Veterans Affairs: Improved Management Processes Are Necessary for IT Systems That Better Support Health Care
Highlights
What GAO Found
The Department of Veterans Affairs (VA) has established information technology (IT) management processes that are partially consistent with leading practices. VA has issued strategic plans that identify goals and objectives related to health IT; established investment review boards at the department-level and within the Veterans Health Administration (VHA) that are responsible for selecting IT investments aligned to VHA priorities; and documented VHA's core business functions within an enterprise architecture. However, the IT strategic plans do not include performance measures and targets for their defined objectives, VA's department-level IT investment board has been inactive and its investment selection guidance lacks criteria, and the department has not fully identified metrics aligned to core business functions to inform investment decisions. Until VA can improve these processes, it risks having IT systems that may not fully support VHA's mission.
IT systems at VA are generally aligned to core business functions defined by VHA; however, among new service requests, which identify unmet needs of business owners, 817 out of a total of 2,772 IT needs identified for VHA since 1998 had not been met as of October 2016. About 39 percent of these open requests had been open for more than 5 years.
Breakdown of the Veterans Health Administration's Information Technology New Service Requests
GAO's review of the business needs identified in three key program areas—Pharmacy Benefits Management, Veterans Access to Care, and Community Care—showed a number of long-standing needs. According to VA officials, their need to balance the resources for IT needs across the department is a reason that business needs have remained unresolved. Until VA prioritizes resources to address these needs, VHA's programs may not be well supported by IT systems capable of delivering health care services consistent with its objectives.
Why GAO Did This Study
VHA, an administration within VA, provides a broad range of primary care, specialized care, and related medical and social support services to veterans. In doing so, VHA operates one of the nation's largest health care systems through 168 VA medical centers and more than 1,000 outpatient facilities. The administration managed total budget resources reported at nearly $91 billion in fiscal year 2016. Based on interest in VHA's ability to oversee its health care system and provide timely care, GAO reviewed IT management at VHA. Specifically, GAO determined the extent to which VA's (1) IT management processes are consistent with leading practices and (2) current IT systems support VHA's core business functions. To do so, GAO analyzed documentation and interviewed officials about VA's approach to IT management processes related to strategic planning, investment management, and enterprise architecture, and compared VA's processes to leading practices. In addition, GAO reviewed data related to VA's IT systems and VHA's IT business needs. GAO further reviewed IT needs from three key VHA program areas.
Recommendations
GAO is recommending that VA address the deficiencies identified with IT strategic planning, investment management, and enterprise architecture; and ensure that the three programs' IT needs are addressed. VA agreed with GAO's recommendations and described actions planned to address them by the end of fiscal year 2018.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to identify performance metrics and associated targets for the goals and objectives in the department's IT strategic plans, including the Information Resources Management strategic plan and the Health Information Strategic Plan, as they relate to the delivery of health IT and the VHA mission. |
Closed – Implemented
The Department of Veterans Affairs (VA) concurred with our recommendation. The department has updated and aligned several strategic planning documents consistent with our recommendation. Specifically, updates have been made to the Veterans Health Administration Health Information Strategic Plan, the VA Information Technology Strategic Plan, the Office of Information and Technology's Digital Transformation Strategy, and the Fiscal Year 2018-2024 VA Enterprise Roadmap. These updates, which occurred at various times over the past 2 years, included describing goals and objectives as well as incorporating high-level targets and associated metrics aligned across plans that can be used to describe progress made for the delivery of health IT and the mission of the Veterans Health Administration.
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| Department of Veterans Affairs | To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to ensure that the department-level investment review structure is implemented as planned and that guidance on the IT governance process is documented and identifies criteria for selecting new investments, and reselecting investments currently operational at VHA. |
Closed – Implemented
In its comments on our report, VA concurred with our recommendation and took steps to evolve its approach to IT governance consistent with our recommendation. Specifically, starting in 2018, VA established an IT governance framework to support an incremental approach for making improvements to IT governance for the department. Since that time, the IT Governance Board was chartered to serve as the senior-level leadership forum and to provide IT management across the department and its administrations. According to the department, as of May 2021, this charter is being rewritten to reflect the organizational changes within the department and is intended to establish the IT Investment Board to evaluate, oversee, and approve VA's IT investment portfolio in accordance with the department's capital planning and investment control process using real costs, timing, risk, and business outcomes. This new body is to be chaired by the Chief Information Officer and the Chief Financial Officer and is supported by various councils, committees, and working groups that integrate with cross-departmental IT governance including the VHA IT governance bodies. In addition, the Office of Information and Technology is reevaluating its approach to IT governance and is in the process of creating guiding principles such as standard operating procedures for IT governance activities and performance metrics that will integrate with governance forums that serve mission needs. Decisions using the department's latest governance structure have begun to be documented and are to include both new investments as well as investments in sustainment. Because VA has taken these actions to transform its IT governance structure and policy and further define its approach to selecting and reselecting investments, the department is better positioned to manage and oversee its IT investments. These steps also increase the department's ability to ensure support for VHA's IT capabilities that are necessary to deliver mission results.
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| Department of Veterans Affairs | To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to identify additional performance metrics to align with VHA's core business functions, and then use these metrics to determine the extent to which the department's IT systems support performance of VHA's mission. |
Open – Partially Addressed
In its comments on our report, VA concurred with our recommendation. In addition, the department outlined steps it intended to take to address our recommendation, including developing a set of metrics to provide continuous input into investment portfolio decisions and establishing a methodology for ensuring that IT investments are aligned to business needs and that expected outcomes are defined prior to making the investments. Since 2017, the department has taken a variety approaches to establishing metrics and providing input to the investment prioritization and governance processes. As of September 2023, VA officials provided a summary of dashboards used by the department that include health product business metrics. Given the expected growth for veteran's health services and VA's persistent challenges with IT systems' support of health care delivery, we will continue to monitor progress made by VA to ascertain whether the metrics identified are stabilized and used to effectively impact IT systems support of the VHA mission.
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| Department of Veterans Affairs | To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to ensure that unmet IT needs identified by key program areas--pharmacy benefits management, scheduling, and community care--are addressed appropriately and that related business functions are supported by IT systems to the extent required. |
Open – Partially Addressed
In its comments on our report, the Department of Veterans Affairs (VA) concurred with our recommendation. At that time, the department described its intention to ensure that unmet information technology (IT) needs for the pharmacy benefits management, scheduling, and community care program areas were addressed appropriately during fiscal year 2018 budget formulation. As of September 2023, VA provided information about the VHA prioritization process including metrics about investments in the key program areas. However, additional efforts remain to demonstrate that unmet meets are being met consistently and expeditiously for each of these areas. We will continue to monitor and update progress made as appropriate.
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