GAO: VA's second outpatient scheduling system needs more work
After spending an estimated $127 million over nine years on its outpatient scheduling system project, the Department of Veterans Affairs (VA) has not implemented any of the planned system’s capabilities and is essentially starting over, according to a June 28 report published online by the Government Accountability Office (GAO).

"Management improvements are essential for VA's second outpatient scheduling system replacement effort,” the report stated.

In 2000, the Veterans Health Administration (VHA)–a component of VA–began the Scheduling Replacement Project to modernize an outpatient scheduling system as part of a larger departmentwide modernization effort called HealtheVet. Of the total amount already spent, $62 million was expended for, among other things, project planning, management support, a development environment and equipment. Additionally, the department paid an estimated $65 million selected to the contractor selected to develop the replacement scheduling application, according to GAO's report.

However, the application software had a large number of defects that VA and the contractor could not resolve resulting in the contracts termination; officially ending the Scheduling Replacement Project in September 2009, the report found. In October 2009, VA began a new initiative referred to as HealtheVet Scheduling. As of April, the department’s efforts on this new initiative has largely consisted of evaluating whether to buy or custom build a new scheduling application.

The impact of the scheduling project on the HealtheVet initiative cannot yet be determined because VA has not developed a comprehensive plan for HealtheVet that, among other things, documents the dependencies among the projects that comprise the initiative.

VA’s efforts to successfully complete the Scheduling Replacement Project, GAO stated, were hindered by weaknesses in several key project management disciplines and a lack of effective oversight that, if not addressed, could undermine the department’s second effort to replace its scheduling system:
  • VA did not adequately plan its acquisition of the scheduling application and did not obtain the benefits of competition;
  • VA did not ensure requirements were complete and sufficiently detailed to guide development of the scheduling system;
  • VA performed system tests concurrently, increasing the risk that the system would not perform as intended, and did not always follow its own guidance, leading to software passing through the testing process with unaddressed critical defects;
  • VA’s project progress and status reported were not reliable, and included data that provided inconsistent views of project performance;
  • VA did not effectively identify, mitigate and communicate project risks due to, among other things, staff members’ reluctance to raise issues to the department’s leadership; and
  • VA’s various oversight boards had responsibility for overseeing the Scheduling Replacement Project; however, they did not take corrective actions despite the department becoming aware of significant issues.

“After almost a decade of effort, VA has not accomplished what it set out to achieve in replacing its patient scheduling system," concluded the report. “Until the department effectively implements measures that prevent the types of management weaknesses that plagued its earlier efforts, it risks incurring similar weaknesses in its latest scheduling replacement effort, which could again prevent VA from delivering this important capability for serving the healthcare needs of veterans and their families.”

GAO reported that VA officials stated that the department plans to document the interdependencies, project milestones and deliverables in an integrated master schedule as part of a project management plan that was expected to be completed by June.