Veterans Affairs:

Improved Management Processes Are Necessary for IT Systems That Better Support Health Care

GAO-17-384: Published: Jun 21, 2017. Publicly Released: Jun 21, 2017.

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What GAO Found

The Department of Veterans Affairs (VA) has established information technology (IT) management processes that are partially consistent with leading practices. VA has issued strategic plans that identify goals and objectives related to health IT; established investment review boards at the department-level and within the Veterans Health Administration (VHA) that are responsible for selecting IT investments aligned to VHA priorities; and documented VHA's core business functions within an enterprise architecture. However, the IT strategic plans do not include performance measures and targets for their defined objectives, VA's department-level IT investment board has been inactive and its investment selection guidance lacks criteria, and the department has not fully identified metrics aligned to core business functions to inform investment decisions. Until VA can improve these processes, it risks having IT systems that may not fully support VHA's mission.

IT systems at VA are generally aligned to core business functions defined by VHA; however, among new service requests, which identify unmet needs of business owners, 817 out of a total of 2,772 IT needs identified for VHA since 1998 had not been met as of October 2016. About 39 percent of these open requests had been open for more than 5 years.

Breakdown of the Veterans Health Administration's Information Technology New Service Requests

Breakdown of the Veterans Health Administration's Information Technology New Service Requests

GAO's review of the business needs identified in three key program areas—Pharmacy Benefits Management, Veterans Access to Care, and Community Care—showed a number of long-standing needs. According to VA officials, their need to balance the resources for IT needs across the department is a reason that business needs have remained unresolved. Until VA prioritizes resources to address these needs, VHA's programs may not be well supported by IT systems capable of delivering health care services consistent with its objectives.

Why GAO Did This Study

VHA, an administration within VA, provides a broad range of primary care, specialized care, and related medical and social support services to veterans. In doing so, VHA operates one of the nation's largest health care systems through 168 VA medical centers and more than 1,000 outpatient facilities. The administration managed total budget resources reported at nearly $91 billion in fiscal year 2016. Based on interest in VHA's ability to oversee its health care system and provide timely care, GAO reviewed IT management at VHA. Specifically, GAO determined the extent to which VA's (1) IT management processes are consistent with leading practices and (2) current IT systems support VHA's core business functions. To do so, GAO analyzed documentation and interviewed officials about VA's approach to IT management processes related to strategic planning, investment management, and enterprise architecture, and compared VA's processes to leading practices. In addition, GAO reviewed data related to VA's IT systems and VHA's IT business needs. GAO further reviewed IT needs from three key VHA program areas.

What GAO Recommends

GAO is recommending that VA address the deficiencies identified with IT strategic planning, investment management, and enterprise architecture; and ensure that the three programs' IT needs are addressed. VA agreed with GAO's recommendations and described actions planned to address them by the end of fiscal year 2018.

For more information, contact David A. Powner at (202) 512-9286 or pownerd@gao.gov.

Recommendations for Executive Action

  1. Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to identify performance metrics and associated targets for the goals and objectives in the department's IT strategic plans, including the Information Resources Management strategic plan and the Health Information Strategic Plan, as they relate to the delivery of health IT and the VHA mission.

    Agency Affected: Department of Veterans Affairs

  2. Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to ensure that the department-level investment review structure is implemented as planned and that guidance on the IT governance process is documented and identifies criteria for selecting new investments, and reselecting investments currently operational at VHA.

    Agency Affected: Department of Veterans Affairs

  3. Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to identify additional performance metrics to align with VHA's core business functions, and then use these metrics to determine the extent to which the department's IT systems support performance of VHA's mission.

    Agency Affected: Department of Veterans Affairs

  4. Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to ensure that unmet IT needs identified by key program areas--pharmacy benefits management, scheduling, and community care--are addressed appropriately and that related business functions are supported by IT systems to the extent required.

    Agency Affected: Department of Veterans Affairs

 

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