Veterans Affairs:

Health Information System Modernization Far from Complete; Improved Project Planning and Oversight Needed

GAO-08-805: Published: Jun 30, 2008. Publicly Released: Jul 30, 2008.

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The Department of Veterans Affairs (VA), through its Veterans Health Administration (VHA), provides health care for more than 5 million veterans each year. In 2001, VHA began an initiative, HealtheVet, to modernize its current medical information system. GAO's objectives were to determine the status of the modernization, VA's overall plan for completing it, and how VA is providing oversight to ensure the success of the initiative. To conduct this review, GAO analyzed project documentation and interviewed officials responsible for the development and implementation of the new system.

As of June 2008, the HealtheVet initiative has these eight major software development projects under way. One project is to further develop the Health Data Repository, a database of standardized health data. This database, which is currently operational, is not yet complete; additional types of health data remain to be standardized and added to the repository. Four application projects are currently in development. One application project is in the planning stage. Two projects are being pursued to enhance current systems, prepare them for transition to HealtheVet, and develop new applications. From 2001 through fiscal year 2007, VA reported spending almost $600 million for these eight projects. The time frame for completing the projects and the HealtheVet system as a whole was 2012, but the projected completion date has now been delayed until 2018. The department has a high-level strategy for HealtheVet, in which the remainder of the initiative is to be completed incrementally in phases (referred to as "blocks"), but it does not have a comprehensive project management plan to guide the remaining work. This work is considerable: the department plans to replace the 104 applications in its current medical information system with 67 modernized applications (of which 5 are currently in development, as described), 3 databases, and 10 common services (general software functions, such as messaging and security, on which application software can call as needed). In view of this scope, the importance is increased of developing a comprehensive project management plan that includes, among other things, an integrated schedule that considers all dependencies and defines subtasks to ensure that deadlines are realistic. Another important component of such planning is determining the resources necessary to accomplish tasks throughout the life cycle of the initiative. In April 2008, VA provided an $11 billion cost estimate for completion of HealtheVet; however, it has not yet independently validated this estimate. Having a validated cost estimate is essential to improve the accuracy of cost, schedule, and performance management. Without an integrated plan that includes independently validated cost estimates, VA increases the risk that HealtheVet could incur cost increases and continued schedule slippages and not achieve its intended outcomes. Various levels and types of oversight are currently being provided for the HealtheVet initiative by business owners, developers, and departmental information technology governance boards. However, the business owners have not yet implemented a complete governance structure, several key leadership positions within the developers' organization are either vacant or filled with acting personnel, and the governance boards have not yet scheduled critical reviews of HealtheVet projects. Until all elements of governance and oversight are in place, the risk to the success of the HealtheVet initiative is increased.

Status Legend:

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  • 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 better ensure the success of HealtheVet, the Secretary of Veterans Affairs should direct the Chief Information Officer to develop a schedule for and conduct milestone reviews of the HealtheVet projects.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA concurred with the recommendation and took steps to begin addressing the issues that we identified. For example, in August 2009, milestone review schedules for HealtheVet had been established as part of VA's newly implemented Project Management Accountability System (PMAS) oversight initiative. Further, the department reported that it had implemented software to help manage the PMAS reviews and related artifacts. Although VA changed its strategic direction and discontinued HealtheVet in August 2010, we consider the steps taken to be responsive to our recommendation to develop a schedule for and conduct milestone reviews of the HealtheVet projects.

    Recommendation: To better ensure the success of HealtheVet, the Secretary of Veterans Affairs should direct the Chief Information Officer to expedite efforts to permanently staff the position of the Director of the Program Management office and fill other critical leadership positions in the Office of Enterprise Development.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA concurred with the recommendation and filled the Assistant Deputy CIO for Program Management position in January 2009. However, in April 2010, we learned that this position was again vacant. In August 2011, VA provided information that this position (now called the Assistant Deputy CIO for Project Management) was filled in May 2011. Further, with regard to other critical positions, (1) the Assistant Deputy CIO of Software Development position was filled in October 2009, (2) the Assistant Deputy CIO for Software Engineering position was realigned to a non-SES product support role, and (3) the Deputy Director position for the Interagency Program Office was filled in January 2010. Although VA changed its strategic direction and discontinued HealtheVet in August 2010, we consider the department's actions to be responsive to our recommendation.

    Recommendation: To better ensure the success of HealtheVet, the Secretary of Veterans Affairs should direct the Chief Information Officer to validate cost estimates for all six blocks of HealtheVet.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA concurred with our recommendation and, in May 2008, tasked the Space and Naval Warfare Systems Center (SPAWAR) with conducting an independent validation of the 10-year life-cycle cost estimate for the HealtheVet suite of applications. In August 2009, VA provided briefing slides with the results of the independent validation, which showed that the SPAWAR cost estimate for HealtheVet was within 5 percent of the estimate developed by VA. Although VA changed its strategic direction and discontinued HealtheVet in August 2010, we consider the department's actions to be responsive to our recommendation.

    Recommendation: To better ensure the success of HealtheVet, the Secretary of Veterans Affairs should direct the Chief Information Officer to develop a project management plan that encompasses all six blocks of HealtheVet.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA concurred with the recommendation and took actions to address the issues that we identified. For example, in August and September 2009, VA held meetings with stakeholders to develop a new integrated master plan and integrated master schedule for HealtheVet. Additionally, the department provided evidence that it intended to use its newly implemented Project Management Accountability System as the basis for developing a complete HealtheVet project plan. However, VA changed its strategic direction and discontinued HealtheVet in August 2010. Although the department canceled the HealtheVet program, we consider the above actions to be responsive to our recommendation that it develop a project management plan for HealtheVet.

    Recommendation: To ensure proper oversight of HealtheVet, the Secretary of Veterans Affairs should direct the Veterans Health Administration Under Secretary to finalize and implement the plan to establish the HealtheVet governance structure.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: VA concurred with the recommendation and took steps to address the issues that we identified. For example, in July 2009, VA approved a revised charter and governance plan for HealtheVet which reflected organizational changes to the department and its adoption of PMAS. Although VA changed its strategic direction and discontinued HealtheVet in August 2010, we consider the initial steps taken to be responsive to our recommendation to finalize and implement a governance structure for HealtheVet.

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