In 1996, the  department changed the name of the system to the Veterans Health  Information Systems and Technology Architecture—VistA. Nevertheless, even with the enhancements and modifications made to  VistA over time, the system is more than 30 years old and has become  increasingly difficult and costly to maintain. VA Has Pursued Four VistA Modernization Initiatives Since 2001, with Over a Billion Dollars Obligated for Contractors’ Activities During Fiscal Years 2011 through 2016

Since 2001, VA has pursued four efforts to modernize VistA. These  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 to be comprised of a collection of projects and  efforts focused on improving the efficiency and quality of veterans’ health  care by modernizing the department’s health information systems,  increasing the department’s data exchange and interoperability with DOD  and private sector health care partners, and reducing the time it takes to  deploy new health information management capabilities. Each facility is expected to continue  using VistA until the new system has been deployed at that location. VA Obligated About $1.1 Billion for VistA Modernization Contracts from 2011 through 2016

For iEHR and VistA Evolution, the two modernization initiatives for which  VA could provide contract data, VA obligated approximately $1.1 billion  for contracts with 138 different contractors during fiscal years 2011  through 2016. Funding for the 34 contractors that worked on both iEHR and VistA  Evolution totaled about $793 million of the $1.1 billion obligated for  contracts on the two initiatives. Additionally, we determined that, of the $741 million obligated to the key  contractors, $411 million (about 55 percent) was obligated for contracts  supporting the development of new system capabilities, $256 million  (about 35 percent) was obligated for contracts supporting project  management activities, and $74 million (about 10 percent) was obligated  for contracts supporting operations and maintenance for iEHR and VistA  Evolution. Since the VA Secretary announced that the department would acquire the  same electronic health record system as DOD, VA has begun planning  for the transition from VistA Evolution to EHRM. However, the department  is still early in its efforts, pending the contract award. In this regard, the  department has begun developing plans that are intended to guide the  new EHRM program. The department also has begun  documenting the EHRM program risks. According to the Executive Director, the department  intends to complete the development of its plans for EHRM within 90 days  after award of the Cerner contract, which is anticipated to occur in early  2018. The  department’s continued dedication to completing and effectively executing  the planning activities that it has identified will be essential to helping  minimize program risks and guide this latest electronic health record  modernization initiative to a successful outcome—one which VA, for  almost two decades, has been unable to achieve. Appendix I: Objectives, Scope, and Methodology

The objectives for this study were to (1) identify the efforts that the  Department of veterans Affairs (VA) has undertaken to modernize VistA,  including key contractors, contract costs, and expected contractor  activities and (2) to determine the department’s current plans for, and  progress to date, in modernizing VistA. We also reviewed meeting minutes for the VistA modernization projects  and prior GAO work on efforts to modernize VistA. To determine the progress achieved on the current efforts,  we obtained documentation, such as draft schedules and organization  charts, and met with program officials in VA’s Electronic Health Record  Modernization program office to obtain updated information on the efforts.
Why GAO Did This Study

VA operates the largest health care delivery system in America and VistA is essential to helping deliver the health care services and ensure the quality of health care received by the nation's veterans and their dependents. The system has been in operation for more than 30 years, is costly to maintain, and does not readily support VA's need to electronically exchange health records with the Department of Defense and private health care providers. VA has pursued initiatives to modernize VistA, using government contractors to support its efforts. In June 2017, VA announced a new effort to purchase a commercial solution to replace VistA.
GAO was requested to review VA's prior and current efforts to modernize VistA. This review determined (1) VA's efforts to modernize VistA, including key contractors, contract costs, and expected contractor activities and (2) VA's current plans for modernizing VistA and the progress that has been achieved to date. To conduct its study, GAO reviewed VA documentation and its prior work and requested and obtained data on contracts, related obligations, and expected contractor activities for previous efforts. GAO also obtained documentation on plans for VA's current modernization efforts and progress made on the efforts, and interviewed VA officials.
GAO has made recommendations to VA aimed at improving its prior modernization efforts. The department concurred with the recommendations and generally took responsive actions. GAO is making no recommendations at this time. VA provided technical comments on this report, which were incorporated as appropriate.

What GAO Found

The Department of Veterans Affairs (VA) has, since 2001, pursued four separate initiatives to modernize its health information system—the Veterans Health Information Systems and Technology Architecture (VistA). These 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 system over the course of nearly two decades (see figure). This latest effort, the EHRM program, is to include the adoption of the same commercial electronic health record system that the Department of Defense is in the process of acquiring.
VA obligated about $1.1 billion to 138 different contractors that worked on iEHR and VistA Evolution (the two efforts for which VA could provide contract data) during fiscal years 2011 through 2016. Funding for the 34 contractors that worked on both efforts totaled about $793 million of the $1.1 billion obligated for contracts on the two initiatives. The top 15 of the contractors that worked on the two efforts (key contractors) accounted for approximately $741 million—$411 million for the development of new system capabilities, $256 million for project management activities, and $74 million for operations and maintenance for iEHR and VistA Evolution.
VA has begun planning for the transition from VistA Evolution to EHRM. However, the department is still early in its efforts and has begun developing plans that are intended to guide the new EHRM program. According to the EHRM Executive Director, the department intends to complete development of its plans for EHRM within 90 days after awarding the contract for its new system, which is planned to occur in early 2018. VA has also begun to staff the EHRM program's leadership positions. The department's dedication to completing and effectively executing the planning activities that it has identified will be essential to helping minimize program risks and expeditiously guide this latest electronic health record modernization initiative to a successful outcome—which VA, for almost two decades, has been unable to achieve.