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Witness Testimony of Paul A. Tibbits, M.D., Office of Information and Technology, Deputy Chief Information Officer, Office of Enterprise Development, U.S. Department of Veterans Affairs

Thank you, Mr. Chairman.  I would like to thank you for the opportunity to testify on the realignment progress in the Office of Information & Technology (OIT) and to share with you the progress made in VA as a result of the centralization of IT development activities.

Joining me on this panel is Dr. Ben J. Davoren, Director Clinical Informatics, from our San Francisco Medical Center.

This Committee has demonstrated great support for and interest in IT in the VA, and we genuinely appreciate it.

You have just heard testimony from Assistant Secretary Howard regarding the GAO report on our realignment progress and the need for more work to be done to achieve successful transition from a decentralized to a centralized organization.  While General Howard focused on the information protection aspects of the realignment, I would like to share with you our progress in establishing an IT governance plan, strengthening development process improvement efforts, and fostering innovation.

You have also heard General Howard refer to his seven (7) priorities and how they are guiding the realignment process.    I would like to talk more about those priorities that have special significance to the Office of Enterprise Development.  They include (1) establishing a well-led, high-performing, IT organization that delivers responsive IT support to the three Administrations and Central Office staff sections;  (2) standardizing IT infrastructure and IT business processes throughout VA;  (3) establishing programs that make VA’s IT system more interoperable and compatible; (4) effectively managing the VA IT appropriation to ensure sustainment and modernization of our IT infrastructure and more focused application development to meet increasing and changing requirements of our business units.

CIO Priorities

First, with respect to establishing a well-led, high-performing, IT organization that delivers responsive IT support to the three Administrations and Staff Offices, we are pursuing improvement of the development workforce throughout the Office of Enterprise Development. In so doing, development staff will be better prepared to act as knowledgeable consultants at the local level to assist health care providers in development of innovation software solutions that are likely to be technically sound and ready for national deployment.

To improve the capability of the VA IT development workforce we are instituting real-time coaching and mentoring by industry experts in best practices for systems development, to institutionalize these practices at the VA.

Improving workforce capability increases the staff’s readiness to perform critical development processes, increases the likelihood of achieving desired results from performing the processes, and allows the VA to realize the benefits from the investment in process improvement for all VA facilities.

Second, with respect to standardizing IT infrastructure and IT business processes throughout VA, standardization of these processes provides the baseline for measuring the effectiveness of its development process.  It is the first step to reduce time to deliver applications, reduce costs to develop applications, implement business-driven process performance measures, and increase productivity of the development workforce. And it is hard work.

For the IT development organization, our standardized processes are based on industry best practices as codified in the Capability and Maturity Models from the Software Engineering Institute for both software development and workforce competency. We are using independent industry to guide us through this self-improvement initiative.

Third, let me address establishing programs that make VA’s IT system more interoperable and compatible. Interoperability begins with a common understanding of terminology.  To establish this with sufficient precision, the IT development organization is collaborating closely with the Administrations in use of business modeling to provide a uniform basis of developing a shared understanding of new way to serve veterans and the information required to do so.

Next we are engaging with the Administrations and with DoD to strengthen and accelerate data standardization activities within VA and with DoD. We are exploring ways to focus on high priority patient groups, such as traumatic brain injury and post traumatic stress disorder, while continuing the hard work of semantic analysis and reconciliation and the consolidation of multiple data feeds between VA and DoD.

Fourth, we are focused on managing the VA IT appropriation to ensure sustainment and modernization of our IT infrastructure and more focused application development to meet increasing and changing requirements of our business units. We are applying life cycle and total cost of ownership management practices to all development projects, to account for all costs of implementation and operations, as a foundation for budget formulation. We are moving toward clear, line-of-sight alignment with the VA strategic plan and the Performance Accountability Report by re-shaping our OMB 300 exhibits in FY 2010, creation of the first multi-year IT budget, and strengthening our relationship with the requirements processes of the Administrations and Staff offices.

Governance

We have established a participative, transparent IT governance process at the senior executive level of the VA. Decision makers a the VA were not equipped with the framework for understanding the relative importance of one dimension of project performance with respect to others, leading to a bias toward financial metrics during process prioritization. Decision makers lacked key information with respect to project benefits and total cost to make effective decisions on priorities. We have created a set of organizational principles and governance structures and practices that surface business strategy; facilitate accurate project cost, benefit, and risk estimation, and provide a decision-making framework that focuses attention on a subset of the most critical projects and delivers timely, accurate information to the VA’s senior decision-makers.

