VA Health Care Delivery:

Top Management Leadership Critical to Success of Decision Support System

AIMD-95-182: Published: Sep 29, 1995. Publicly Released: Sep 29, 1995.

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Pursuant to a congressional request, GAO reviewed the Veterans Health Administration's (VHA) efforts to implement a medical decision support system, focusing on: (1) the kinds of benefits that such a system can provide the Department of Veterans Affairs (VA); (2) whether VA is pursuing the comprehensive business strategy needed to achieve these benefits; and (3) whether VA is establishing an adequate information infrastructure for the Decision Support System (DSS).

GAO found that: (1) DSS has the potential to be an effective tool for improving the quality and cost-effectiveness of VHA health care operations; (2) VA has not formulated business goals or a comprehensive implementation strategy to clearly define how it will use DSS-generated information or prioritize its limited resources to implement DSS; (3) VA also has not established the information infrastructure needed to support DSS; (4) some of the data provided to DSS from other VA information systems are incomplete and inaccurate, limiting VA ability to make sound business decisions; and (5) sustaining top management leadership and commitment within VHA is critical to the successful implementation and use of DSS.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To increase the likelihood of DSS success, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a comprehensive business strategy to identify the specific business goals (for example, reduction of cost in a specific area by a specific percentage), performance measures, and key decisions that DSS will be required to support.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA concurred with this recommendation. VHA's national strategic plan covering fiscal years 1997 through 2002 identifies strategic targets and annual performance measures. The plan also enumerates how DSS will enable managers to: (1) analyze information on patterns of care and patient outcomes, which is linked to resource consumption and the costs associated with that care; and (2) make an accurate determination of the results of performance measurements.

    Recommendation: To increase the likelihood of DSS success, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a comprehensive business strategy to give high priority, by allocating appropriate resources, to establishing a complete, consistent, and accurate DSS information infrastructure.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: The Under Secretary personally communicated his commitment to implementing DSS to VHA managers and program staffs. VHA appointed a CIO to oversee both the Decentralized Hospital Computer Program and DSS. The CIO's goals include ensuring a complete, consistent and accurate DSS information infrastructure. In addition, VHA allocated additional resources to DSS. Total FTEs have grown from 57 in 1994 to 101. Management of DSS is provided by the DSS Program Office, supported by offices for project and resource management, technical implementation, systems development, clinical systems and education. VHA is developing image scanning applications for the proposed ambulatory care database, with systemwide implementation in late 1996. VHA believes that the database will resolve many data integrity, accuracy, and completeness questions. Complete resolution of all information infrastructure issues is dependent on available resources in fiscal years 1996 and 1997.

    Recommendation: To increase the likelihood of DSS success, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a comprehensive business strategy to identify data that are needed to support decisionmaking and ensure that these data are complete, accurate, consistent, and reconciled monthly.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA concurred with the recommendation. To address data completeness and availability, VHA made Event Capture Software (ECS) available to VA medical centers. As of September 1999, approximately 96 of the current 144 VA medical centers had set up ECS departments.

    Recommendation: VA should not implement DSS at any site beyond the 38 identified until: (1) defined business goals and a supporting information infrastructure supporting key decisions are in place; and (2) VA capability to use DSS effectively as a management tool can be demonstrated.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Not Implemented

    Comments: The Secretary of Veterans Affairs did not concur with this recommendation. VHA has proceeded with DSS implementation beyond the 38 sites; there are 97 sites involved with DSS implementation as of June 30, 1996, and all 154 DSS sites are expected to be involved by January 1997. According to VHA, significant strides have been made by the sites implementing DSS since GAO's review.

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