Prob­lems be­set VA’s lo­cat­ing sys­tem

Northwest Arkansas Democrat-Gazette - - NATIONAL - JEREMY SCHWARTZ

AUSTIN, Texas — Four years af­ter the Depart­ment of Vet­er­ans Affairs awarded a half-bil­lion-dol­lar in­for­ma­tion tech­nol­ogy con­tract — so big that one ex­ec­u­tive pre­dicted it would jump-start an en­tire in­dus­try — Austin-based VA of­fi­cials warned that the fledg­ling ef­fort to dig­i­tally track med­i­cal equip­ment was in dan­ger of “cat­a­strophic fail­ure.”

In­ter­nal doc­u­ments ob­tained by the Austin Amer­i­can-States­man show that last year, even as gov­ern­ment over­seers were tak­ing the VA to task for fail­ures in other high-pro­file tech­nol­ogy projects, VA of­fi­cials wor­ried that the depart­ment’s $543 mil­lion con­tract with Hewlett-Packard En­ter­prise Ser­vices to im­ple­ment a real-time lo­cat­ing sys­tem was ca­reen­ing off the rails.

The sys­tem, which con­sists of tag­ging and wire­lessly track­ing ev­ery­thing from catheters to hos­pi­tal beds, has been hailed as a way to po­ten­tially save mil­lions of dol­lars in lost or mis­placed equip­ment.

The VA has also vowed the project would pre­vent death and dis­ease from un­ster­il­ized equip­ment, a per­sis­tent prob­lem at the VA. The con­tract was awarded in 2012, soon af­ter colono­scopies with dirty equip­ment led to a rash of hep­ati­tis and HIV in­fec­tion at vet­er­ans hos­pi­tals in Florida and Ge­or­gia.

But the con­tract has been be­set by a host of prob­lems, in­clud­ing failed op­er­a­tional tests, ques­tions over the re­li­a­bil­ity of equip­ment tags and fun­da­men­tal con­cerns over whether the depart­ment’s Wi-Fi can sup­port the sys­tem, ac­cord­ing to thou­sands of pages of emails, reports and doc­u­ments ob­tained by the Amer­i­can-States­man us­ing the Free­dom of In­for­ma­tion Act.

The pre­vi­ously undis­closed set­backs with the track­ing sys­tem un­der­score the depart­ment’s larger in­for­ma­tion tech­nol­ogy chal­lenges as it em­barks on its most ambitious in­for­ma­tion tech­nol­ogy project to date: re­plac­ing its decades-old VistA med­i­cal record sys­tem. At an es­ti­mated cost of up to $16 bil­lion, it rep­re­sents the first ma­jor tech­nol­ogy test of Pres­i­dent Donald Trump’s ad­min­is­tra­tion.

The track­ing sys­tem should have gone live in VA fa­cil­i­ties across the na­tion last month. Cen­tral Texas VA of­fi­cials have said work stalled about 18 months ago due to con­tract is­sues. Of­fi­cials say they have since fixed many of the prob­lems and plan to launch the project na­tion­wide by June 2018.

The fail­ure to im­ple­ment the project in a timely man­ner has al­ready con­trib­uted to at least one trou­bling sit­u­a­tion. Fol­low­ing up on a com­plaint, VA in­ter­nal in­ves­ti­ga­tors vis­ited the Wash­ing­ton, D.C., Med­i­cal Cen­ter in March, where they found the hos­pi­tal had no func­tion­ing in­ven­tory sys­tem and was un­able to en­sure its equip­ment was prop­erly ster­il­ized.

That led to a se­ries of sup­ply-re­lated crises: In re­cent months the hos­pi­tal has run out of blood­lines for dial­y­sis pa­tients, clip ap­pli­ers to close blood ves­sels dur­ing surgery, and sup­plies as ba­sic as al­co­hol pads and wound dress­ings. The hos­pi­tal has been forced to can­cel prostate biop­sies and, in at least one case, a sur­geon used ex­pired sur­gi­cal equip­ment.

