The Veterans Affairs Department's pharmacy re-engineering project " tagged as a troubled project last year " was put back on track after being divided into a series of smaller, incremental jobs, the VA's top information official said today.
The system, designed to modernize the way VA pharmacists perform medication ordering and dosage control, is now in production at a VA hospital in South Carolina and will expand to four more hospitals soon, VA chief information officer Roger Baker said at a Oct. 6 congressional hearing.
The project is expected to reduce drug dosing errors, said Baker, who cited it as an example of how VA has improved IT management by putting its projects through the Program Management Accountability System (PMAS), a rigorous process to track delivery of VA products and services.
Records from PMAS show that VA has met more than 80 percent of the milestones for it major IT projects in fiscal 2010, Baker said. PMAS measures progress on 97 VA IT development projects.
"I know of no other CIO, government or private sector, who has this level of insight into such a large portfolio of development projects," said Baker, who noted that in 2009 VA met only 30 percent of its IT milestones.
"Most IT development organizations, public or private sector, would be ecstatic with meeting 80 percent of their committed milestones," he said at the hearing of the Senate Veterans Affairs Committee.
All IT projects must now deliver at least every six months advances in functionality that customers can use, or the project does not proceed, he said.
The department also avoided $220 million in costs in 2010 by eliminating poorly performing projects and lowering the risk and spending on others, he said.
Last year, VA canceled 12 and restructured 33 IT projects, including the pharmacy project, using the PMAS system, Baker said.
VA's top IT priorities now include creating an open source method to modernize the Veterans Health Information Systems and Technology Architecture (VistA) electronic medical record system, he said.
VistA is an EMR that was written in vintage MUMPS code and upgraded over the last 30 years. While highly regarded by clinicians, its decentralized architecture has made it costly and complex to maintain and upgrade. VistA modernization will include more standards and common services and will support interoperability among the applications.
Ed Meagher, vice president of health care strategy at CSC, an IT vendor, and former deputy CIO at VA, urged the agency to adopt recommendations published in May by the Industry Advisory Council, a vendor group, that VA start planning to move VistA to an open source and open standards model.
Meagher, who led the IAC's VistA panel, told the committee the approach would "yield the greatest improvements in VA healthcare delivery."
In discussing the continuation of the use of MUMPS in the core VistA, Glen Tullman, CEO of Allscripts, an electronic health record provider, said VA needs to broaden its view of what technical architectures and systems can best support communications and information exchange.
"(No one) is using MUMPS to build systems that communicate with each other to exchange data today, except in the government," he said.
Tom Munnecke, one of VA's architects of VistA and retired chief scientist at Science Applications International Corp., said that even as a legacy system VistA has been effective and deciding how to modernize it was a complex project.
"Going with the standards of the IT industry and thinking that we're going to take these shiny new technologies and buzzwords off of Power Point presentations and come up with a successful system is not going to work," he said.
Tremendous medical informatics challenges have to be dealt with and in a way that actually works on the ground for the Indian Health Service, Defense Department and VA, he said.
