Testimony of 

Howard H. Green, M.D.

Concerning the Veterans Health Administration

 Decision Support System (DSS) to the Subcommittee

 on Oversight and Investigations 

 September 21, 2000

 

I am the originator of the VHA Decision Support System along with my colleague Dr. Elisabeth McSherry.  The invitation to present testimony about the VHA Decision Support System (DSS) from the Chairman, Honorable Terry Everett, of this Subcommittee is appreciated.  I have served the Department of Veterans Affairs as a resident physician, and attending physician.  In 1973 I was appointed Chief of Staff of the VA Medical Center in White River Junction, Vermont and served in that capacity until 1994.  From 1991 to 1999 I was the Contracting Officer’s Technical representative for the DSS Contract and in 1994 assumed the role of Deputy Director for Technical Implementation of the DSS System.  I retired from the VA on October 20, 1999. 

Purpose of Testimony

The purpose of this testimony is to explain the capabilities of the DSS System as they relate to running the business aspects of VHA and how the DSS System supports the evaluation and monitoring of Health Care Quality.  Finally it is my purpose to comment on the status of the DSS Implementation and the utilization of the system for the purposes for which it was intended.  I will address the reasons why this implementation and subsequent use of the system have not yet reached the expectations established when the implementation began.

A detailed report of my evaluation of the DSS implementation was sent to Ms. Gail Cotten, Contracting Officer for the DSS Contract in October of 1999.  Subsequently, a copy was provided to Ms. Helen Lew of the General Accounting Office, the staff of this subcommittee, and to Mr. Charles Yarbrough while he was the Acting VHA CIO.

It should be noted that the DSS system implemented by VHA is the same tool used by over 1,400 hospitals and Health Care systems worldwide.  Many of these systems use this tool extensively for evaluating the cost and quality of their patient care system. 

Summary of the Contract

The contract officially started on September 20, 1991.  It went through eleven (11) modifications which were required because of changing conditions.  Implementation of the system started in the medical centers in 1994.  The contract was scheduled to end on September 20, 1999 but was extended to October 19, 1999 to accommodate the time required to complete negotiations on a follow on maintenance contract.  Eclipsys Corporation (the vendor) agreed to this extension at current labor rates detailed in the contract.  There are several important noteworthy points about the contract.

·     The contract closed out approximately $761,000 under the original GSA disbursement authority of $24,368,533.  This includes the extension period costs.  The vendor was an important partner in meeting this goal.

·     The functionality received exceeds that defined in the original contract document.

·     The contract was completed on time.

Comment:  I believe that this record has few parallels in VHA or possibly in DVA.  My view is that a thorough review of contracts not meeting this standard should be carried out by both the Administration and by the Congress. 

The Issue

This hearing is convened to determine in part whether the DSS System is being used by VHA for the purpose for which it was intended.  Approximately 200,000,000 dollars (by the end of 2000) have been spent on installing this system (24 million for the vendor and 175 million or so contributed costs of VHA for personnel, supplies, travel, processing, etc.).  It is time to determine whether the system is yielding the Return On Investment (R.O.I) expected.

The direct answer to this question is that the system is being creatively used in certain VHA medical centers, but is not currently being used across the system to generate the R.O.I. required.  The real question then is why not?  Since approximately 1400 Medical Centers and Healthcare Systems in the United States and Internationally – Australia, the Netherlands, New Zealand and others – are using this exact system for meeting management and certain clinical needs. 

What does DSS do?

There are six questions, which are of central importance.

The first:           Does VHA need to know (to be in compliance with statute), what it costs, at the level of tests and procedures to deliver care and to sell its services to other Federal, State and Private entities?

The second:      Does VHA need to know the cost for encounters of each patient for hospital, ambulatory, long-term care, etc?

The third:          Does VHA need a system by which to determine the process of care in order to evaluate the efficiency of care, the adherence to clinical care guidelines, the frequency of selected adverse events and the impact of these adverse events on the cost of care?

The fourth:        Does VHA need to be able to build budgets from workload defined by the descriptions commonly used in the private sector such as DRGs, long-term care Resource Utilization Group (RUG) classifications and ambulatory classifications as used by HCFA?

The fifth:           Does VHA need to know what it costs for patient episodes in order to set rates for MCCF (medical care cost recovery) reimbursement from third party insurance; and to determine whether or not VHA is making or losing money on these transactions?

