VA under new fire for high-risk status, IT, scheduling systems
VA Inspector General Michael Missal had a laundry list of damning evaluations concerning the state of VA and its IT systems. Those include: Ambiguous policies, inconsistent processes, inadequate oversight, delays, series of questionable decisions and mismanagement by Veterans’ Affairs senior officials, and more.
Missal, along with Debra Draper, director of Health Care Team of the Government Accountability Office, took the VA to task for what Draper called “the VA’s exceedingly slow pace of progress,” during the U.S. Senate Committee on Veterans’ Affairs meeting on Wednesday.
VA ended up on the GAO’s high-risk list again this year, the third year in a row. It was added to the list for the first time in 2015 because of the agency’s concerns about the “VA’s ability to ensure the timeliness, cost-effectiveness, quality and safety of the care provided to veterans,” Draper said.
Its risk was calculated by five categories: ambiguous policies and inconsistent processes; inadequate oversight and accountability; IT challenges; inadequate training for VA staff; and unclear resource needs and allocation priorities.
“As I noted at the time of their high-risk designation in 2015, VA had more than 100 open GAO recommendations related to healthcare,” Draper said. “Seventy-four new recommendations have been added since then; currently, there are still more than 100 open recommendations. And about a quarter of these have been open for three to four years.”
While some leadership actions have been taken, Draper said, “I want to be very clear, that even in the areas the VA has made some progress, there’s a long path toward fully meeting the criteria.”
Missal voiced similar concerns, focusing primarily on the VA’s IT shortcomings.
“We’ve frequently identified the VA’s struggle to design, procure and or implement functional IT systems,” Missal said. “IT security is continually reported as a material weakness in VA’s consolidated financial statements.”
“Moreover, VA has a high number of legacy IT systems needing replacement,” he continued. “After years of effort focused on replacement of VA’s legacy scheduling software, a new scheduling system is still not in place.”
The problem? The VA’s inability to define scheduling software requirements and determine if a commercial or in-house design is necessary, Missal said. These problems stem from inadequate, lack of or incorrect training for staff, the lack of understanding of the process by their managers and, in some cases, “the disregard of VA’s scheduling policies.”
“VA needs to accurately forecast the demand for healthcare services in both the near term and the long term,” Missal said.
In response, VA Deputy Under Secretary for Health for Policy and Services Jennifer Lee provided an update on the commercial rollout of scheduling software. VA decided on an in-house update to current software to serve as a bridge to the commercial replacement, MASS. The update should be in place across the U.S. by the summer.
Carolyn Clancy, VA deputy undersecretary for Health for Organizational Excellence, explained the cause of the delays are the large number of VA policies. Just two years ago the agency had over 800 policies, which the VA has since whittled down to about 650.
“Transformation is a marathon, not a sprint. It takes several years to turn any organization around, and we’re acutely aware that most of the candidates on GAO’s High-Risk List have taken multiple years to meet that requirement,” Clancy said. “Secretary Shulkin is absolutely dedicated that we do this as rapidly as possible.”
The senators at Wednesday’s meeting seemed committed to commercial software throughout the VA, including for VistA. These sentiments were shared by VA Secretary David Shulkin, MD on March 8.