Failed Outpatient Scheduling System

1. Failed Outpatient Scheduling System At The Department of Veteran Affairs Professor Dr. Chung ESE6361 by Raleigh Murráy

2. Overview • Background • Problems

4. Veteran Affairs

5. Background Veteran Affairs (VA) Mission • To serve Veterans and their immediate family members • The Veterans Health Administration (VHA) is a component of VA which manages one of the largest healthcare systems in the United states seeing over 6.33 million patients at 1500 plus facilities. To manage day to day operations VHA uses the Veterans Health Information Systems and Technology Architecture (VistA).

6. Background cont. • The VistA information system is composed of many applications for health providers; financial and management; registration, enrollment, eligibility; and health data applications. • VistA includes an electronic outpatient scheduling system which automates the outpatient appointment process from scheduling patient to compliation of managerial reports.

8. Application Problems • The VistA outpatient scheduling system is over 25 years old. • VistA is centric to each individual medical system or hospital; coordinating and scheduling across multiple facilities is difficult and inefficient. • The scheduling system has been cited as a contributing factor to increasing wait times for appointments. • PRIOR TO APP'T NEXT DISPLAY • |8 |9 |8 |9 • [4 4 4 4|4 4 4 4| [3 3 3 3|4 4 4 4| • Clinicians must maintain different calendars to track the services they provide. • Appointments and ancillary services are linked in the current data, resulting in the inability to make correlations between medical data and appointments.

9. What’s the answer? • In 2000 VA launched Scheduling Replacement Project (SRP) initiative to replace the existing system. SRP was the first part of a larger VHA revamp initiative of existing system call HealtheVet. • After 9 years, the VA terminated the contract in support of the SRP to produce an outpatient scheduling system in February 2009. • A total lost of a $127 million

10. Hope • With SRP, VHA envisioned the new scheduling system would provide benefits for the entire department • a single enterprise database would allow all appointments to be viewed, regardless of the point of care • calendars that would include sequential appointment settings • long-term appointment lists that would track and remind staff of future appointments • ancillary service links would allow for automated updates to appointment cancellations

11. Project Failure

12. What?? Issue 1: Oversight on the SRP and Southwest Research Institute (SwRI)Contract Was Ineffective. Issue 2: VA did not ensure requirements were complete and sufficiently detailed to develop a system over all poor requirements analysis • not verifiable • not testable • open to interpretation • no traceability Issue 3: No internal ability to manage IT projects of this magnitude Issue 4: No risk management

14. Failed IT Projects • VA’s HR Links Payroll and Human Resources System - $469 million • Procurement and Deployment of the Core Financial and Logistics System–CoreFLS (August 11, 2004) - $300 million • Patient Financial Services System (January 31, 2007) - $140 million • Scheduling Replacement Project (February 2009)-$127 million • Integrated Financial Accounting System program (IFAS) • (June 2010) -$300 million Total: $1.336 billion

15. Thank you

16. References • http://www.gao.gov/new.items/d10579.pdf • http://www.fiercehealthit.com/story/gao-raps-va-management-failed-outpatient-scheduling-system/2010-07-05 • http://www.va.gov/oig/52/reports/2009/VAOIG-09-01926-207.pdf • http://gcn.com/articles/2004/08/12/va-ig-corefls-failed-on-inadequate-expertise-oversight.aspx • http://www.fiercehealthit.com/story/gao-raps-va-management-failed-outpatient-scheduling-system/2010-07-05 • http://www.va.gov/oig/52/reports/2007/VAOIG-06-03285-73.pdf • http://www.google.com