The sixth:          Does VHA need to know patient specific costs in order to reasonably allocate appropriated funds to its principal operating units, the medical center? 

This is precisely what DSS does.  Furthermore, there is no other DVA or VHA system in operation which does this.  DSS is the only system in place which is specifically designed to meet precisely the intent of the questions presented. 

I have left out the seventh question and that is:

Does the VHA need a reliable system to answer the questions Congress asks about the costs of care such that the answer to the question can be proven if necessary by an audit of the process by which the answer was derived?  Only the Congress can answer this question.

The DSS System is designed to accommodate this need. 

Concrete Illustrations of what DSS does.

I can think of no better way to illustrate the DSS system capabilities than to cite the titles of presentations given between June 11-14, 2000 at the Eclipsys (the vendor) Decision Support 14^th Annual User and Education Conference at the Washington Hilton and Towers in Washington DC.  Presentations by VHA Medical Centers were well attended and the evaluations of the presentations were high. 

Titles, Presentations by VHA Medical Centers:

- Alvin C. York VA Medical Center, Murfreesboro, TN

·     Using DSS to Guide Clinical Interventions:  A Case of Poly pharmacy and a Concomitant Illness of the Geriatric Population.

·     Drug Utilization Review a Breeze with DSS: Utilization of HMG-COA Reductase Inhibitors (cholesterol lowering drugs). 

Portland VA Medical Center

·     Clinician’s use of DSS Data to Identify Opportunities in Cost Reduction.  (Note: the problem of a 10 million-dollar operating deficit appropriately includes physicians in its solution.  DSS contributed significantly by providing necessary information.)

·     Allocation of Faculty Salary Dollars and Determination of Cardiac Cath Lab Procedure Costs in an Academic VA Hospital. 

VAMC North Chicago

·     DSS Reports Database for Department Reviews.  (Note:  Department refers to operating units within the Medical Center such as Radiology, Laboratory Medicine, Surgery and their specialty units.) 

South Texas Veterans Health Care System, San Antonio, TX

·     Forecasting Effects of Integrating Mental Health in a Multi Hospital System. 

VAMC Northern Indiana

·     Automated DSS Monthly Processing and Audit steps.  (Note: A tool developed to assist new DSS personnel responsible for maintaining the system, given the fact of employee turnover.

 

Selected presentations from Non-VA Medical Centers.

-     AMC Amsterdam – The Netherlands.  “Decision Support in the Operating Room Department.

-     St. Joseph Health System – Orange, CA  “Using Decision Support Information in Establishing Quality Improvement Benchmarks”

-     Jefferson Health System – Philadelphia, PA  “Promoting Clinical Integration in an Integrated Delivery System.”

-     Mayo Clinic – Rochester, MN  “Thrills, Chills and Spills Revisited: Teaming Clinical and Financial Analysts to Support Performance Improvement.

-     Royal Children’s Hospital, Women’s and Children’s Health Care Network – Melbourne, Victoria, Australia  “Integrated and Enhanced Quality of Patient Care using Sunrise Decision Support Manager”

-     The University of Iowa Hospitals and Clinics – Iowa City, IA  “Decision Support: Meeting a JCAHO standard on Resuscitation”

-     Wellington Hospital Capital Coast Health Ltd. – Wellington, New Zealand  “Benchmarking, A Tool to Improve Clinical Performance?”

-     Queensland Health, Brisbane – Queensland Australia  “Corporate Quality Improvement and Enhancement: The Queensland Health Way”

-     Texas Children’s Hospital – Providence, TX  “Using Decision Support for Facility Expansion Projections”

-     Emory University Health Care – Atlanta, GA  “Consolidated Financial Statement and Department Management Reporting Using Transition II and Crystal Reports”

-     St. Michael’s Hospital – Toronto, Ontario Canada  “Using Transition II to Support Effective Merger Decision-Making”

-     Children’s Hospital, Stanford Medical Center – Palo Alto, CA  “Building a Basic Business Plan”

-     Holy Family Hospital – Methuen, MA and Caritas Christi Health Care System, - Boston, MA  “Negotiating Payment Rates that Mimic Patient Care Cost”

-     University of Chicago Hospital – Chicago, IL  “Using Eclipsys to Predict Base Staffing and Overtime/Temporary Labor Needs”

-     The Cleveland Clinic Foundation – Cleveland, OH  “Cost Savings and Cost Avoidance of Pharmacist’s Intervention” 

I believe that anyone reading this list carefully could come to several conclusions.

