VA’s health information  system—VistA—has been essential to the department’s ability to deliver  health care to veterans. Since 2001, VA has identified the need for enhancements and  modifications to VistA and has pursued multiple efforts to modernize the  system. Two major efforts have included the VistA Evolution program  and, most recently, the planned acquisition of the same electronic health  record system that the Department of Defense (DOD) is acquiring. Cerner is to replace VistA  with a commercial electronic health record system. VA Has Reported Obligating about $3.0 Billion to VistA and Related Activities from Fiscal Years 2015 through 2017

According to VA, the department’s costs for VistA and related activities  are approximated by funding obligations of about $1.1 billion, $899  million, and $946 million in fiscal years 2015, 2016 and 2017,  respectively, for a total of about $3.0 billion over 3 years to support the  system. These obligations also include other VistA- related technology investments, such as networks and infrastructure  sustainment, continuation of legacy systems, and overall patient safety,  security, and system reliability. Table 1 provides a summary of the total VistA and related obligations that  VA identified for fiscal years 2015 through 2017. VA Is Working to Define VistA’s Scope and Identify Components to Be Replaced by the Cerner System

Understanding the scope of VA’s current health information system is  essential to effectively planning for the new system. However, according  to VA officials, there is no single information source that fully defines the  scope of VistA. In the absence of a complete definition of VistA, EHRM program officials  have taken a number of steps to define the system’s scope and identify  the components that the Cerner system will replace. These steps have  included conducting two analyses, performing preliminary site  assessments, and planning for Cerner to perform a detailed assessment  of each site where the new system will be deployed. VA’s Preparations for Transitioning from VistA to the Cerner System Are Ongoing

Since the former VA Secretary announced in June 2017 that the  department would acquire the same electronic health record system as  DOD, VA has taken steps to position the department for the transition to  the new system. These actions, which are ongoing, have included  standardizing VistA, assessing the department’s approach to increasing  interoperability, establishing governance for the new program and the  framework for joint governance with DOD, and preparing initial program  plans. Specifically, we reported in 2011 on common factors critical  to the success of IT acquisitions, based on seven agencies having each  identified the acquisition that best achieved the agency’s respective cost,  schedule, scope, and performance goals. The factors are:
Active engagement of senior officials with stakeholders. Additionally, officials for six of the seven selected investments indicated  that the knowledge and skills of the program staff were critical to the  success of the program. Based on these  preliminary observations and as the department continues its activities to  transition from VistA to the Cerner electronic health record system, critical  success factors can serve as a model of best practices that VA could  apply to enhance the likelihood that the acquisition of the new system will  be successfully achieved.
Why GAO Did This Study

VA provides health care services to almost 9 million veterans and their families and relies on its health information system—VistA—to do so. However, the system is more than 30 years old, is costly to maintain, and does not support interoperability with DOD and private health care providers. Since 2001, VA has pursued multiple efforts to modernize the system. In June 2017, VA announced plans to acquire the same system—the Cerner system—that DOD is implementing.
GAO was asked to summarize preliminary observations from its ongoing review of VistA and the department's efforts to acquire a new system to replace VistA. Specifically, the statement summarizes preliminary observations regarding (1) costs incurred for the system and related activities during the last 3 fiscal years; (2) key components that comprise VistA and are to be replaced; and (3) actions VA has taken to prepare for its transition to the Cerner system. The statement also discusses common factors critical to the success of IT acquisitions that GAO has previously identified.
GAO reviewed its prior reports on the VistA modernization and on critical success factors of major IT acquisitions. GAO also reviewed records of obligations for VistA for fiscal years 2015, 2016, and 2017; analyzed VA documentation that describes the scope of VistA, and reviewed program documentation.

What GAO Found

According to the Department of Veterans Affairs (VA), the Veterans Health Information Systems and Technology Architecture (VistA) and related costs, as approximated by funding obligations, were approximately $1.1 billion, $899 million, and $946 million in fiscal years 2015, 2016 and 2017, respectively. These obligations total about $3.0 billion over 3 years to support the system. As identified by the department, the obligations were to cover the costs for three programs (VistA Evolution, Interoperability, and Virtual Lifetime Electronic Record Health) and other supporting investments for activities such as networks and infrastructure sustainment. The following table provides a summary of the total VistA and VistA-related obligations.
GAO's preliminary results indicate that VA is working to define VistA and identify system components to be replaced by the new system. However, according to VA officials, there is no single information source that fully defines the scope of VistA. This situation is partly due to differences in VistA at various facilities. In the absence of a complete definition of VistA, program officials have taken a number of steps to define the system's scope and identify the components that the new system will replace. These steps have included conducting analyses, performing preliminary site (medical facility) assessments, and planning for a detailed assessment of each site where the new system will be deployed.
Since VA announced in June 2017 that the department would acquire the same electronic health record system as the Department of Defense (DOD), GAO's preliminary results indicate that VA has begun taking actions to prepare for the transition from VistA. These actions have included standardizing VistA, clarifying the department's approach to interoperability, establishing governance for the new program and the framework for joint governance with DOD, and preparing initial program plans. VA is early in its effort to transition from VistA to the Cerner system and the department's actions are ongoing.
In 2011, GAO reported on nine common factors critical to the success of major IT acquisitions. Such factors include ensuring active engagement of senior officials with stakeholders and having qualified, experienced program staff. These critical success factors can serve as a model of best practices that VA could apply to enhance the likelihood that the acquisition of a new electronic health record system will be successfully achieved.