While spending for most federal IT groups will be flat in 2013, Department of Veterans Affairs seeks budget boost to improve access to electronic health records, telehealth, and mobile devices.
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While IT spending across most of the federal government would be flat next year under President Obama's budget released last week, the Department of Veterans Affairs (VA) would see a 6.9% increase, with much of the uptick going to improved electronic health records (EHRs).
The coming year will see "major investments" in an ongoing project to integrate Department of Veterans Affairs health records with Department of Defense health records, VA CIO Roger Baker said in an interview last week. Currently, more than 100 VA employees are staffed to the effort. More than 20 projects are in planning mode, including single sign-on, an effort to unify VA and DOD pharmaceutical systems, and more.
Baker announced last year that the integrated health record system would eventually reside in the Defense Information Systems Agency's (DISA's) cloud computing infrastructure. Currently, according to Baker, DISA is working with VA to stand up VA's own VistA EHR system in a cloud environment. "Hospitals don't need to know and shouldn't care where their VistA system is running," Baker said.
The VA's Blue Button initiative, which allows vets to download their VA health records into a text or PDF file directly from VA's website, is another part of the agency's work on EHRs. According to Baker, almost one million veterans have downloaded their health information through Blue Button.
Baker said that big things are planned for the Blue Button effort in the coming year. For example, in summer 2012, the agency plans to turn on a feature that Baker calls Blue Button Connect, which will enable more information sharing with medical providers nationwide. Other healthcare providers are already using Blue Button-like systems, and by the end of the year, Baker estimates, about 60 million people will have access to such capabilities.
Also in the works are a project to add veterans' service records to Blue Button data and work to improve Blue Button's backend IT infrastructure. And last month, Office of Personnel Management director John Berry said that he would be making Blue Button available across the federal government.
Telehealth is another big part of VA's continuing IT strategy. According to Baker, VA's clinical partners are starting to realize real savings from telehealth, which allows doctors to work remotely with patients rather than requiring them to come into a VA facility, resulting in savings on travel costs, costs of admission, and even doctors' time seeing patients.
The IT piece of that puzzle is increased bandwidth and secure conferencing. Customers are increasingly demanding improved access to telehealth. However, in some cases, they are outpacing VA's ability to deliver technology. For example, while there's a demand for telehealth services via mobile video, Baker said that mobile security concerns have thus far prevented the VA from acting on those demands.
The VA is also working on ways to reduce a benefits backlog that has plagued the agency for years. Much of the help will come from a long-term paperless initiative that will digitize much of the benefits process. The Veterans Benefits Management System, one of the major elements of this initiative, has already undergone pilot testing, and the system will ramp up to a broader operational capacity this summer, according to Baker.
Mobility is another significant initiative for VA, and Baker said increased use of smartphones and tablet computers could improve the quality of VA's care. Baker announced in August that iPhones and iPads would soon be making their way to VA networks.
Currently, the agency is putting together a set of applications that will help establish a business case for broad, expanded access to mobile devices, and will eventually make their way to a VA-controlled application marketplace for clinical apps. Baker said he expects a significant uptick of smartphones and tablets at the agency by summer 2012.
Arguably, the accomplishment for which Baker's tenure is recognized most is his overhaul of dozens of VA IT projects soon after he joined the agency in 2009. After suspending 45 troubled projects, Baker nursed many of the projects back to help and restarted them with an assist from a project management system he calls the Project Management Accountability System or PMAS.
As recently as April, Baker questioned whether PMAS would remain in place if he left the agency. However, now, 10 months later, he said that he's confident that won't be the case. "The phase we're in on PMAS right now is hammering it home," he said. "I had said that I was worried about PMAS staying if I didn't, but I'm now not worried about it at all."
Thanks to PMAS and Baker's strong commitment to accountability, VA met 89% of its project milestones last year. If Baker wants to ensure that he gets the increased IT funding he seeks next year, even in the face of federal belt-tightening, he may have to continue to deliver numbers like that.
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