1.   The DSS System has broad functionality.

2.   There are University Medical Centers affiliated with the VA using DSS.

3.   The nature of the Medical Centers using the system includes Fee for Service, Fixed Price Reimbursement, and Governmental Systems. 

How does the DSS System Produce its Information?

Simply put the DSS System takes appropriate computerized extracts of workload data (tests, procedures, patient encounter, prosthetics, etc.) from the VHA VistA transaction and Austin Automation Center Systems and combines this with extracts from the VHA portion of the Financial Management Systems, applies management accounting and cost accounting principles to this data to yield its outputs.  Audit procedures if used, assure that the data accurately represents that in the feeder system and in addition there are automated audits which can demonstrate deviations from the established standardization of internal structural rules promulgated as part of the implementation sequence of the system.

Proper function of the DSS System is optimized if it receives accurate and complete data from the feeder systems.  The clear responsibility for this data rests with the top management of Medical Center, VISN’s and Headquarters.  Those who criticize DSS data quality are looking at the responsible party if they are facing a mirror. 

Why is DSS information not being universally used to help to improve the management of VHA and to assist in improving the quality of its service?

It was clear by FY1997, that use of the information from DSS by management was not robust from those sites that had solid systems with information which was current enough for looking at production costs, processes and quality issues.  Part of this had to do with the fact that most top  managers and their staff did not know how to use the information to improve hospital performance, the second was that the leadership was not requiring them to manage at this level of process and cost details.  The old formulas for extracting money through the political process and the “no brainer” actions of Medical Center integrations, shifting care from inpatient to ambulatory settings and creating better access to the system which should have happened long ago, appeared to be working.

President Harry S. Truman had a sign on his desk that said “The Buck Stops Here.”  This simple statement summarizes the management literature dealing with management accountability and organizational behavior.

It is well known that organizational behavior reflects the behavior at the top of an organization.  Top management in the VA is and should be held responsible for failure to provide, execute and use appropriate information and strategy to optimize VHA performance, assure quality and to meet their fiduciary responsibility to the taxpayer.  Those responsible in top management in the VHA include the Secretary, the principal Undersecretaries.  The VHA VISN and Medical Center Leadership.  The sign on the desk should not read “The Buck Stops with our Subordinates, the Systems, the Data, etc. 

It is my opinion that the following factors although unpleasant, are supportable.

1.   Accountability at the level of detail supported by DSS is feared.  It is contrary to the traditional mechanisms used for managing in a governmental system.  The action which will be suggested by careful analysis of DSS information could be powerful and will be seen as jeopardizing programs, power and careers.

2.   There is no ownership by the Executives of VHA or DVA of the DSS System and the management principles it represents; hence, no leadership of significance.

3.   The Department is essentially rudderless.  A number of important positions, Secretary, Deputy Secretary, Assistant Secretary for Management, Undersecretary for Health, all are held by people designated as “Acting.”

Two positions (VHA CIO and CFO) which affect the DSS effort are held by new incumbents.  Corporate Discipline (in the healthy sense), which in recent years has been tenuous at best, does not exist.  The uncertainty generated by current circumstances has a profound effect on the behavior in the Bureaucracy.  People shift their attention to personal survival and position.

4.   The current method for acquiring resources by the Department of Veterans Affairs works.  VA managers have become expert at manipulating the current system and don’t want to change. 

Statements made about DSS by top management are having a serious negative impact on DSS.

“It ain’t so much the things we don’t know that gets us in trouble.  Its the things we know that ain’t so.” – Artemus Ward

I am particularly concerned about public statements about DSS made by the incumbent Assistant Secretary for Management who is now the Acting Deputy Secretary at the Leadership Forum in Phoenix and a meeting for VA VISN and Headquarters Executives in Seattle in August.  He in essence stated that if it was up to him that he would kill DSS, the data quality was not good and the standardization was not good.  (I did not directly hear these statements but they were reported to people in the DSS Program by several attendees).  I do not believe that the Acting Deputy Secretary had had appropriate briefing by technically knowledgeable people about DSS nor is it likely that he had researched carefully the reports by GAO, the IG and the Program Office on these subjects.

The effect of such statements in hierarchical organizations by people who have authority to make decisions can have disastrous effects on programs.  If made without proper investigation it represents a failure to exercise Due-diligence. 

