VA pilots agile project management system, starting with e-health overhaul

The Department of Veterans Affairs’ CIO office is trying a new approach to project management, and will start with one of its most contentious and high stakes programs — the redesign of its electronic health records system. 

The VA’s Enterprise Program Management Office within the Office of Information and Technology officially launched a pilot of the Veteran-focused Integration Process, VIP for short, on Jan. 1. The plan is that VIP will eventually replace the department’s Project Management Accountability System, introduced in 2009 to improve the success of IT delivery. 

Prior to 2009, VA’s on-time project delivery rate hovered around 30 percent, before PMAS bumped it up to 84 percent. But VA thinks there’s still room for improvement, which is the basis for launching VIP, according to a guide on the framework. 

The VA Office of the Inspector General issued an audit of PMAS in 2011 in which it found the system incompletely established and far from fully operational. In the meantime, the VA’s Office of Information and Technology has made the push, like many other federal IT shops, to embrace a more agile development process. But under the highly waterfall-constrained PMAS structure, there was only so far the department could go in achieving true agile development.

One IT consulting firm described VA’s development model prior to VIP as more of an agile-waterfall hybrid — “agile-fall.”

“VA has tried to embrace Agile IT for years, but has been held back by the PMAS processes, which only works in a Waterfall fashion,” the Clendon Partners wrote in a blog post on the update to VIP. Despite the increase in on-time project delivery, the firm wrote, “on-time delivery is only one measure of project success. Often business objectives were compromised along the way, projects were over budget, or simply abandoned.”       

VIP is a follow-on of sorts to PMAS, and VA hopes that it will overcome the gaps of the former system and “propel the Department with even more rigor toward Veteran focused delivery of IT capabilities,” the guide says. “The VIP framework unifies and streamlines IT delivery oversight and will deliver IT products more efficiently, securely and predictably. With VIP, VA takes another generational leap forward in its commitment to serve our nation’s Veterans.”

In essence, it transitions away from waterfall practices of IT development to an agile delivery with more frequent cycles — three months instead of six, the standard under PMAS — with “near-continuous delivery as the highest priority,” an openness to changing requirements and “working products as the principal measure of progress.”

VA Chief Information Officer LaVerne Council wrote in an email to staff at the end of 2015 that “VIP reduces the amount of project management artifacts by 88% and emphasizes value to the Veteran over documentation.”

The department will pilot a handful of projects on the VIP system through the end of March, and the intent is to have all 218 of its IT projects transitioned to VIP by the close of fiscal year 2016, managing the entire enterprise with the framework starting in fiscal 2017. In the near term, Council wrote in a blog post Monday, the goal is to deliver 50 percent of its projects on time and on budget. 

“VIP is revolutionary because it utilizes a single release process designed to eliminate redundancy in review, approval, and communications,” Council wrote in that post.

Specifically, VA is adopting the VIP system in its work to update the current EHR platform within the Veterans Health Information Systems and Technology Architecture, better known as VistA. In a recent solicitation to industry, VA announced the move to the enterprise Health Management Platform, or eHMP, “intended to provide significant new support for Veteran-centric, team-based, quality driven healthcare” under the VistaA Evolution Program. 

The eHMP system will combine feature of VistA’s current EHR platform — the Computerized Patient Record System — “as well as new features and functionality not available in the current VistA system,” according to the request for information. More specifically, it’s expected to “tailor and track care to Veteran functional goals and preferences, [provide] robust long-running workflow and decision support for clinicians, and [gather] new data in a way that VA can analyze healthcare patterns to increase quality and efficiency of operations.” 

VistA has come under scrutiny in recent years because of its involvement in a patient wait list scandal connected to the deaths of veterans who allegedly didn’t receive timely care and its lacking interoperability with Defense Department EHRs. The VA plans to address the latter through the VistA Evolution Program by “improving re-usability (develop once and reuse often), improving its ability to consume and implement open source and commercial products, utilize current healthcare data standards, improve security and auditability, reduce costs, and reduce time to market,” the RFI says. Lawmakers, though, have been impatient with and dismayed by the DOD and VA’s coordinated progress for interoperability thus far.

VA has already delivered several iterations of eHMP, with plans for several more to come later this year. That said, because of the need for backward compatibility and functionality with the CPRS, essentially having them run in parallel, throughout the development process, VA says “it will require several years to develop, test, implement and nationally deploy a full CPRS replacement.”

The department hopes industry can help it address that issue of modernizing the older systems and keeping them running fluidly while building out new ones in the eHMP, and do so in an effective and agile manner. It will accept comments until Feb. 17.