Audit Finds Weaknesses in VA’s EHR Scheduling

April 27, 2022
Office of Inspector General report said the project could cost approximately $2 billion more for each year it runs behind schedule

An audit of the Department of Veterans Affairs’ Electronic Health Record Modernization (EHRM) program said it needs to beef up its integrated master schedule (IMS) to strengthen the credibility of the program’s timeline.

Without a strong IMS, “OEHRM cannot demonstrate how slippages will affect the overall timeline, nor can OEHRM assure stakeholders that the reported timeline is realistic and achievable. Any schedule delays that extend the program beyond 10 years is also likely to result in billions of dollars in cost overruns,” the report said.

The audit, published by the Office of Inspector General (OIG) on April 25, is titled, “The Electronic Health Record Modernization Program Did Not Fully Meet the Standards for a High-Quality, Reliable Schedule.” It noted that VA previously reported that this effort will cost about $16 billion—but, as of December 2021, VA is re-evaluating its cost. It is expected to take about 10 years to implement the new system across VA facilities nationwide. As of October 2021, completion was projected for fiscal year (FY) 2028.

The IMS is designed to cover the entire required scope of work needed to successfully complete the program from start to finish, including both government and contractor work. It is intended to provide VA personnel with a road map to completion, track progress, help identify potential problems and track their resolutions, and promote accountability for assigned tasks, the report said.

As of June 30, 2021, the OIG found that neither the overall IMS nor the five underlying individual project schedules the audit team reviewed fully met standards adopted by OEHRM for a high-quality, reliable schedule. Here are some details of weaknesses identified by OIG:

Comprehensive. The IMS should reflect the entire scope of program work in some level of detail to plan how the system deployment will be executed. However, the OIG determined that the IMS did not capture all work for the program’s duration, including missing activities for the Veterans Health Administration (VHA) and Office of Information and Technology (OIT). Although the OIG recognizes that not all details are available for a decade-long project, planning packages and other approaches can be used to help account for all work.

Credible. A credible IMS should include a complete schedule risk analysis. This analysis predicts the level of confidence VA can have in meeting a program’s completion date based on the schedule. However, OEHRM did not conduct a schedule risk analysis for the IMS.

Well-constructed. A well-constructed IMS should have a valid “critical path.” As described by GAO, this path determines the earliest date the program can be completed and helps managers examine the effects of activity slippages.6 However, there was no overall IMS critical path for the program.

The EHRM Integration Office program executive director concurred with six OIG recommendations for improvement and provided responsive actions plans. The program executive director provided target completion dates to implement recommendations from May 2022 through December 2022. The OIG said it would continue to monitor implementation of the planned actions.

The head of the Department of Veterans Affairs said Monday the department will not need to request more money from Congress to complete the nationwide rollout of a computer system projected to cost at least $16 billion over a decade, after an internal watchdog agency said the already-delayed effort’s cost is likely to rise.

The OIG report said the project could cost approximately $2 billion more for each year it runs behind schedule. However, in response to the report, VA Secretary Denis McDonough told the Spokane Spokesman Review that the department will not need to request more money from Congress to complete the nationwide roll-out. “I continue to believe that we have the budget authority that we need over the life of this project,” McDonough told the Spokesman-Review. “If we have reason to believe that that’s changed, we’ll obviously go straight to Congress and talk that through with them. … But at the moment, I believe that we have the budget authority we need.”

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