What are the excuses used by managers for not using DSS?

The most common excuses are as follows:

·     It’s not ready yet. – It is my understanding the Dr. Garthwaite has told the Congress that DSS is implemented in all of the medical centers.  What might not have been said is that a number of medical centers have not structured the system entirely according to the guidelines provided.  The IG report on standardization addresses these issues.

·     The data in DSS is no good for comparison because there is no standardization.  This is not a true statement.

Dr. Kizer requested that the IG examine the issue of standardization within the DSS application, apparently because some Hospital Directors and Fiscal Officers said they couldn’t rely on the data for comparing hospital performance because it wasn’t standardized.

The IG examined the issue and concluded that DSS had a structure and standardization guideline which if followed would give a system which was useful for managing locally and at the VISN systems level.

 

Their exact conclusions are as follows:

·      “Local DSS staff and users need to understand that the basic DSS model, if adhered to, is fully capable of meeting the data needs of all management levels.  DSS’ ability to group production units into any set of larger reporting groups that users may choose ensures the maximum utility of DSS data at all management levels, and by maintaining relatively small production units with closely related products, DSS can calculate product costs with better precision.

·     To better guide local staff in their implementation of DSS systems, VISN and VHA Headquarters management need to continually update what their DSS data needs are.  They need to determine what types of reports they want, what the data elements should be, and what the formats should be.  We would expect these determinations to be part of an overall assessment of VHA’s “business needs.”

·     VHA top management must then ensure that DSS structures in use at medical centers adhere to the basic DSS model to satisfy the business and data needs of local, VISN, and VHA Headquarters managers.

·     Much of this effort will involve the “education” of staff at all levels.  To this end, facilities and VISNs that have successfully implemented DSS in adherence to the model should be identified and held up to others as “best practices” sites, so that they can be emulated.”

The fact is that the feeder system data feeding DSS from VistA, Austin Automation Center encounter and Fiscal System data from FMS came from standardized fields.  Audit systems are available to demonstrate the integrity of this data and to demonstrate deviation from the DSS Structural Guidelines.

Dr. Kizer accepted the findings and recommendations of the IG.

The first and usual response of managers who duck responsibility and attendant accountability is to blame the system.  Since the structure and standardization of DSS at any Medical Center is within the direct control of the Medical Center, the IG conclusions would appear to point to the famous statement by the cartoon character, Pogo – “We have met the enemy and it is us.”

·        It’s not easy to get information out of the system, it is not user-friendly.

Despite the fact that patient specific inpatient and outpatient costs from DSS are available on a secured VHA web site called the KLF report and extensive training on how to generate reports from the system, has been offered to VISNs and Hospital Management, the fact the site teams can generate extensive adhoc reports requested, and that the fixed reports from the system are designed for managers, the complaint continues.  The simple fact is the complainers won’t take the time to learn.  The DSS Program Group is currently providing extensive training on the use of the system and the vendor is training users on an advanced SQL DSS reporting tool which uses standard state of the art third party point and click reporting tools (Crystal Reports) as a front-end to make it easier to get information.  There will be no way to satisfy those who don’t want the information and who are unwilling to change previous habits.

In contrast to the top management, the people on the front lines of the site teams, although frequently understaffed, and on some occasions not having appropriate backgrounds for the task, have dug in and done a remarkable job of implementing this complex application.  The number of successes are greater that the failures.  A few sites have developed robust systems which have been used for aiding decisions at the medial centers and VISNs.  These sites in the last three years have prepared and given presentations on how they are using the system to improve performance at the annual user group meeting of the Eclipsys (the vendor) Corporations Decision Support customers.  These presentations have received praise from the private sector users.  The VA gave the presentations listed above in this testimony and all were well done.

It is my opinion that many of the site managers and site teams have far better insight on the processes which make the Medical Centers run than those who manage the Centers. 

·     The data isn’t timely.

There is no question that system-wide the medical centers are not in synchrony with the monthly processing of data.  It is obvious that processing cannot begin until the transactional databases close. 

Specific factors which impede bringing DSS to an optimal state.

End of year closure on transactional databases which feed DSS.

·     The financial database (FMS) closes promptly within 5-7 days of the October 1^st closure date.  Therefore, this database does not impede movement forward into the new year.