We are strengthening the use of earned value systems in our large programs. We have undertaken independent assessment of the soundness of our approach to managing certain IT development projects and will expand this activity.

We are developing management dashboards to implement early warning of issues with system development:

  • Project/program Status - tracking of project performance as compared to cost, schedule, and scope estimates.
  • Project/program data quality - Assesses the quality of software releases, through analysis of defects found and problems noted
  • Project/program Return on Investment (ROI), earned value, and risk management - Compares real program ROI with estimated ROI, and uses earned value to serve as a leading indicator of deviation from forecasted cost and schedule.
  • Portfolio resource allocation – Determines the application of financial resources to various projects, to balance production across multiple related initiatives.
  • Portfolio timelines - Provides an integrated view of program timelines, highlighting the programs that will attain significant milestones or be complete by a specific future date.
  • Portfolio mix - Displays the mix of project spending among groups of related software applications.

We are focusing intense effort on managing the execution of funds in accordance with established plans, to ensure project are adequately resourced, and learning lessons for improvements next year.

Promote innovation

Challenges. The Secretary has migrated all IT activities under a single leadership authority, in part, due to the need to drive standardization and interoperability of applications and infrastructure across VA.  We need application development plans that employ industry best practices and have the potential to accelerate the successful completion of IT projects, including implementation across the VA.  

The centralized IT budget (the single IT appropriation) sets a context for competition among new ideas, since some are not affordable. This creates the perception at the hospital that many good ideas are disregarded despite “local needs”, and that the flexibility available to VISN and hospital directors to use healthcare funds for IT is a constraint. This view disregards the rest of the story.  Solutions developed locally were rarely deployed across all VA medical centers, resulting in some centers not getting the advantage of these IT capabilities.

Furthermore, many needs were thought of as local, when in fact they were enterprise-wide requirements, such as reports to support Joint Commission accreditation visits.

Under the single IT authority and single IT appropriation, we operate in an environment of financial transparency. Funds dedicated to sustainment, extending legacy systems to meet urgent needs of returning warriors, and to modernize our computing environment are now visible to senior VA executives. We have no formal mechanism to allocate funds to IT innovation. Unmanaged local innovation makes the implementation of enterprise solutions very difficult. Many IT products are operating in various VAMCs, with no support mechanism to proliferate the more successful of them to all other medical centers.

In close collaboration with VHA, we are moving to create a mechanism to deal with this challenge. We have developed a process to identify new ideas at the local level, facilitate collaboration among field developers and VAMC health care professionals, to develop new software products in a non-production environment in an unconstrained manner.  In order to enter the live production environment and assure deployability across all VA sites, certain technical, business value, security, and patient safety assessments will be made and any remediation necessary applied. There are effectively no constraints on the trail development of new IT solutions; there are disciplined assessments prior to VA-wide implementation to assure safety and continuity of operations of the IT production environment. 

The migration from the VistA legacy system to the HealtheVet platform entails complex development, a new programming medium, a new architecture, and establishment of a veteran-centric medical record versus the facility-centric nature of VistA. This form of innovation must be centrally-managed. It is too large for local initiatives alone to accomplish.  In addition, some forms of new IT support require an analysis of end-to-end processes to serve veterans, such as transition from DoD to VA, again not easily accomplished at the local level when complex data standardization and security issues are involved. We are attempting to strike the right balance.

Effective communication is critical to successful organizational change.  The migration of IT development personnel under a single IT authority will need to be supported by a focused communications strategy and plan to avoid disruption to VA’s business operations and to achieve the benefits of new organization.

We are strengthening our communications strategy for the development staff.

There has been no significant change in the delivery of healthcare and benefits to veterans with this realignment.   We have had some problems, but we have also gained valuable visibility over unknown IT activities - a definite improvement.  We also now know more about IT funding details across the VA and have a greater ability to protect the sensitive veterans’ information.

In closing, let me say that we want your ideas. I want to assure you, Mr. Chairman, that a successful realignment of IT development activities is a key goal within the VA.   We have accomplished many things this past year but more remains to be done.  I appreciate having this opportunity to discuss this with you and will gladly respond to your questions.