In all, the med­i­cal cen­ter had $154 mil­lion in sup­plies that were not be­ing in­ven­to­ried. The au­dit also found that em­ploy­ees were shun­ning an­other trou­bled in­for­ma­tion tech­nol­ogy pro­gram, called Cata­ma­ran, that man­ages sup­plies through pre­dic­tive an­a­lyt­ics. The pro­gram, the re­sult of a $275 mil­lion con­tract with Hous­ton-based Ship­com Wire­less, was ter­mi­nated last year, ac­cord­ing to doc­u­ments ob­tained by the Pitts­burgh Tri­bune-Re­view, which re­ported that em­ploy­ees com­plained of fre­quent crashes that made it dif­fi­cult to or­der sup­plies.

“The Med­i­cal Cen­ter placed pa­tients at un­nec­es­sary risk by fail­ing to en­sure that ap­pro­pri­ate med­i­cal sup­plies and equip­ment were avail­able to providers when needed,” in­ves­ti­ga­tors wrote.

AR­CHAIC SYS­TEMS

When the lo­cat­ing sys­tem’s con­tract was awarded in 2012, the sys­tem was seen as an op­por­tu­nity for the VA to shed its rep­u­ta­tion as an old-school tech di­nosaur and chart a path to­ward what lead­ers were call­ing a “trans­for­ma­tion ini­tia­tive.”

The same year the con­tract was awarded, the VA’s in­spec­tor gen­eral warned that de­spite calls for dig­i­tal­iza­tion, thou­sands of pages of paper ben­e­fit files were stacked so high in VA of­fices that they were com­pro­mis­ing the struc­tural in­tegrity of build­ings.

A year ear­lier, the VA’s nine-year, $127 mil­lion ef­fort to mod­ern­ize its out­pa­tient sched­ul­ing soft­ware was de­clared a bust. In 2013, the VA and Depart­ment of De­fense aban­doned their ef­fort to merge med­i­cal records, af­ter spend­ing $564 mil­lion. To­day, the VA spends more than half of its $4.3 bil­lion in­for­ma­tion tech­nol­ogy bud­get on main­tain­ing ar­chaic legacy sys­tems.

The real-time lo­cat­ing sys­tem, on the other hand, was a foray into the “In­ter­net of Things,” a cut­ting-edge tech­nol­ogy with a track record of mak­ing fac­to­ries, ware­houses and hos­pi­tals more ef­fi­cient. The Hos­pi­tal Cor­po­ra­tion of Amer­ica cred­its its lo­cat­ing sys­tem with re­duc­ing time spent look­ing for equip­ment by 75 per­cent.

Driven in part by growth in med­i­cal fa­cil­i­ties, the real-time lo­cat­ing sys­tem in­dus­try is ex­pected to ex­pand five times over be­tween 2015 and 2022, to more than $8 bil­lion.

In­dus­try ex­perts pre­dicted the mas­sive VA con­tract would be a boon to the nascent field.

“It’s pretty rare that some­thing this big comes along to jump-start a whole in­dus­try,” said Mar­cus Ruark, for­mer vice pres­i­dent of lo­cat­ing sys­tem sub­con­trac­tor In­tel­li­gent InSites Inc., in 2013.

The sys­tem doesn’t just track equip­ment. It also mea­sures tem­per­a­ture, air pres­sure and hu­mid­ity, so hos­pi­tals can re­motely mon­i­tor tem­per­a­ture-sen­si­tive med­i­ca­tions and tis­sue and get quick alerts on wa­ter leaks.

“[Real-time lo­cat­ing sys­tem] tech­nol­ogy is as trans­for­ma­tive to hos­pi­tal op­er­a­tions as Uber is to per­sonal trans­porta­tion,” wrote Ari Naim, chief ex­ec­u­tive of­fi­cer of sys­tem de­vel­oper CenTrak, last year.

But doc­u­ments sug­gest the devel­op­ment of a na­tion­wide track­ing sys­tem at the VA has been be­sieged by prob­lems since work be­gan.

Six months af­ter the con­tract was awarded in De­cem­ber 2012, the VA com­plained that tags were too wide for smaller pieces of equip­ment and “could be knocked off upon con­tact.”

In Septem­ber 2013, the VA de­clared Hewlett-Packard’s un­der­ly­ing data ar­chi­tec­ture “un­ac­cept­able.”

