‘Connecting The Dots’ In the Military And Veterans Health Care Records Systems Maze

By Ken Larson

I am a Vietnam Veteran and former federal contracts manager, who has been in the VA Health Care System for 19 years. History and experience must be connected to yield some tough solutions to a project that has spanned decades without yielding results

The expense and poor performance in the VA Healthcare records system upgrade, recently highlighted in the Congress and the Press, reveal a dire necessity for simplification, communication and efficiency in processes and systems.

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However, the real root causes lie in the massive volume of war veterans returning from our wars in the Middle East over the last two decades, coupled with the historically poor process and systems work conducted between the Department of Defense and the VA utilizing poorly managed contractors taking home millions on systems specifications that change like the wind blows.

The news media, the auditors and the average American are pointing the finger at the President and the Head of the VA.  One cannot ignore the accountability aspects of these individuals.  

 HISTORY: After returning from two combat tours in Vietnam, I worked in the government contracting environment for 36 years then went through the VA system as a Veteran getting treatment at retirement in 2006. I am in the system today.

In 2006 I found the VA had a magnificent system capable of handling medical records and treatment anywhere in the world once a veteran was in the system; a key point.  Why have we had such deterioration?

ANSWER:   We have not experienced deterioration in services within the VA itself, except  from pressures due to millions returning from war coupled with COVID factors and human beings who look for excuses when systems fail.

We have had 2 decades of Middle East incursions, a sudden discharge of veterans and poor management from the DOD to the VA, from the systems contractors to the state veterans homes.  Veterans fall through the cracks as a result. We have a cost plus contracting scenario in the form of veterans care systems mismanagement and it will cost billions to fix. 

THAT IS THE COST OF WAR. We must have effective and timely veterans health care or our volunteer army will disappear. Low recruiting numbers in the present day are demonstrating that fact.

THE TOTAL SPECTRUM MUST BE VIEWED TO MANAGE THE ISSUES. 

BACKGROUND

A 3 part special in Time Magazine in 2013 addressed the serious gaps developing between treatment,  benefits and services processes and systems between the military  services and the Veterans Administration:

https://nation.time.com/2013/04/22/what-the-hell-is-going-on-with-va/#ixzz2RnspoSM4

“While awaiting  processing, “the veteran’s claim sits stagnant for up to 175 days as VA  awaits transfer of complete (service treatment records) from DoD,”:

After years of work to move toward integrated electronic records that would eliminate this sort of delay, Defense Secretary Chuck Hagel conceded in that the Defense Department was not holding up its end of the bargain to improve the disability process.

“I didn’t think, we knew what the hell we were doing.”:

DoD chooses interoperability over integration for new e-health record system

HISTORICAL SIMILARITIES

The above scenario is not unlike the Walter Reed Army Hospital care fiasco a few years ago, before the facility was shut down and consolidated with the Bethesda Naval facility.

https://www.wbur.org/npr/139641856/in-2007-walter-reed-was-the-armys-wakeup-call

OTHER SYMPTOMS

The VA decided to have those who would  actually use the system (claims processors) work with software  developers. This process would take longer, they estimated, but would create a system more  likely to meet the needs of those who actually use it. VA also worked closely with major Congressional-chartered veterans’ service  organizations.

2013 was the year in which regional offices were to be transitioned to the resulting electronic system.  It obviously did not occur as planned.

In recent years a switch to the commercial software approach through a single company contract award without competition by the VA has been a $16 Billion debacle. The non-compete contract was justified because the awarded contractor already had the in-process contract for DOD records system modernization.

https://rosecoveredglasses.wordpress.com/2022/07/29/veterans-administration-16-billion-medical-records-overhaul-could-triple-in-cost/

ROOT CAUSE

Both DOD and the Veterans  Administration use service contractors to perform this type of systems development.  Government Computer News (GCN)  carried a story on the  difficulties experienced with, “Performance-Based Contracting”, which  has been made part of the Federal Acquisition Regulation (FAR) in an  attempt to pre-establish at contract award those discrete outcomes that determine if and when a contractor will be paid.

https://www.route-fifty.com/digital-government/2006/12/performance-based-contracting-still-baffles-agencies/301132/

Interestingly enough, the article splits the blame for the difficulties right down the middle, stating the government typically has problems  defining what it wants as an end product or outcome and looks to  contractors to define it for them. More than willing to do so, the contractors detail specific end products or outcomes, set schedule  milestones and submit competitive proposals.

The winner is selected based on what the government thinks it needs at  the time to fulfill its requirement and a contract is negotiated. Once underway, the government decides it wants something else (usually a  management-by-government committee phenomena with a contractor growing  his product or service by offering lots of options).

