VA’s IT system for Family Caregiver Program remains troubled

Efforts to implement an information technology system that fully supports services for family caregivers of post-9/11 veterans continue to be mired in problems.

That’s the contention of members of Congress and a Government Accountability Office official who testified on Wednesday before a joint House subcommittee hearing.

“Caregivers are the most important component of rehabilitation and maintenance for our veterans with severe injuries and their welfare directly impacts the quality of care,” said Rep. Julia Brownley (D-Calif.), chair of the House Veterans’ Affairs Subcommittee on Health. “Given the unique nature of the Family Caregiver Program and the larger than anticipated demand, VA has encountered several complications including staff shortages, unclear procedures and—the reason for today’s hearing—an antiquated IT system.”

In 2011, the Veterans Health Administration created the Family Caregiver Program at each of its VA medical centers nationwide and implemented an IT system—called the Caregiver Application Tracker (CAT)—designed to facilitate the exchange of information about approved caregivers between VAMCs and other VHA entities. However, problems with CAT and a replacement system persist.

“In the case of the Family Caregiver Program, we have one system that was too small for the program, a failed effort to rescue that system, and the complete scrapping of another system—after it was developed, accepted, and paid for by the VA—due to problems with user acceptance testing,” observed Susie Lee (D-Nev.), chair of the House Veterans’ Affairs Subcommittee on Technology Modernization.

“Now, we embark on the fourth effort to build an application with an uncertain timeline and uncertain deliverables,” added Lee, referring to the Caregiver Record Management Application (CARMA), which is being developed on a Salesforce platform and is intended to replace CAT.

Carol Harris, GAO’s director of IT management, told the House subcommittees that the “VA’s efforts to implement a fully capable system have been ongoing for at least four years and there’s no end in sight.”

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While the MISSION Act of 2018 directed the VA to implement an IT system to fully support the Family Caregiver Program by Oct. 1, 2018, the agency failed to meet this deadline.

“The Family Caregiver Program relies on an IT system—and, that system is on the rocks,” remarked Rep. Jim Banks (R-Ind.), ranking member of the House Subcommittee on Technology Modernization. “In fact, it isn’t one system but a confusing succession of four.”

Also See: Lawmakers voice concerns about VA’s plans for Cerner EHR

Steven Lieberman, VHA’s acting principal deputy under secretary for health, acknowledged in his testimony that the agency has faced significant technology challenges.

“To better meet the program’s needs, the VA Office of Information Technology and VHA executed a strategic pivot away from a custom developed system to adopt an industry-leading, commercial off-the-shelf platform suited for these needs which can be configured to meet the specific requirements,” Lieberman testified. “Additionally, VA has shifted from its prior approach of seeking to deliver all desired functionality in one big release to an approach grounded in agile development—best practices for software development in widespread use across the private and public sectors.”

Lieberman told lawmakers that first release of CARMA is slated for the first quarter of Fiscal Year 2020.

“It will replace much of the CAT functionality as it currently exists and feature increased data integrity, to allow for improved oversight at the medical center level,” according to Lieberman’s testimony. “The second release of CARMA, anticipated in January 2020—exact date to be determined—will automate the processing of stipend payments to caregivers.”

In addition, Lieberman noted that subsequent releases “will modify systems with which CARMA will interface” such as the Computerized Patient Record System, Enrollment and Eligibility System, and Veterans Information Systems and Technology Architecture.

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