·     The workload database – dealing primarily with Medical Records Data are generally not actually closed until December.  An inordinate number of corrections are entered at the end of the year.  Sites cannot start the processing of October data and the end of year processing sequence which corrects and recosts the products and encounters until this closure.  This sequence requires 2-3 weeks and is delayed until after the Christmas and New Year Holiday.  The sites can however, build new structures in DSS required for the coming year as soon as they are known.  In fact these structures could be built prior to October 1 of the current year. 

Lack of communication between those responsible for the VistA transactional databases to those on the DSS technical support team.

This single factor was a major stumbling block in the implementation sequence and a principal cause of delay in the process of starting a new fiscal years information processing sequence.  DSS requires lead-time to adapt to changes planned in the VistA data set.  Extracts have to be re-written and coded, deblocker of the extract e-mail messages changed at AAC – SAS routines redone.  The new software must be carefully tested.  This requires extensive work planning and writing of specifications.  The VistA team assigned to support the DSS technical team was frequently not informed by other VistA developers of their changes, despite oral and written agreements to do so.  This delays the ability of the DSS Technical Support people to get the appropriate change instruction to the field.  The cooperation by VistA reached a nadir between 1996 and 1998 because of the assignment from the Birmingham, Alabama CIO field office to the Albany field office for VistA support.  The Albany group had no experience or knowledge about DSS support.  The number of people assigned to the project was reduced and there appeared to be growing hostility in VistA toward the DSS application.  It is my belief that this hostility came directly from the top of the CIO organization.  It was not until about 19 months ago when the program support was taken out of the Albany field office and reassigned to Bay Pines that this attitude changed.  Lack of stability of programming staff assigned to dealing with the VistA needs of DSS is a constant problem. 

Decreasing reliability of support by the Austin Automation Center

At this point, VHA spends about 12-13 million dollars per year on computer and system support of the DSS application.  This represents 40-50% of the revenue received by AAC from VHA.  It is important to acknowledge that this application represented a real challenge for the AAC in that it requires a very high degree of user interactivity to build the structure, set up processing sequence and generate reports prior to the advent of this application.  The AAC was the home of a number of DVA, VISN and VHA databases requiring little end user interactivity, such as Payroll, the Financial Management System, the Patient Treatment File, etc.  In short, it was a batch shop structured according to a set of routines and rigid timelines.  DSS represented for AAC a huge change of role and operating philosophy.  DSS was no more or less than a view toward the future role of mainframe computing systems which had begun much earlier in the corporate world.  Control of the process and service to a single entity had to give way to service of multiple users and control by the customer.  They had to shift over a short period of time to a vendor role offering services which met the needs defined by the user, not by them.  This required a change on staff training, automation of processes which previously required manual intervention, design and execution of systems to analyze the flow of processes within the database and applications.  The process towards this goal was going reasonably well, but began to deteriorate rapidly during the preparations for the FY2000 DSS rollover, this was unrelated to the Y2K issue which was done well.  The number of errors made by the AAC in the testing and preparation for this rollover has been notably greater.  I see little evidence that the AAC has given continuous training to staff who are assigned to the application.  In fact the AAC staff was given the same training at the inception of the project as the medical centers were given and a vendor expert was physically assigned to AAC for a full year at the inception of the implementation, followed by approximately six months on site and then access as required.  Although the AAC has begun the capability maturity model which is widely accepted in the computer world as a way to improve performance, they apparently have not used it as an analytic process improvement tool to track and analyze internal errors at the detailed processing task level.  This decrement in performance delayed the initiation of FY2000 change over by two months. 

Staffing of the site teams at the Medical Centers

Directors have not followed the guidelines for staffing numbers or the background experience of staff assigned. 

Timeliness Need

There is little need for so called real time cost data.  In a fixed cost environment product costs fluctuate on a monthly basis primarily because of volume.  As the year progresses a year to date cost profile emerges (usually in the fourth month) which begins to make sense and at the end of the year the entire database is recosted to yield end of year costs for products and the patient encounters which use these products – cost trends with time are more valuable in many cases than short-term costs. 

What is the critical factor required for integrity of DSS information?

Central to the whole process is the integrity of the data which is collected and used to monitor, measure, evaluate, control, and build the systems which reduce error, prevent mistakes and improve outcomes.  DSS can be looked on as a tool which uses this data to aid in the improvement of patient outcomes.