The resulting  change of contract scope invalidates the original price and schedule, so  a whole new round of proposals and negotiations must occur with the  winner while the losers watch something totally different evolve than  that for which they competed. The clock keeps ticking and the winner  keeps getting his monthly bill paid based on incurred cost or progress  payments.

CONCLUSION

The present state of the economy and the needs of our servicemen will not allow the aforementioned to  continue. Government agencies are now hard pressed to insure the most  “Bang for the Buck”. It is in the long term interests of the politician, the DOD, the VA and astute contractors to assist in that endeavor. 

(1)The only way to achieve such an objective is through sound technical, cost and schedule contract definition via an iterative process of baseline management and control.

https://www.smalltofeds.com/2009/08/contract-baseline-management-in-small.html

(2)  Government civil servants must be trained to report systemic poor service up the line in lieu of hiding bad news from superiors or developing workarounds.  This must be an expectation built into their job description and they must be rewarded and promoted for meeting that requirement just as they are for the other requirements of their jobs. 

The first whistle to be blown must be to the boss when the service issue occurs, not to the press a year from the occurrence. 

Government service contracting improvement in DOD and the Veterans Administration as well as better management of federal government contractors are mandatory. There are solutions, but they involve accountability, discipline and change.

Our returning soldiers and those who have served before deserve better.

GAO Says More Veterans Heading For Veterans Homes That May Not Be Ready

Image: “Columbiacare.org“

“MILITARY.COM“

“The report, released Aug. 2, found the number of veterans in VA funded nursing home care is expected to total about 44,000 by 2022.

Challenges in contracting with community nursing homes (CNHs), which provide the bulk of that care, could keep the agency from being able to meet demands."

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“Although the number of veterans in nursing homes is expected to rise 16% between 2017 and 2022 as veterans who served in Vietnam continue to age, the VA may not be prepared to handle the increase, according to a new report from the Government Accountability Office.

And while some of those issues may be helped by a recent VA healthcare law, known as the Mission Act, concerns remain, auditors wrote.

“While VA expects to continue placing more of the veterans needing nursing home care into CNHs, officials noted some challenges contracting with these homes,” the GAO report states. “Specifically, VA central office officials said that about 600 CNHs had decided to end their contracts with VA over the last few years for a variety of reasons. For example, officials from four of the [VA Medical Centers] we interviewed told us about CNH concerns that contract approvals can take two years, homes have difficulties meeting VA staff requirements, and VA’s payment rates were very low.”

In addition, the homes may not be able to handle the special needs some elderly veterans face, including behavioral issues or dementia, the study found.

“[VA officials] said homes may not have any of the necessary specialized equipment or trained staff, or may not have as many of these beds as needed, to meet certain veterans’ special care needs,” the report said. “VA officials told us that they are working to expand the availability of special needs care in each of the three setting.”

The VA covers the full or partial cost of nursing home care for veterans, depending on availability and the veteran’s disability rating or injuries. Veterans rated at 70 percent or higher for service-connected disabilities or those who are receiving nursing home care as the result of a service-connected disability are fully covered.

The system provides care in three types of homes. CNHs are publicly or privately owned and operated and contracted with the VA. State veterans homes are typically owned and operated under the preview of the state in which they are located. And community living centers, which often provide acute care, are owned and operated by the VA and associated with the local VA hospital.

Auditors found the VA should do a better job monitoring the quality and performance of nursing homes, an improvement that will be increasingly important as the number of veterans using the facilities increases.

VA officials contract out inspections of nursing homes, but do not regularly monitor contractors’ performance to determine whether or not inspections are being done correctly, the report said. And the way the system works with state veteran homes does not flag all quality problems, which keeps the system from tracking them.

Moreover, VA officials haven’t given VA hospital staff instructions on how to conduct on-site reviews of nursing homes without the contractor, which means they can’t hold those facilities accountable for correcting problems, the report said.

“By making enhancements to its oversight of inspections across all three settings, VA would have greater assurance that the inspections are effective in ensuring the quality of care within each setting,” the report said.

The report also recommended that VA clarify its communication on the types of nursing home care are available, giving more information on state veterans homes and how their quality compares to the other options.

