By Stephen Spotswood
Washington – Many of the changes at VA over the last several years have been in furtherance of resource management—finding ways to more efficiently use the money, facilities, and healthcare resources provided to them. This includes one of the most precious of commodities: physicians’ time.
VA is currently seeking assistance in finding ways to better allocate this resource in the form of modernized scheduling software and in October launched the VA Medical Appointment Scheduling Contest (vascheduling.challenge.go). It is a competition soliciting private industry to encourage the creation of updated, open-source software that would accommodate the rapidly evolving needs of the department. Up to three winning submissions—ones that succeed in creating the best proof of concept software—could win as much as $3 million each.
VA’s current Medical Scheduling Package (MSP) is a component of VistA; it’s legacy electronic health record (EHR) system. The MSP not only makes appointments for clinicians, but also captures data that allows VA to measure, manage, and improve efficiency and access to care.
However, VA’s current MSP is more than 25 years old. It neither meets current requirements, nor does it provide the flexibility needed to adapt for future needs.
“This legacy system was developed over the last 25 years in locations around the country,” explained Edward Syms, a program analyst with VA’s Office of Information and Technology. “It was created based upon needs as they arose in an ever-changing system.”
While the system has managed to keep up with VA needs in most respects, there are now more physicians using the system, and more patients being scheduled using it, than it was originally built to accommodate. Last year, around 80 million appointments were made in the VA system.
And the needs of the patients and physicians making those appointments are vastly different than those VA experienced 25 years ago.
The care of a VA patient today is not nearly as centralized. Frequently a veteran will receive care at a number of facilities—hospitals, Vet Centers, and community-based outpatient clinics to name a few. And when they do receive care at a single facility, it is with numerous different clinicians.
The current scheduling software is unable to integrate those multiple schedules. For example, there’s not a link between a general physician’s appointment calendar and the calendar of the radiology department where a patient might need to be sent.
Whoever is doing the scheduling must open up both screens on their computer, put them side-by-side, and compare them.
“The current system is designed with multiple queues. Every activity has its own schedule, and they’re really not communicating with each other. All of the coordination is being done through a human being,” explained Michael Davies, VHA’s National Director of System Redesign, who, along with Syms, is helping spearhead the software competition. “In the future, we want the system to make that coordination of appointments easier for the scheduler.”
Even a single provider could have multiple schedules—something Davies considers a waste of time and a waste of expensive provider resources.
“The poster child are mental health clinicians,” Davies said. “They schedule organized by appointment type or reason for visit.”
A psychiatrist might have one schedule for PTSD patients, one for general mental health, and another for military sexual trauma, Davies explained. “We want that all in one view so we can manage the number of appointment slows that they have and how they’re committed. It’s fragmented now.”
The Search For A New System
Attempts have been made previous attempts to create a replacement for the MSP. In 2000, VHA began an initiative called the Scheduling Replacement Project that had the goal of creating an outpatient scheduling application that would improve veterans’ access to care. The project was the result of a larger, department-wide initiative to modernize VA’s health information system known as HealtheVet.
From 2000 to 2009, VA spent an estimated $127 million on the project. About half was spent on project planning, support and equipment and half was paid to the contractor selected to develop the software. The project was designed to be tested at an alpha site—a VA facility in Muskogee—before being rolled out nationwide.
Problems integrating the application with other VA components led to continuing delays in deployment at the alpha site. Finally, in 2009, VA leaders directed the project team to abandon the alpha site testing and focus its efforts on a national deployment of the new scheduling software.
However, the application software had a number of defects that VA and the contractor could not resolve. In February 2009, VA terminated its contract with the developer and, in September 2009, ended the entire Scheduling Replacement Project.
“We’ve taken the time between then and now to do a more detailed analysis,” Syms said. “We learned that we needed to improve the quality and method by which we do our acquisitions. And we’ve created a better acquisition process.”
That includes creating this challenge to encourage private companies to come up with innovative ideas—something VA felt it needed to do before beginning and acquisition process. Syms and Davies are very excited about the contest and confident that it will provide better results than previous efforts.
Best and Brightest
“We expect to have a lot of interest and a lot of entries,” Syms said. “We’re going to get to see what industry capabilities are available to us. We want them to bring their best and brightest ideas.”
An optimal submission would not only work seamlessly with VA’s EHR and solve the multiple schedules problem, but would be able to work on a national level. Currently, a patient being seen at one hospital cannot make an appointment at another hospital—something VA would like patients to be able to do. It is not uncommon for a veteran planning a trip to another state—either a permanent move or a vacation—to need to schedule an appointment at a VA facility and be unable to do so until they contacted the other hospital.
VA also wants the software to be ready for what VA plans to accomplish in the future, which includes giving the veteran more access and control of their health care.
“If we’re successful in the future, the patient could go in electronically, see their appointments at any facility in the VA, be able to manage them, and keep their care coordinated no matter where they are,” Davies said.
Over the years, VA has had extensive input from clinicians and other providers about what new scheduling software needs to be capable of. That input has created what amounts to a set of scoring criteria for submissions.
“We’ve translated that input into objectives and scoring guidelines,” Davies said. “After the May 1 deadline, contestants will be looked at in a two-tiered approach.”
The first tier will be whether it meets the very basic tech requirements. Those that make it past that tier will face a second tier with scoring criteria based on VA’s business needs. A panel of raters will test each software for its ability to meet the goals VA is hoping to achieve.
“I would say the best entrant will not only have solved the technical problems, which we think are hard enough to solve, but will also set us up to meet all the challenging needs of our veterans in the future, including self-service portals, telemedicine, coordination of care across facilities and geographic boundaries,” Davies said. “As if that isn’t simple enough, also make it simple to use.”