VA puts brakes on contract for medical appointment scheduling system

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A Department of Veterans Affairs contract to modernize the VA’s system for managing medical appointments has been put on hold, pending the outcome of an internal initiative to update its legacy system.

Last year, the VA awarded Lockheed Martin’s Systems Made Simple the worth $624 million Medical Appointment Scheduling System (MASS) contract, with the goal of replacing the system by 2017 with commercial off-the-shelf software through a series of incremental upgrades. However, despite Congress concern, the agency has decided to put the acquisition on the backburner for now while it takes a homegrown technology approach.

“VA planned to conduct an initial pilot of MASS in Boise, Idaho, through 2016 but it was never started, and activity on MASS has apparently been suspended,” said Rep. Mike Coffman (R-Colo.), chairman of the Veterans’ Affairs Subcommittee on Oversight and Investigations, during an April 14 hearing. “This decision is a dramatic about-face. It means sticking with the government-developed technology indefinitely.”

Rep. Dan Benishek (R-Mich.), MD, chairman of the Veterans’ Affairs Subcommittee on Health, agreed, saying that VA’s IT projects often have “progressed to a critical decision point and then been abandoned in favor of another initiative or plan.” Benishek warned that “maintaining manual systems and deferring to archaic operating systems as a default cannot continue—we need a sense of urgency.”

The MASS procurement was supposed to fix inefficiencies at VA facilities, many of which have struggled to provide timely healthcare services to veterans by inaccurately recording the required dates for appointments and inconsistently tracking new patients waiting for outpatient medical appointments, resulting in delays in care delivery.

“The wait time crisis in Phoenix highlighted the VA’s antiquated scheduling system and how difficult it was to use,” added Rep. Ann Kuster (D-NH), ranking member of the Veterans’ Affairs Subcommittee on Oversight and Investigations. “Modern IT systems and processes are critical to ensuring that patients receive quality coordinated care…VA’s outdated and cumbersome patient scheduling system was a major contributor to the patient access crisis and remains a challenge.”

Kuster stated that MASS was a “promising response to the clear inadequacies of the current system.” Yet, despite the VA spending $27.5 million on a pilot for the new scheduling system, she argued that the VA’s putting the acquisition on hold “seems like déjà vu all over again” and in the process has “wasted nine years and $127 million without an update to its scheduling system after finding a commercial product and abandoning that for an in-house solution that could not deliver an adequate update.”

VA’s change in direction on MASS comes at a time when department is also re-considering its planned modernization of the Veterans Health Information Systems and Technology Architecture (VistA). The agency is re-evaluating future clinical needs to determine whether it should move forward with VistA or follow the lead of the Department of Defense and procure a commercial EHR system.

“We want to be certain that continuous modernization of a 40-year-old electronic medical record is an appropriate decision as well as our approach to modernizing scheduling,” David Shulkin, MD, under secretary for health at the Veterans Health Administration, told lawmakers. “We will share this vision with you this summer.”

Currently, the VA is piloting homegrown “Microsoft Outlook-type” scheduling solutions in two facilities, ramping up to 11 other centers shortly, with an eventual national rollout possible, according to Shulkin. While the department might ultimately decide to implement its own technology, he quickly reiterated that they “have not ruled out MASS” but have merely paused the contract which they “can execute on at any time.”

From a cost perspective, Shulkin asserted that its national-level pilot of its own in-house technology this summer will cost $6.4 million, compared with about $152 million for a MASS pilot at three sites over 10 months. “That’s if VA stays on schedule with its pilots,” he concluded.

LaVerne Council, VA’s CIO and assistant secretary for IT, testified that MASS is based on “a capacity scheduling and work planning system” within the Epic electronic health record system. Systems Made Simple, the prime contractor for MASS, was unavailable for comment. A senior Epic official declined to comment.

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