VA officials generally concurred with all four recommendations. They said they plan to act on the report’s recommendation to increase oversight of inspectors while changing how issues with state veteran homes are flagged. They argued, however, that their employees don’t have the authority or oversight to inspect community nursing homes directly. They also said they would investigate whether or not it’s feasible to provide data on state veteran home quality.”

https://www.military.com/daily-news/2019/08/07/more-vets-will-be-headed-nursing-homes-and-va-may-not-be-ready-report.html

A Veteran Connects the Dots In the Military and Veterans Health Care Systems Maze

PLEASE CLICK ON IMAGE TO ENLAGE

The Massive backlog recently highlighted in the press and in Congress  reveals a dire necessity for simplification, communication and  efficiency in processes, systems and government service contracting in DOD and the Veterans Administration as well as better management of federal government contractors. 

The news media, the auditors and the average American are pointing the finger at the President and the Head of the VA.  One cannot ignore the accountability aspects of these individuals.  

However, the real root causes lie in the massive volume of war veterans returning from our pointless incursions in the Middle East over the last decade, coupled with the historically poor process and systems work conducted between the Department of Defense and the VA and poorly managed contractors taking home millions on systems specifications that change like the wind blows.  

It is not unlike the Obama Care fiasco.

After returning from two combat tours in Vietnam, I worked in the government contracting environment for 36 years then went through the VA system as a Veteran getting treatment at retirement in 2006

In 2006 I found the VA had a magnificent system capable of handling medical records and treatment anywhere in the world once a veteran was in the system; a key point.  Please contrast the below Time Magazine Story with current events and ask yourself : Why have we had such deterioration?  

http://content.time.com/time/magazine/article/0,9171,1376238,00.html

ANSWER:   We have not experienced deterioration - within the VA itself, except  from pressures due to millions returning from war and from human beings who look for excuses when systems fail.

We have had over 17 years of Middle East incursions, a sudden discharge of veterans and poor management from the DOD to the VA, from the systems contractors to the state veterans homes.  

Veterans fall through the cracks as a result.

 This is an F-35 aircraft, cost plus scenario, revisited in the form of veterans care systems mismanagement and it will cost billions to fix.  THAT IS THE COST OF WAR.

Unlike the F-35 we must have veterans health care or our volunteer army will disappear.

THE TOTAL SPECTRUM MUST BE VIEWED TO MANAGE THE ISSUES. 


BACKGROUND

A recent 3 part special in Time Magazine addresses the serious gaps between treatment,  benefits and services processes and systems between the military  services and the Veterans Administration:

http://nation.time.com/2013/04/22/what-the-hell-is-going-on-with-va/#ixzz2RnspoSM4

"While awaiting  processing, "the veteran’s claim sits stagnant for up to 175 days as VA  awaits transfer of complete (service treatment records) from DoD,":

After years of work to move toward integrated electronic records that would eliminate this sort of delay, Defense Secretary Chuck Hagel recently  conceded that the Defense Department is not holding up its end of the bargain to improve the disability process.

"I didn’t think, we knew what the hell we were doing.":
 
http://www.federalnewsradio.com/394/3288748/Hagel-orders-DoD-to-restructure-path-toward-integrated-health-record 
 

HISTORICAL SIMILARITIES

The above scenario is not unlike the Walter Reed Army Hospital care  fiasco a few years ago, before the facility was shut down and consolidated with the Bethesda Naval facility.

OTHER SYMPTOMS

The VA decided to have those who would  actually use the system (claims processors) work with software  developers. This process took longer but will create a system more  likely to meet the needs of those who actually use it. VA also worked  closely with major Congressional-chartered veterans’ service  organizations.

2013 was the year in which regional offices were to be being transitioned to the new electronic system.  It obviously has not occurred as planned.

ROOT CAUSE

Both DOD and the Veterans  Administration use service contractors to perform this type of systems development.  Government Computer News (GCN)  carried a story on the  difficulties experienced with, "Performance-Based Contracting", which  has been made part of the Federal Acquisition Regulation (FAR) in an  attempt to pre-establish at contract award those discrete outcomes that determine if and when a contractor will be paid.

http://gcn.com/articles/2006/12/01/performancebased-contracting-still-baffles-agencies.aspx 

Interestingly enough, the article splits the blame for the difficulties  right down the middle, stating the government typically has problems  defining what it wants as an end product or outcome and looks to  contractors to define it for them. More than willing to do so, the contractors detail specific end products or outcomes, set schedule  milestones and submit competitive proposals.

The winner is selected based on what the government thinks it needs at  the time to fulfill its requirement and a contract is negotiated. Once underway, the government decides it wants something else (usually a  management-by-government committee phenomena with a contractor growing  his product or service by offering lots of options). The resulting  change of contract scope invalidates the original price and schedule, so  a whole new round of proposals and negotiations must occur with the  winner while the losers watch something totally different evolve than  that for which they competed. The clock keeps ticking and the winner  keeps getting his monthly bill paid based on incurred cost or progress  payments.

