***VIDEO FILE INCLUDED*** Chairwoman Susie Lee to VA Officials: Your Plan to Update Patient Scheduling System in ‘Very Rough Shape’
Washington, D.C. – Chair of the House Veterans’ Affairs Subcommittee on Technology Modernization Susie Lee (Nev.-03) oversaw a hearing to hold the Department of Veterans Affairs (VA) accountable for its blatant ineffectiveness in implementing a modernized patient scheduling system. Prolonged appointment scheduling and wait times at VA health facilities remain long-standing issues within the VA, and this is in part due to the VA’s archaic, confusing, and often cumbersome patient appointment scheduling system.
VA has been working to modernize its scheduling system for almost two decades and has only made marginal progress, despite the investment of millions of taxpayer dollars in the Department’s efforts. Recently, the VA announced that it plans to transition from the legacy VistA scheduling modules to the Cerner Scheduling Software. However, VA has already changed their implementation approach mid-transition, and increased their transition timeline from three years to five years.
Chairwoman Lee emphasized that their proposed plan is short on detail, raising concerns that the transition will not be successful within the given timeline:
“I am concerned that VA made assertions to Congress before it had any actual analysis of user needs, cost, or benefits. Despite being six months out from beginning system implementation, the plan seems to be in very rough shape. This includes cost, which VA has said won’t be finalized until November.”
The lack of direction, leadership, and details raise concerns that it is a waste of American taxpayer dollars to invest in a project that is destined to fail, as Rep. Lee emphasized in her opening remarks:
“I wonder why none of this would have been done before proceeding with the Cerner Scheduling Solution implementation. This seems backwards to me. VA has said it plans to begin the Cerner implementation in Columbus [Ohio]—so just months after the successful completion of one scheduling solution, VA is going to scrap it and implement another. I expect our VA witnesses to explain how that is not wasteful.”
BACKGROUND: As Chair of the Subcommittee on Technology Modernization, Chairwoman Lee refuses to waiver in holding VA accountable for the implementation of the scheduling system, and their assurance that taxpayer dollars will be used responsibly.
Legacy VistA Scheduling
The Legacy VistA Scheduling System is the original software developed to manage scheduling at VA. It is a Disc Operating System (DOS) interface, which is largely considered obsolete. The Legacy Vista Scheduling system is “clinic based,” meaning that scheduling is organized by “clinics” that encompass a patient type or reason for a visit. Clinics used in scheduling include, the PTSD Clinic, the Alcohol Treatment Clinic, and the Military Sexual Trauma (MST) Clinic, which all exist under Behavioral Health. A single provider could see patients in all of those clinics. In this case, that provider would have three different schedules, one for each clinic. This is incredibly inefficient and leads to confusion among schedulers, providers, and patients. Not only does the provider have to track multiple schedules, but schedulers would have multiple schedules for multiple providers to go through in order to find an open slot for a patient appointment.
Cerner Scheduling Solution (CSS)
In May 2018, a month after MASS went live in Columbus, VA sign the long-anticipated contract with Cerner for its Millennium suite of electronic health record applications. In December 2018, VA notified Congress of its intent to terminate the MASS contract with Epic and Leidos, and that it would instead proceed with Cerner’s scheduling solution. In order to assuage concerns about whether implementing the scheduling system would take the full ten years expected for EHRM, VA indicated its intent to separate the implementation of CSS and EHRM.
Since that notification was received by the Committee, staff have repeatedly requested more information on:
- The decision-making process related to cancelling MASS and moving to CSS
- The plan for implementation of the “fast tracked” CSS
- The cost of implementing CSS separately from EHRM
In July 2019, the Chairwoman Lee, as well as the Chairs of the Health and Oversight & Investigations Subcommittees, sent a letter to Secretary Wilkie asking for a series of documents and a staff briefing in an attempt to answer these questions. VA did not respond to the letter until September 3, 2019. Staff finally received the briefing on September 17, 2019, after making it a requirement for the currently scheduled hearing.
VA contends that there will be no new costs associated with separating the scheduling solution and rolling it out independently from the rest of EHRM. It will, according to OEHRM, require that VA move some of the expenses from the second half of EHRM forward to the first half in order to deploy CSS. Staff has concerns with this logic, since it mostly involves moving around unappropriated funds.