Dude! The $100M VistA Open Source Opportunity

05 Aug Dude! The $100M VistA Open Source Opportunity

Dude (dyūd) n.

  1. Used to express approval, satisfaction, or congratulations.
  2. In informal speech, many young people use the word “dude” freely. “Dude” may also be used alone in a sentence, serving as an exclamation; denoting a feeling of surprise, happiness, disappointment, amazement or anger, among other emotions.[1]
  3. The word might also be used practically anywhere in a sentence in order to convey such sentiments in conversation.

Dude.

I am know for throwing an occasional “Dude” into my jocular speech. Ok, maybe more than a couple when excited. OK, maybe more than a couple when I am not so excited as well. OK, maybe I use it indiscriminately at random times. But hey, I am just following Merriam-Webster definition of the appropriate usage of the term “practially anywhere” within a sentence.

But dude! Have you actually read the recent GAO reports regarding the status of the current VistA modernization project? I was literally shocked – let me save you the trauma by pulling in the highlights (where is WorldVistA, VistA Software Alliance, Roger Maduro, or any of the VistA luminaries in terms of reporting on this?) :

  • The VA is currently engaged in a MASSIVE rewrite of the entire VistA System
  • They are planning on replacing 104 of the current applications that run in 128 different VA hospitals with a completely new suite of 67 applications, 10 common services, and 3 separate databases (this is based off the August 2006 HealthEVet Development Plan with assist from Carnegie Mellon)
  • They have spent $600M dollars from 2001 to 2007 on this project and here is the status report of the 8 projects initiated so far
    • Health Data repository – partially completed standarization project (see below for summary)
    • Enrollment
    • Scheduling – beta tested at first site in September 2008; general availability in 2011
    • Laboratory –
    • Pharmacy
    • VistA applications development project
    • VistA foundations modernizations project
    • Billing – is in early design planning (this after spending $150M on a failed system with Bearing Point).
  • Original delivery date was estimated at 2012, which has subsequently been pushed back to 2018 (and counting)
  • Furthermore the report found the following:
    • VA Has Developed an Overall Strategy for HealtheVet, but It Lacks a Project Management Plan
    • VA Has Not Fully Established an Oversight Structure for HealtheVet
    • VHA Has Not Fully Implemented a HealtheVet Governance Structure
    • Key Positions within the Office of Enterprise Development Are Vacant
  • Which led to the following conclusion:
    • “Although VA has made progress on its $11 billion HealtheVet initiative, it has also experienced significant delays, and NONE of the associated development projects have been completed. Moreover, VA is proceeding with this complex initiative without a project management plan and validated cost estimates to coordinate and guide the effort. At the same time, a governance structure for HealtheVet has not yet been established, and key leadership positions that are responsible for providing day-to-day oversight have not been permanently staffed. Further, several IT governance boards with oversight responsibility for HealtheVet have not yet performed essential reviews of HealtheVet projects to gauge progress and funding requirements and the department lacks a time frame for doing so. Until the department takes the necessary actions to fully address these matters, it will face the risk that HealtheVet may experience cost overruns and continued schedule slippages, and may not achieve the outcome it intends to achieve.”

Dude? What the heck – $11B project without any of this stuff in place, no clear plan, no direction, no people to do the work, and constant changes. Heck, I bet Epic would be happy to go into the VA and put that $11B dollars to work and having now experimented with Kaiser, I bet they could actually pull it off. Reading this makes one wonder what on earth the government is doing developing sofware.

However, the silver lining in my warped mind is that with this amount of money being thrown around, it is hard to think of a justification for the government not to take a portion of this money – say 10%, or 5%, or even a measley 1% of anticipated project costs ( >$100M dollars) – and engage the open source community on collaborative development. Better yet, why not use that money to develop an open source collaborative framework from which all the paid contractors, the open source fraternity, and a growing international community can contribute to the project.

Forward motion, forward movement, and forward thinking . . .Dude, where is the community leader to catalyze this opportunity?

HIGHLIGHTS from the 45 page report: (emphasis is mine):