CONCLUSION

The present state of the economy and the needs of our servicemen will not allow the aforementioned to  continue. Government agencies are now hard pressed to insure the most  "Bang for the Buck". It is in the long term interests of the politician, the DOD, the VA and astute contractors to assist in that endeavor. 

(1)The only way to achieve such an objective is through sound technical, cost and schedule contract definition via an iterative process of baseline management and control.

http://www.smalltofeds.com/2009/08/contract-baseline-management-in-small.html

(2)  Government civil servants must be trained to report systemic poor service up the line in lieu of hiding bad news from superiors or developing workarounds.  This must be an expectation built into their job description and they must be rewarded and promoted for meeting that requirement just as they are for the other requirements of their jobs. 

The first whistle to be blown must be to the boss when the service issue occurs, not to the press a year from the occurrence. 

Our returning soldiers and those who have served before deserve better"

VA Will Shift Medical Records To DOD’s “In-Process” Electronic Medical Records System

Image:  Military Times

Total Investment To Date Now Projected at Nearly $10 Billion

“MILITARY TIMES”

“VA has already spent more than $1 billion in recent years in attempts to make its legacy health record systems work better with military systems.

The military’s health record system is still being put in place across that department, more than three years after the acquisition process began. The initial contract topped $4.6 billion, but has risen in cost in recent years.

Shulkin did not announce a potential price tag for the move to a commercial electronic health records system, but said that a price tag of less than $4 billion would likely be “unrealistic.”

---

“Veterans Affairs administrators on Monday announced plans to shift veterans’ electronic medical records to the same system used by the Defense Department, potentially ending a decades-old problematic rift in sharing information between the two bureaucracies.

VA Secretary David Shulkin announced the decision Monday as a game-changing move, one that will pull his department into the commercial medical record sector and — he hopes — create an easier to navigate system for troops leaving the ranks.

“VA and DoD have worked together for many years to advance (electronic health records) interoperability between their many separate applications, at the cost of several hundred millions of dollars, in an attempt to create a consistent and accurate view of individual medical record information,” Shulkin said.

“While we have established interoperability between VA and DOD for key aspects of the health record … the bottom line is we still don’t have the ability to trade information seamlessly for our veteran patients. Without (improvements), VA and DoD will continue to face significant challenges if the departments remain on two different systems.”

White House officials — including President Donald Trump himself — hailed the announcement as a major step forward in making government services easier for troops and veterans.
Developing implementation plans and potential costs is expected to take three to six months.

But he did say VA leaders will skip standard contract competition processes to more quickly move ahead with Millennium software owned by Missouri-based Cerner Corp., the basis of the Pentagon’s MHS GENESIS records system.

“For the reasons of the health and protection of our veterans, I have decided that we can’t wait years, as DOD did in its EHR acquisition process, to get our next generation EHR in place,” Shulkin said.

Shulkin for months has promised to “get VA out of the software business,” indicating that the department would shift to a customized commercial-sector option for updating the health records.

The VA announcement came within minutes of Trump’s controversial proposal to privatize the nation’s air traffic control system. The president has repeatedly pledged to make government systems work more like a business, and in some cases hand over public responsibilities to the private sector.

Shulkin has worked to assure veterans groups that his efforts to rely on the private sector for expertise and some services will not mean a broader dismantling of VA, but instead will produce a more efficient and responsive agency.

He promised a system that will not only be interoperable with DOD records but also easily transferable to private-sector hospitals and physicians, as VA officials work to expand outside partnerships.

Shulkin is expected to testify before Congress on the fiscal 2018 budget request in coming weeks. As they have in past hearings, lawmakers are expected to request more information on the EHR changes then. ”

http://www.militarytimes.com/articles/va-share-dod-electronic-medical-records-decision

THE VA - AN UPDATE BY A SERVICE VETERAN ON DEPARTMENT PROGRESS AND PROCLIVITIES

                                                                        Records Backlog at a VA Center

HISTORY

In September of 2012 this site published an article on the VA and its efforts to improve services to veterans as well as support small business. It was noted from personal experience that excellent care was being received by those in the system but that there was a growing backlog of cases and lack of an effective process to support getting a faster rate of entrance by those returning from the battlefield. 

 

Also noted were disturbing trends in outlandishly expensive conferences and ridiculous video productions, wasting funds earmarked for veteran care. Red flags were going up in the Inspector General office regarding mismanagement of small business set aside programs as well. 

2012 Article on the Veterans Administration Services

UPDATE 

 

Much as occurred since September of 2012. 

