern about Duplication with DOD’s Electronic Health Record System Acquisition

VA has moved forward with modernizing VistA despite concerns that  doing so is potentially duplicative with DOD’s acquisition of a  commercially available electronic health record system. Specifically, VA  took this course of action even though it has many health care business  needs in common with DOD. We recommended that VA and DOD develop cost and schedule  estimates that would include all elements of their approach (i.e., to  modernize both departments’ health information systems and establish  interoperability between them) and compare them with estimates of the  cost and schedule for developing a single, integrated system. However, as of January 2017, the  departments had not provided us with a comparison of the estimated  costs of their current and previous approaches. Scheduling System Challenges Contributed to Designation of VA Health Care as High Risk

In February 2015, we designated VA health care as a high-risk area. We have previously reported on the department’s outpatient appointment  scheduling system, which is about 30 years old. In May 2010, we reported that, after spending an estimated $127 million  over 9 years on its outpatient scheduling system modernization project,  VA had not implemented any of the planned system’s capabilities and  was essentially starting over by beginning a new initiative to build or  purchase another scheduling system. 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. We recommended, among other actions, that the department develop a  plan with a time frame and a reliable cost estimate for completing VBMS,  establish goals for system response time, assess user satisfaction, and  establish satisfaction goals to promote improvement. Specifically, we reported that VA’s closure of 20 out of its total of 356 data  centers gave the department a 6 percent closure rate through fiscal year  2015—ranking its closure rate 19th lowest out of the 24 agencies we  studied. With regard to cost savings and avoidance resulting from data center  consolidation, our analysis of the department’s data identified a total of  $19.1 million in reported cost savings or avoidances from fiscal year 2011  though fiscal year 2015. This equated to only about 0.7 percent of the  total of approximately $2.8 billion that all 24 agencies reported saving or  avoiding during the same time period. VA also lagged behind other agencies in making progress toward  addressing data center optimization metrics established by OMB in  2014. Accordingly, we recommended that VA take action to improve its  progress in the data center optimization areas that we reported as not  meeting OMB’s established targets. Personnel and Accounting Integrated Data (PAID)—This 53-year old  system automates time and attendance for employees, timekeepers,  payroll, and supervisors. Benefits Delivery Network (BDN)—This 51-year old system tracks  claims filed by veterans for benefits, eligibility, and dates of death. Accordingly, we recommended that VA identify and plan to modernize or  replace its legacy systems. Further, VA has not justified the  development and operation of an electronic health record system that is  separate from DOD’s system, even though the departments have  common system needs. Further, the department has  not yet demonstrated expected progress toward consolidating and  optimizing the performance of its data centers. In addition, VA’s continued  operation of two of the oldest legacy IT systems in the federal  government raises concern about the extent to which the department  continues to spend funds on IT systems that are no longer effective or  cost beneficial.
Why GAO Did This Study

The use of IT is crucial to helping VA effectively serve the nation's veterans, and each year, the department spends over $4 billion on IT. However, over many years, VA has had difficulty managing its information systems, raising questions about the effectiveness of its operations and its ability to deliver intended outcomes needed to help advance the department's mission. GAO has previously reported on a number of the department's IT initiatives.
This statement summarizes results from key GAO reports related to increasing electronic health record interoperability between VA and DOD; system challenges that have contributed to GAO's designation of VA health care as a high-risk area; and VA's development of its system for processing disability benefits, data center consolidation, and legacy systems.

What GAO Found

GAO noted in July 2016 that the Department of Veterans Affairs (VA) had moved forward with an effort to modernize its health information system—the Veterans Health Information Systems and Technology Architecture (VistA)—but that the department is uncertain of its long-term plan for addressing its electronic health record system needs beyond fiscal year 2018. Beyond modernizing VistA, GAO reported in August 2015 that VA and the Department of Defense (DOD) had not identified outcome-oriented goals and metrics to clearly define what they aim to achieve from their efforts to increase electronic health record interoperability (i.e., the electronic exchange and use of health records) between the two departments. Moreover, VA has begun to modernize VistA separate from DOD's planned acquisition of a commercially available electronic health record system, even though both departments have many health care business needs in common. In 2014, GAO noted that the departments' decision to abandon the development of a single system in favor of modernizing their two separate systems was not justified and was identified as an example of duplication among government activities. The departments have not yet provided a comparison of the estimated costs and schedules of their current and previous approaches as GAO recommended.
In February 2015, GAO designated VA health care as a high-risk area, with IT challenges being one contributing factor. Specifically, GAO noted that the outpatient appointment scheduling system, which is currently about 30 years old, is time-consuming to use and error prone. However, the project to modernize that system failed after VA spent an estimated $127 million over 9 years. VA has begun a new initiative to build or purchase another scheduling system.
GAO reported in September 2015, that VA had made progress implementing the Veterans Benefits Management System (VBMS) for processing disability benefits. However, the department had not developed a time frame and a reliable cost estimate for completing VBMS. VA also had not established goals for system response time, and had not minimized incidences of high and medium severity system defects for future VBMS releases. Further, the department had not assessed user satisfaction, or established user satisfaction goals.
In addition, VA's consolidation and closure of data centers has lagged behind other agencies, as GAO reported in March 2016. For example, VA's closure of 20 out of a total of 356 data centers gave the department a 6 percent closure rate through fiscal year 2015 that ranked 19th of the 24 agencies in GAO's study. Also, VA's reported $19.1 million in cost savings or avoidances from fiscal year 2011 through fiscal year 2015 was only about 0.7 percent of the total of about $2.8 billion that all 24 agencies reported saving. In addition, the department had not met any of the data center optimization areas established by the Office of Management and Budget.
VA was identified in a May 2016 GAO report as using antiquated and expensive to maintain, legacy IT systems. At that time, the 53-year-old Personnel and Accounting Integrated Data (PAID) system was slated to be replaced in 2017. Further, VA has plans to retire the 51-year-old Benefits Delivery Network, which tracks veterans' claims for benefits, eligibility, and death dates in 2018.

What GAO Recommends

GAO has made numerous recommendations to VA to improve the modernization of its IT systems. For example, GAO has recommended that VA develop goals and metrics for determining the extent to which its modernized electronic health record system is achieving interoperability with DOD's; address challenges associated with modernizing its scheduling system; address shortcomings with VBMS planning and implementation; take actions to improve progress in data center optimization; and modernize or replace obsolete legacy IT systems. VA agreed with these recommendations and said it has begun taking actions to implement them.