VA Cybersecurity and IT Oversight

In March of 2013, over a year before the scheduling wait time scandal in Phoenix, Arizona would open a wider window of scrutiny onto the entire Department of Veterans Affairs (VA) healthcare system, The American Legion was raising concerns about problems with VA’s scheduling software.  In a hearing before the Oversight and Investigation (O&I) Subcommittee of the House Committee on Veterans Affairs (HVAC), The American Legion sounded the alarm that contrary to reported numbers, veterans were waiting far longer for care and “figures are being manipulated by employees to look better, statistics such as VA’s reported 94 percent of primary care appointments within the proper period, mean very little.”[1] 

Chairman Hurd, Ranking Member Kelly and distinguished members of the Subcommittees on Health and Economic Opportunity on behalf of National Commander Dale Barnett and The American Legion; the country’s largest patriotic wartime service organization for veterans, comprising over 2 million members and serving every man and woman who has worn the uniform for this country; we thank you for the opportunity to testify regarding one of the critical components of VA’s Information Technology (IT) infrastructure, the scheduling software used to track veteran appointments with their healthcare providers.

A year after our testimony, VA found itself embroiled in the center of a nationwide scandal as concerns that advocates such as The American Legion had raised in the past became a staple of nightly news reports.  At the heart of this scandal was the accusation that, exactly as The American Legion had predicted a year previous, figures were being manipulated to hide wait times through the use of offline, paper lists that avoided the public record of the computer scheduling software and its automatic tracking of wait times.

VA would see massive leadership change over the summer of 2014, but would still struggle with an IT plan to fix the problems.

In 2013 The American Legion noted a large portion of the problem was that previous attempts to replace the software had wasted money to no result and that there was not plan in place at the time to fix the problems.  The American Legion stated:

As we are now a decade into the 21st Century, The American Legion believes that VA should also begin implementing 21st Century solutions to its problems.  In 1998, GAO released a report that highlighted the excessive wait times experienced by veterans trying to schedule appointments, and recommended that VA replace its VistA scheduling system.^[2] To address the scheduling problem, the Veteran’s Health Administration (VHA) solicited internal proposals from within VA to study and replace the VistA Scheduling System, with a Commercial Off-the-Shelf (COTS) software program. VA selected a system, and about 14 months into the project they significantly changed the scope of the project from a COTS solution to an in-house build of a scheduling application.  After that, VHA ended up determining that it would not be able to implement any of the planned system’s capabilities, and after spending an estimated $127 million over 9 years, The American Legion learned that VHA ended the entire Scheduling Replacement Project in September 2009.^[3]  We believe that this haphazard approach of fits and starts is crippling any hope of progress.  It has now been over three years since VHA cancelled the Replacement Scheduling Application project, and as of today, The American Legion understands that there is still no workable solution to fixing VA’s outdated and inefficient scheduling system.

In the summer of 2014 VA announced plans to replace the software, going back to the original idea of Commercial Off the Shelf (COTS) software to accomplish that end.  However, by September reports out of VA estimated the COTS plan would not roll out until 2020, over half a decade down the road.[4]  VA would ultimately backtrack from this and revise that estimate down to 2017; however the move did little to ensure confidence in the ability to rectify the very real problems that the Phoenix scandal had highlighted.

Recent leadership changes, including the addition of Dr. David Shulkin as the Undersecretary for Health and LaVerne Council as VA’s Assistant Secretary for Information and Technology and Chief Information Officer, have been promising moves and The American Legion has generally been impressed with the leadership team as they have worked to move forward on this issue.

While briefing VSOs on plans for future integration upgrades, VA shared ideas about a plan to move to an online scheduling system where veterans could schedule their own appointments.  Because our Four Pillars include veterans issues as well as issues related to a strong national defense, The American Legion is well versed in both VA healthcare as well as TRICARE and military healthcare and was able to point out the many problems that arose when TRICARE implemented a similar scheduling system online. 

Without scheduling personnel to oversee the process, and manage appointments, doctors’ calendars rapidly overfill, clogging the system and making it impossible for patients to find time on the schedule.  With a scheduling specialist available to determine what the type of appointments are and whether there can be multiple patients scheduled during certain time periods, the system is reduced to inelegant, brute force blocks of time, with little regard to whether doctors and support staff could handle different volumes of patients. This is just one example of how a strong and transparent partnership between VA and VSO stakeholders improves services to veterans.

We are hopeful that the dialogue with The American Legion and other groups will help guide VA moving forward with plans to reform the scheduling software.  There were serious problems with the way VA had gone about business scheduling appointments for veterans.  Under the old system, while veterans were left out on secret lists, few alarm bells were raised inside the system because employees had developed pencil and paper workarounds to the computer solutions VA had implemented.  It took the combined pressure of groups like The American Legion and brave whistleblowers within VA who cared deeply about the safety of veterans to step forward and identify the problem.

We are now at a stage where VA is engaging with the very people whose membership utilize VA facilities across the country on a daily basis and are best in a position to identify problem areas.  Hopefully VA is listening to these critical stakeholders.

Conclusion

The American Legion is deeply committed to working with VA to ensure that not only are these IT challenges worked out, but that any and all challenges are resolved to help protect the healthcare system designed specifically to service the unique needs and challenges of the veterans’ population.  Consistently, veterans speak highly of the high quality of care they receive when they can see their VA providers, and note how well VA understands their unique sacrifices and military culture when they are treating them.  Therefore it is doubly important that we solve these challenges and make it easier for veterans to access the system best suited to treat them.

The American Legion thanks this committee for the opportunity to explain the position of the over 2 million veteran members of this organization. 

For additional information regarding this testimony, please contact Mr. Warren J. Goldstein at The American Legion’s Legislative Division at (202) 861-2700 or wgoldstein@legion.org