 

Last month (January 2015) I visited the VA in Minneapolis for a blood analysis in connection with my annual physical. I marveled at the hundreds of personnel who were going through the blood draw process at 8AM that morning. Polite technicians handled everyone carefully and courteously. My test results were on my doctor's computer for my 11 AM appointment that day.

 

In 2012 I used the VA hospital courtesy center computers for veterans, finding them hopelessly out of date, security-bound and barely functioning. During my January 2015 visit I found beautifully functioning high speed computers and a courteous attendant serving many veterans at the the center

.

On my most recent visit I also went to the department that handles I.D. Cards and applied for a new one, having been informed my card was out of date. I was attended by a sharp technician who checked my credentials, transferred by data, took my picture and processed my application inside of 20 minutes and I was behind several others. 

 

We who are in the system are still receiving fine service. 

 

But the massive number of returning veterans has strained the VA Health Care System to the point where the Department Secretary has been fired. A corporate executive from outside the system has been placed in charge. The department has been massively reorganized into 5 regions across the country to deal with a scandalous scenario of wait times and neglect in services for incoming veterans. 

When All Else Fails - Reorganize 

 

We forecast the above situation.  It is principally due to the fact that the 5 armed forces medical records systems are not connected to the VA Health Care System and the government contractors who have attempted to develop a system to connect them have failed miserably. 

"Next Gov"

" Defense and VA Scrap New Electronic Health Record after estimated costs ballooned to $28 billion. By Congress’ count, the doomed effort – a result of the 2008 Defense Authorization Act – already cost taxpayers more than $1 billion. "
 

A Veteran Connects the Dots

THE FUTURE

Congress is focusing on firing personnel as a remedy. In our view that is symptom-like remedy, not a solution. 

Recent VA Firings 

 

We now have a corporate bureaucrat in charge of the department who is running it like a corporation, reorganizing and establishing a 5-headed bureau under him. There will no doubt be 5 separate fiefdoms to manage. Who knows what will happen to requirements for IT as existing IT system designs get split 5 ways? 

Government contracting services companies are continuing to have a field day, growing rich and failing in the classic fashion we saw with the Obama Care roll out.  Success is not a money-making proposition for these firms.  They get their monthly bills paid as they march hundreds of service workers into government buildings to catch the latest whim of the civil service program managers as they change specifications depending on which way the wind is blowing in the massive bureaucracy.

We believe those who are lucky enough to have entered the system will continue to receive good care. 

We pity those younger or seasoned injured and ill who are knocking on the door and waiting to get in.

Traces of TCE in Camp Lejeune’s Water Supply Could be the Cause of Some Veteran’s Health Concerns

This article is brought to you courtesy of Douglas Karr a US Navy Veteran and highly regarded blogger at the Mesothelioma Cancer Alliance Blog:

http://www.mesothelioma.com/blog/authors/doug/bio.htm

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Following service in the military, many servicemen and women think their most complicated battles are behind them. Unfortunately, many veterans suffer long-lasting mental and physical health issues. Scientists and doctors are continually making connections between veterans and the multiple diseases and health conditions that seem to plague them.

Though it has long been known that the nation's veterans are at high risk for developing asbestos cancer or mesothelioma, other cancer risks are newly emerging. In fact, as recently as early October 2011, the Environmental Protection Agency warned that anyone who served or lived on base at Camp Lejeune in North Carolina between the 1950s and 1980s is at risk for developing a number of cancers related to water contamination on the base. Though multiple cancers are listed as possible risks, the EPA specifically linked consumption of the water's contaminants to breast cancer, kidney cancer, non-Hodgkin lymphoma and liver cancer.

Apparently, trichloroethylene - known as TCE - made it into the water supply at the base. TCE is highly toxic to humans and causes multiple types of cancer. Exposure to the contaminant is responsible for claiming many lives, including children living at the base. Some diseases related to the exposure are latent, meaning it may take many years before they develop in the body. Unfortunately, those effects may continue for many years to come. According to the EPA, individuals who lived or worked on the base between the 1950s and 1980s were exposed to the chemical, placing them at risk for many years to come.

The discovery is no surprise to the countless men, women and children who have fallen ill due to exposure to the water at Camp Lejeune. What else could account for the more than 70 recorded cases of male breast cancer at the base? Despite decades of suspicion surrounding the water at Camp Lejeune, previous studies from the National Research Council found no confirmation of a link between the base's water and the multiple diseases that service members and their families were suffering. However, the recent discoveries by the Environmental Protection Agency disprove those previous reports, raising hope and awareness for veterans who have long sought out answers and recompense for their suffering.