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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

Good Afternoon Chairman Michaud, Chairman Mitchell, Ranking Member Brown-Waite, Ranking Member Miller and Members of the Subcommittees, thank you for the opportunity to report on the progress made by the Department of Veterans Affairs (VA) on providing the information technology needed to ensure that veterans are afforded timely access to health care.  We are committed to serving veterans and meeting the wait time policies of the VA.

VHA has been using a scheduling system that was designed in the 1970’s and is out-of-date, negatively impacting patient scheduling and patient access.  The HealtheVet Scheduling Project (Replacement Scheduling Application) was initiated in May 2001 to address this deficiency.  The RSA software offers a number of advantages over the current scheduling system and I will highlight just a few:

  • Improved support and flexibility for site management of resources (people, rooms, equipment).

  • Greater efficiency in scheduling appointments

  • Improved continuity of care for referral management and veterans who travel to other VA medical centers

RSA waiting time metrics will be similar in construct to the metrics now used by VHA but will have a higher degree of specificity because they will be provider based rather than clinic based.

As you know the RSA project has experienced significant delays from the original plan to release the software in mid - 2005.  These delays have resulted from both vendor and VA related issues.  My office is actively addressing the causes of these delays by taking the following actions:

  • Bringing in industry experts to strengthen program management discipline;

  • Establishing standard IT processes for system development, based on industry best practices, with mentoring for the VA staff by industry experts;

  •  IT staff professional development focused on implementation of the high priority industry best practices needed to assure software delivery on schedule and at cost.

  • Re-organizing the IT development organization to better focus on high priority software projects and to identify and develop common services once for use in all projects. 

However, much work remains to be done.

The current schedule for RSA is to release the alpha version to Muskogee VAMC in early summer 2008.  This release will support basic functionality followed by a test release with full functionality at the Dallas VAMC in December 2008.  I anticipate that RSA will be installed at all VAMC’s by January 2011.

Recognizing the difficulty that these delays impose upon VHA, the VA Office of Information and Technology is making limited enhancements to the current scheduling system as well as formalize the process for converting locally developed “Class III” software adapted to become national “Class I” software.  Class III software is developed locally to meet a business need and historically sites have shared this software to some extent.  This sharing has produced variations in the base VistA system which if we allow to continue will impede our ability to convert to a national HealtheVet architecture, while providing less than uniform IT support for scheduling across VA medical centers. In the interest of leveraging the ingenuity and innovation that resides locally we have created a path for converting Class III software to national Class I software so that the Class III software will be standardized before it is shared across VA facilities, and it will be implemented in all VA facilities. As of October 2007, the VHA Informatics and Data Management Committee prioritized the first three Class III products for national release: Shift Hand off tool, Medication Reconciliation, and Surgery Case Manager. The Shift Hand-Off Tool is projected for release in January 2008.  This will provide, when the veteran’s primary care physician is not available, a synopsis of the hospital care, pertinent medical history, alerts and special instructions relative to a patient’s care during a particular shift.  Medication Reconciliation is projected for release in January 2008.  This will provide a complete and accurate medication list that would be given to every patient upon discharge from the VA facility or upon departure from every clinic visit.  Lastly, Surgery Case Manager is projected for release in May 2008.  This will track and report the length of time veterans must wait for surgical procedures.  Tracing this will give VA the ability to improve efficiency and improve access to inpatient surgical care by allowing facilities to identify delays and access issues.

To assure that we are addressing all the high priority requirements, VA has commissioned an independent study which will be completed in Spring 2008. This study will look at patient scheduling, scheduling staff, business rules, patient preferences, data accuracy, and a review of the redesigned scheduling software, as well as comparisons to health industry practices.

Thank you for the opportunity to appear before you and provide you the status of our ongoing efforts.  My colleagues and I are happy to answer any questions you or other members of the Subcommittee might have.