Hewlett-Packard in turn blamed the VA’s wire­less In­ter­net in­fra­struc­ture for the prob­lems, ac­cus­ing the VA of cut­ting cor­ners.

The root prob­lem for the fail­ures lay in “per­for­mance er­rors that it ap­pears VA has failed to take re­spon­si­bil­ity to cor­rect,” Hewlett Packard wrote, adding that the com­pany “should not be held ac­count­able for the VA’s Wi-Fi lim­i­ta­tions.”

STOP WORK OR­DER

In mid-2016, when a VA su­per­vi­sor re­fused to let Hewlett-Packard ac­cess its cloud-based backup sys­tems, an­other VA em­ployee won­dered why in an email chain.

“I was also sur­prised,” a third VA em­ployee wrote in an email. “But I read it as, I am 100 per­cent fed up with these nitwits and I’m not go­ing to give on any­thing any­more.”

The VA later is­sued a stop work or­der and rene­go­ti­ated new or mod­i­fied con­tracts with Hewlett-Packard. The VA down­played the is­sues men­tioned in in­ter­nal doc­u­ments, telling the States­man that the stop work or­der “al­lowed the VA to re­fo­cus ef­forts to­ward de­liv­er­ing ca­pa­bil­i­ties in an in­cre­men­tal ap­proach be­gin­ning with those that were more ma­ture” and “pro­vided both par­ties the op­por­tu­nity to fi­nal­ize the path for­ward and re­align the sched­ule to achieve those goals.”

Hewlett Packard En­ter­prise Ser­vices, which has since be­come DXC Tech­nol­ogy, gave a sim­i­lar ex­pla­na­tion.

“With any large-scale project, pri­or­i­ties and avail­able ca­pa­bil­i­ties evolve over time and of­ten the pru­dent ac­tion is to take a step back to give both par­ties an op­por­tu­nity to re-align be­fore mov­ing for­ward,” a com­pany spokesman said in a state­ment. “We are ag­gres­sively work­ing to­ward the full RTLS im­ple­men­ta­tion.”

Af­ter a new round of test­ing, the plan is to re­lease “the fully in­te­grated so­lu­tion” by June 2018. The VA says a host of is­sues have been re­solved, in­clud­ing equip­ment tags and the Wi-Fi lim­i­ta­tions and the sys­tem has been in­stalled in a dozen fa­cil­i­ties.

U.S. Rep. Phil Roe, R-Tenn., the new chair­man of the House Vet­er­ans Affairs Com­mit­tee, has made in­for­ma­tion tech­nol­ogy con­tracts a key part of the com­mit­tee’s over­sight of the depart­ment. Tech chal­lenges were the sub­ject of the com­mit­tee’s first hear­ing af­ter the new Congress was seated in Jan­uary.

In June, VA Sec­re­tary David Shulkin an­nounced the VA would pur­chase an offthe-shelf sys­tem to re­place its decades-old, home­grown VistA health records sys­tem. The VA, he said, would use the same ven­dor that is build­ing the Depart­ment of De­fense’s new records sys­tem. The de­ci­sion would al­low the two de­part­ments to more eas­ily sync pa­tient records.

Trump praised the de­ci­sion on Twit­ter, call­ing it “one of the big­gest wins for our vet­er­ans in decades.”

But some law­mak­ers grum­bled that in an­nounc­ing it would pur­chase from the same ven­dor used by the Depart­ment of De­fense — Mis­souri-based Cerner Corp. — the depart­ment was los­ing the pric­ing lever­age of a bid­ding process. While the De­fense Depart­ment is pay­ing $4.3 bil­lion for its sys­tem, the price tag for the much larger VA could come out to four times that amount.

Crit­ics say the ex­pe­ri­ence on the real-time lo­cat­ing sys­tem project shows that hir­ing a com­mer­cial ven­dor to build a new sys­tem does not en­sure smooth sail­ing.

Roe has called this year and next “piv­otal” for the VA’s in­for­ma­tion tech­nol­ogy depart­ment, not­ing that it is try­ing to fix prob­lems af­ter years of fail­ure.

“Now,” he said dur­ing a Fe­bru­ary com­mit­tee meet­ing, “is the last chance to get them right.”

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