The success of the DSS as such a tool is critically dependent on the integrity and completeness of data it receives from the transaction system.  I will restrict my comments to this issue. 

In 1995 the GAO report entitled VA Health Care Delivery, Top Management Leadership is critical to the success of Decision Support System.  Concluded in the findings that:

1.   VHA has not developed a business strategy for effectively utilizing DSS as a management tool.

2.   Top Managers have not defined the business goals to be achieved and measured by using DSS.

3.   Top Managers have not provided leadership necessary to DSS.

4.   VA culture constrains progress.

5.   Information infrastructure is inadequate.  Clinical data is incomplete, inaccurate or inconsistent. 

In my opinion all five of these conclusions are applicable today and because of this the DSS tool cannot be optimized.  In terms of data completeness and quality we are a little better off than we were five years ago.  Of these five factors the most critical has to do with VA culture.  Dr. James P. Bogian, Head of the Veterans Health Administration, National Center for Patient Safety, refers to the need for a cultural change as it relates to the comfort with which error reporting can be done by health care professionals.  Until people can tell the truth to their supervisors without fear of reprisal (shoot the messenger syndrome), we will continue to come up short of our goals.  One of Dr. Deming's principles was to "Drive out fear."  I can tell you that “shooting messengers” is a robust activity.  For some reason the truth is unpleasant.  Efforts by the head of DSS Data Systems (who is the co-originator of DSS) to clarify false statements to VA Officials and to point out data problems have been met with threats of disciplinary action by her immediate supervisor.

Culture change requires direct top down leadership and support to accomplish.  Until the goal of patient care safety and quality becomes the unequivocal first priority, data integrity and quality will not change.  Data issues are not the province of the CIO but must be the principal concern of top management.  Absent this culture change, clear direction, and the promulgation of corporate discipline as it applies to financial and workload data systems, nothing will change.  There has been a steady and perceptible degradation in fiscal information as VISNs, Program Offices, and Medical Centers ignore the published guidelines on the use of Cost Center and Budget Object Class categories.  In fact there has not been a systematic audit of compliance in over ten years.

There has been no credible comprehensive audit of workload system data integrity and completeness.  There is no major effort which places a priority on data collection technology to accomplish the need for a complete data set.  The notable exception is the medication administration technology now being implemented.  This effort began over ten years ago, and the implementation was flawed because the Intensive Care Unit (ICU) patients were not included in the original design. 

Conclusion:

The DSS application in the great majority of medial centers can be used for decision making.  If it is made clear by top management that their decisions will be in large measure influenced by DSS information then the integrity and completeness of transactional data which feeds DSS will begin to improve quickly.  Where clinical matters are involved working physicians must be involved in the solution to both financial and clinical problems.  The presentation at the DSS User Group in Washington, DC by the Portland VAMC, points to the effectiveness of this strategy.  Failure of top management to become constructively involved in this process and in changing the VA culture guarantees an adverse outcome. The opinions expressed in this testimony are entirely those of the author.

Brief Curriculum Vitae:  Howard H. Green, M.D. 

Born:  May 18, 1934 – Detroit, MI 

Medical Specialties:

Internal Medicine – Board Certified

Nephrology 

Academic Titles Dartmouth Medical School:

Assistant Professor of Clinical Medicine                              July 1968 – July 1971

Assistant Professor of Medicine                              July 1971 – July 1975

Associate Professor of Clinical Medicine                              July 1975 – July 1992

Professor of Clinical Medicine                              July 1985 – July 1992

Professor of Medicine                              July 1992 – December 1994

 

Academic Administrative Titles:

Assistant Dean for VA Hospital Affairs                          July 1973 – February 1975

Associate Dean for VA Hospital Affairs                         July 1975 – December 1994 

Department of Veteran Affairs; Veterans Health Administration

Attending Physician VAMC White River Jct., VT                              1968 – 1973

Chief of Staff, White River Jct., VT                              June 1973 - December 1994

Presented the DSS Concept to Chief Medical                 

Directors Field Advisory Group                              1983

Managed the DSS development and pilot

testing program                              1983 – 1994

Contracting Officers Technical Representative

to the DSS Contracts                              1991 – October 1999

Deputy Director for Technical Implementation DSS           1994 – October 20, 1999

Retired from Department of Veteran Affairs                              October 20, 1999 

Military Service:

U.S. Navy 1960 – 1963 – Submarine and Diving Medicine