WASHINGTON—A new patient scheduling system that the Department of Veterans Affairs has spent eight years and as much as $145 million developing is reportedly on the brink of failure. According to a memo from the office of Michael Kussman, M.D., VA’s Undersecretary for Health, which was leaked to the media, senior VA leadership is concerned over the near-collapse of the project, the implications of VA’s failure to complete such a critical project and how legislative overseers will react to the news.

The memo, sent by Dr. Kussman on March 20 to Steve Warren, acting assistant secretary for information, said that there was little confidence the Replacement Scheduling Application (RSA) Development Program would yield any significant results or that the current product being tested would prove successful.

The RSAproject began in 1998 when a GovernmentAccounting Office report addressing excessive wait times for VA patients identified the need for a better scheduling system. Beginning in February 2001, VAspent five years and $75 million developing a new system but failed to deliver any useable program. The failure was one of the main issues that precipitated the move by VA to a more centralized information technology system.

Concerns Raised in 2007

Development of the RSA continued, but an assessment by an independent contractor in September 2007 showed numerous concerns, including the fact that there seemed to be no on in charge of implementing the system, should it ever succeed, at a national level. The assessment showed an unlikelihood that the project would meet its major mission objectives, which were to have a working alpha product by mid-October 2008 that could be shown to be minimally operational, allowing one physician to schedule one appointment.

At a September 2008 meeting of VA leadership, concerns were raised that the program had seen no real progress and that no product had been delivered to the field. A directive was given to the Office of Enterprise Development to cease work on the current product and begin work on a beta product, one that would be smaller and include less functionality, but would be able to do the job and be deployed into the field by the end of 2009.

On March 18, Gerald Cross, M.D., VA’s principal deputy undersecretary for health, was briefed by OED and told that product testing had resulted in numerous failures and that work on the RSA had been suspended in February until another course of action could be determined. According to Dr. Kussman’s memo, it was the first his office had heard of the project’s termination.

“The result is that a program starting as far back as 2001, and having spent significant funds, still has not developed a single scheduling capability it can provide to the field, nor is there any expectation of delivery in the near future,” Dr. Kussman wrote. “While corrective actions such as a teaming arrangement with Space and Naval Warfare Systems Command and a new program manager for the RSA have been put in place, there are still many concerns that put in question OED’s ability to ever complete some variant of RSA.”

In the memo, Dr. Kussman expressed concern regarding the effect the revelation of the program’s failure would have on Capitol Hill. “The impact of the above decisions regarding RSA are significant and likely to generate intense Congressional and Office of Management and Budget interest with the high probably of a directed GAO investigation,” he wrote. “In addition to alerting the Secretary, which we need to do at once, I would also suggest we consider an internal audit [by the VA Inspector General] to demonstrate a proactive approach to both recognizing the issue and solving the problem.”

Dr. Kussman also wrote that he and Dr. Cross would have to discuss a “clear communications plan for how we tell the story both inside and outside VA.”

However, before that plan could be created, the memo leaked, news of the project’s failure broke and legislators were informed through the media before VA had a chance to tell them.

“When they spend so much money and they have all of those holes, and all of a sudden [it fails], I’m concerned,” declared Rep. Bob Filner, D.-Calif., chair of the House VA Committee, who added that it was the lack of transparency and communication that concerned him the most.

“Everybody makes mistakes. Unfortunately government makes mistakes that cost so much. But we still don’t have that communication between VA and the Congress on these issues, let alone the public,” he explained. “I never saw the memo. Nobody ever called me up and told me they were running into trouble. Let’s talk about it. Certainly the new administration is nowhere near staffed up so that sort of communication could be routine. But we always hear it first from [the media] which bothers me.”

According to Rep. Filner, the committee will be looking to hold a hearing on the issue in the near future.

The leak was followed shortly by announcement of Dr. Kussman’s plans to resign effective May 9, something that came as no surprise as Dr. Kussman was expected by legislators to resign by the end of May.