VA Relies Extensively on IT

The use of IT is critically important to VA’s efforts to provide benefits and  services to veterans. Specifically, VistA is an integrated medical  information system for all veterans’ health information. This office is led  by the Assistant Secretary for Information and Technology—VA’s Chief  Information Officer (CIO). For example, in its fiscal year 2018  budget submission, the department requested appropriations to support  five IT portfolios, including the development and operations and  maintenance for programs and projects related to the:
Medical portfolio, which provides technology solutions to deliver  modern, high-quality medical care capabilities to veterans ($944.2  million);
Benefit portfolio, which addresses the technology needs managed by  the Veterans Benefit Administration ($296.9 million);
Memorial Affairs portfolio, which provides support for the  modernization of applications and services for National Cemeteries at  133 locations nationwide ($24.5 million);
Corporate portfolio, which consists of back office operations  supporting the major business lines and department management  ($270.6 million); and
Enterprise IT, which provides the underlying infrastructure to enable  the other portfolios to operate and includes such things as  cybersecurity, data centers, cloud services, telephony, enterprise  software, and data connectivity ($1.289 billion). FITARA Is Intended to Help VA and Other Agencies Improve Their Acquisitions of IT

Congress enacted federal IT acquisition reform legislation (commonly  referred to as the Federal Information Technology Acquisition Reform Act,  or FITARA) in December 2014. This legislation was intended to improve  agencies’ acquisitions of IT and enable Congress to monitor agencies’  progress and hold them accountable for reducing duplication and  achieving cost savings. These four efforts—HealtheVet, the integrated Electronic Health Record  (iEHR), VistA Evolution, and the Electronic Health Record Modernization  (EHRM)—reflect varying approaches that the department has considered  to achieve a modernized health care system over the course of nearly two  decades. The program was intended to replace  the two separate electronic health record systems used by the two  departments with a single, shared system. Figure 1 shows a timeline of the four efforts that VA has pursued to  modernize VistA since 2001. VA Obligated about $1.1 Billion for VistA Modernization Contracts During Fiscal Years 2011 through 2016

For iEHR and VistA Evolution, the two modernization initiatives for which  VA could provide contract data, the department obligated approximately  $1.1 billion for contracts with 138 different contractors during fiscal years  2011 through 2016. VA obligated funds to all 15 of the key contractors for system  development, 13 of the key contractors for project management, and 12  of the key contractors for operations and maintenance. Further, while VA  has reported $23.61 million in data center-related cost savings and  avoidances for 2012 through August 2017, the department does not  expect to realize further savings from the additional 10 data center  closures in the next year. VA’s CIO certified the use of  adequate incremental development for all 10 of its major IT investments. However, VA had not yet updated the department’s policy and process for  the CIO’s certification of major IT investments’ adequate use of  incremental development, in accordance with OMB’s guidance on the  implementation of FITARA as we recommended. The department also issued a directive that  documents VA’s software license management policy and responsibilities  for central management of agency-wide software licenses, consistent with  our recommendations. This solution should  allow VA to identify cost saving opportunities and inform future investment  decisions. VA has  recently begun the fourth modernization program in which it plans to  replace VistA with the same commercially available electronic health  record system that is used by DOD. Beyond VistA, the department continues to make progress on key  FITARA-related initiatives. Although the department has made progress  in the area of software licensing, additional actions in the areas of data  center consolidation and optimization, as well as incremental system  development can better position VA to effectively manage its IT.
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 billions of dollars on its information systems and assets. However, VA has faced challenges spanning a number of critical initiatives related to modernizing its major systems. To improve all major federal agencies' acquisitions and hold them accountable for reducing duplication and achieving cost savings, in December 2014 Congress enacted federal IT acquisition reform legislation (commonly referred to as the Federal Information Technology Acquisition Reform Act , or FITARA).
GAO was asked to summarize its previous and ongoing work regarding VA's history of efforts to modernize VistA, including past use of contractors, and the department's recent effort to acquire a commercial electronic health record system to replace VistA. GAO was also asked to provide an update on VA's progress in key FITARA-related areas, including (1) data center consolidation and optimization, (2) incremental system development practices, and (3) software license management. VA generally agreed with the information upon which this statement is based.

What GAO Found

For nearly two decades, the Department of Veterans Affairs (VA) has undertaken multiple efforts to modernize its health information system—the Veterans Health Information Systems and Technology Architecture (known as VistA). Two of VA's most recent efforts included the Integrated Electronic Health Record (iEHR) program, a joint program with the Department of Defense (DOD) intended to replace separate systems used by VA and DOD with a single system; and the VistA Evolution program, which was to modernize VistA with additional capabilities and a better interface for all users. VA has relied extensively on assistance from contractors for these efforts. VA obligated over $1.1 billion for contracts with 138 contractors during fiscal years 2011 through 2016 for iEHR and VistA Evolution. Contract data showed that the 15 key contractors that worked on both programs accounted for $741 million of the funding obligated for system development, project management, and operations and maintenance to support the two programs (see figure). VA recently announced that it intends to change its VistA modernization approach and acquire the same electronic health record system that DOD is implementing.
With respect to key FITARA-related areas, the department has reported progress on consolidating and optimizing its data centers, although this progress has fallen short of targets set by the Office of Management and Budget. VA has also reported $23.61 million in data center-related cost savings, yet does not expect to realize further savings from additional closures. In addition, VA's Chief Information Officer (CIO) certified the use of adequate incremental development for 10 of the department's major IT investments; however, VA has not yet updated its policy and process for CIO certification as GAO recommended. Finally, VA has issued a software licensing policy and has generated an inventory of its software licenses to inform future investment decisions.

What GAO Recommends

GAO has made multiple recommendations to VA aimed at improving the department's IT management. VA has generally agreed with the recommendations and begun taking responsive actions.