  • Department officials acknowledge that VA has experienced significant delays in developing and implementing HealtheVet and attribute the delays to various factors, including loss of experienced contractor staff, changes in technical and deployment approaches, and lack of management continuity. Department officials stated that they are working to address the delays by using an incremental development life-cycle approach; establishing more realistic time frames; and establishing an integrated product team composed of information technology, program, and acquisition personnel to address contracting issues.
  • The department does not yet have a comprehensive project management plan to guide the development and integration of the many HealtheVet projects. That is, it does not have a plan that describes, among other factors, the project’s scope, implementation strategy, and lines of responsibility, and includes an integrated schedule that considers all dependencies and defines subtasks to ensure that deadlines are realistic.
  • In April 2008, VA provided an $11 billion cost estimate for completion of HealtheVet
  • the business owners do not yet have a fully implemented governance structure for development projects that was endorsed by the department following a realignment of IT resources in which IT funding and personnel were placed under the control of the department’s Chief Information Officer (CIO).
  • VistA now consists of 104 separate computer applications. These include 56 health provider applications; 19 management and financial applications; 13 crosscutting applications such as patient data exchange; 8 registration, enrollment, and eligibility applications; 5 health data applications; and 3 information and education applications
  • Besides being numerous, these applications have been customized at all128 VA sites. According to VA, this customization increases the cost of maintaining the system, as it requires that maintenance also be customized. VA has reported expending significant resources (approximately $2.5 billion) to maintain the system between 2001 and 2007.
  • VistA stores data in an organizational format based on the location where care is provided, rather than maintaining a global record for each individual patient, and it is programmed in a language for which there is a continually decreasing supply of qualified software developers.
  • Finally, the Scheduling, Health Data Repository, Laboratory, Vista Application Development, and Vista Foundations Modernization projects were delayed by the loss of experienced contractor staff. These initiatives were supported by an overall contract for HealtheVet. When this contract expired in September 2006, it was renewed on a monthly basis to ensure continuity of work until a new contract was awarded. However, task orders from the new contract, which was signed in November 2006, were not issued until June, July, and September 2007. According to department officials, as a result of these delays, the experienced contractor staff who supported the initiatives had moved to other work, corporate knowledge for these initiatives was lost, and new contractor staff had to be hired and educated.
  • Project Status
    • The Scheduling application is planned for initial deployment at one site (aVA medical center in Muskogee, Oklahoma) in September 2008 (full deployment to all medical facilities is planned for 2011).
    • For the Pharmacy project, final testing of one function (order checking) iss cheduled to begin in September 2008, and new drug file and pharmacydata management systems are scheduled to be implemented in January 2009. Remaining system functions to be developed include inventory, order entry and clinical monitoring, medication dispensing, and medication administration. Further development of the Pharmacy application depends on the results of an ongoing analysis and evaluation of the costs of building and deploying these functions. This analysis, for which a contract was issued in February 2008, is due July 2008.
    • The new Laboratory system is scheduled for independent verification and validation in October 2008. National deployment is planned to begin in 2010, with a phased implementation across the department expected to take place over the next 5 years.
    • The initial implementation of the Enrollment application is scheduled for August 2008. This project is to provide an enrollment workflow for use at VA’s Health Eligibility Center. An enhancement is scheduled for implementation by July 2009 for communicating to veterans and providing operational efficiencies for VA staff at the Health Eligibility Center and medical centers to coordinate changes in veterans’ eligibility. Finally, in December 2011, the department expects to complete a modernized
      registration capability.
    • A fifth project (Billing) is for a new financial system, which is in the planning stage. The current Billing project is a second attempt to modernize the billing system. Under the first attempt, VA awarded a contract in July 2003 to implement a commercial product to provide an updated billing capability for the department (called at that time the Patient Financial Services System); however, after about $107 million was spent on this effort, the contract was terminated in September 2006 by mutual agreement between the department and the contractor. The department expects to complete national deployment of the current project (called the Revenue Improvements and System Enhancement project) at the end of fiscal year 2015. Finally, the program has two ongoing projects that are focused on activities to develop and implement required enhancements to existing VistA applications and lay the foundation for transitioning these applications to HealtheVet:
    • The focus of the VistA application development project in the near term is to develop the critical enhancements and fixes to the VistA system that are necessary to ensure compliance with changes to patient enrollment and billing requirements and accomplish other critical data updates. In fiscal year 2010, the emphasis for this initiative will shift from fixes and enhancements to new development work aimed at the transition to HealtheVet. The initiative will then encompass building many of the replacement systems within HealtheVet.
    • The VistA foundations modernization project includes work on architecture and testing services, including a comprehensive testing suite and strategy for all VistA and HealtheVet applications. In fiscal year 2009, several common services—the deployment toolkit, business rules engine, and workflow engine—are expected to be delivered, along with new testing services capabilities and updates to the overall architecture. This work is expected to be ongoing until the completion of the HealtheVet initiative.
  • Project Concerns
    • VA Lacks a Project Management Plan
    • VA Has Not Fully Established an Oversight Structure for HealtheVet
    • VHA Has Not Fully Implemented a HealtheVet Governance Structure
    • Key Positions within the Office of Enterprise Development Are Vacant
  • Conclusions
    • Although VA has made progress on its $11 billion HealtheVet initiative, it has also experienced significant delays, and none of the associated development projects have been completed. Moreover, VA is proceeding with this complex initiative without a project management plan and validated cost estimates to coordinate and guide the effort.
    • At the same time, a governance structure for HealtheVet has not yet been established, and key leadership positions that are responsible for providing day-to-day oversight have not been permanently staffed. Further, several IT governance boards with oversight responsibility for HealtheVet have not yet performed essential reviews of HealtheVet projects to gauge progress and funding requirements and the department lacks a time frame for doing so. Until the department takes the necessary actions to fully address these matters, it will face the risk that HealtheVet may experience cost overruns and continued schedule slippages, and may not achieve the outcome it intends to achieve.
2 Comments
  • CC
    Posted at 19:48h, 30 December Reply

    Whay wait for government funding? So many OS projects have been started and are functional in one form or another. What we need is an OS leader that has the clout to push this forward.

  • VistA – Its Now or Never « Crossover Healthcare
    Posted at 04:35h, 02 June Reply

    […] the VA (who are finally trying to have a single system for their singular patients). It could save hundreds of millions of dollars if these efforts were done openly, collaboratively, and in a true open source […]

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