History of IT at VA

Early in the 1970s, the National Center for Health Services Research and Development, a component of the U.S. Public Health Service, began planning for development of what would become Electronic Health Records (EHR).

VA Massachusetts General Hospital Utility Multi-Programming System (MUMPS), a precursor to VistA, developed by the Computer Assisted System Staff (CASS) Team.

In the early 1980s, VA made its software available without restriction in the public domain to other government and private sector organizations, in compliance with the Freedom of Information Act. VA recognized this opportunity to support widespread EHR adoption and offered use of VistA as the standard-bearer for EHR implementation around the world.

In June 1981, VA MUMPS was renamed the Decentralized Hospital Computer Program (DHCP), and VA Administrator Robert Nimmo joined Rep. G.V. "Sonny" Montgomery to establish DHCP as VA's Medical Information System Development Program to formalize its organization and management.

The original Section 508 dealt with electronic and information technologies, in recognition of the growth of this field. Due to a number of shortcomings, including lack of enforcement mechanisms, the section was updated in 1998 as part of the Federal Electronic and Information Technology Accessibility and Compliance Act.

Upgrading the computer capacity of its medical facilities allows VA to implement DHCP nationally, allowing VA to further promote the use of emerging technologies in all its locations.

Indian Health Service (IHS) developed additional functionality to integrate outpatient clinics into the system. Through this partnership, VA incorporated changes that supported their extensive network of community-based outpatient clinics.

VistA, VA's first image management system, provided VA physicians with immediate access to patient medical images, regardless of location. VistA first became operational at the Washington, D.C. VA Medical Center (VAMC) to manage radiologic, pathology, gastroenterology, and laparoscopic images, as well as electrocardiograms.

To support VistA's clinical use, VA began developing Computerized Patient Record System (CPRS) — the first clinical user interface for VA's IT architecture.

VA's Under Secretary for Health, Kenneth W. Kizer, M.D., renames DHCP as VistA, the Veterans Health Information Systems and Technology Architecture.

VA became one of the first health care organizations to use bar code technology to improve the accuracy of medication administration. This technology ensured Veteran patients received the gold standard for medication administration software.

In 1995, patient charts were available only 60 percent of the time at VA facility patient encounters. Currently, patient records are available in electronic form at nearly 100 percent of patient encounters across VA facilities.

CPRS is released for clinical use.

CPRS implemented at all VA medical facilities. CPRS' major functionalities included:

1. A clinical data repository with privacy protection,
2. Data retrieval and display,
3. Document entry with role-based business rules,
4. Problem lists, medication lists, reports (including radiology) and health summaries,
5. Provider order entry for all clinical services and departments, and
6. Clinical decision support with reminders, real-time clinical alert systems, notification systems, order checking, and disease management features.

VA initiates the Replacement Scheduling Application (RSA) project.

Federal Health Information Exchange (FHIE) supported the sharing of pharmacy records, laboratory results, radiology reports, and deployment-related health assessments, among other data, from multiple Department of Defense (DoD) health information databases, including the Composite Health Care System.

The Milestone Review Process was established for VA IT projects to gain better control of IT expenditures and to provide the ability to stop or redirect a project during the build process.

VA established the system to track dollars spent on IT.

All of VA's IT functions and personnel centralized under the CIO.

Following VistA's implementation, many VistA professionals banded together in a community to develop a standard knowledge base for VistA development.

Core Financial and Logistics System (CoreFLS) deployed at Bay Pines VAMC in Bay Pines, Florida to track finances, payments to vendors and inventories.

VA launches My HealtheVet nationwide on Veterans Day 2003. The personal health record portal now has over 2.5 million registered users.

The Bidirectional Health Information Exchange (BHIE) program enabled the real-time, two-way data exchange for shared patients between VA and DoD. In addition to expanding beneficiary coverage, BHIE added significant capability, including the ability to view inpatient and outpatient notes, among many others.

Congress created one budget authorization for all VA IT spending, establishing it as an independent entity, and gave VA's CIO sole budget authority.

VA and the Department of Navy's Space and Naval Warfare Systems Center (SPAWAR) created an Interagency Agreement (IAA). Leveraging SPAWAR's expertise in information management and information technology engineering solutions, the IAA provided VA with skilled program management support and knowledge.

By 2007, VA and DoD expanded the capabilities for prescription and drug allergy data to include semantic interoperability, allowing for a more complete clinical understanding of data across both systems. This was achieved through the Clinical Data Repository/Health Data Repository, which has reduced the risk of prescribing medications to shared patients with known drug or allergy reactions.

Post 9/11 GI Bill signed into law and went into effect on August 1, 2009. It provides up to 36 months of education benefits, generally payable for 15 years following a Service member's release from active duty.

As part of the American Recovery and Reinvestment Act of 2009, the U.S. Congress appropriated $19.2 billion to increase the use of EHRs by physicians and hospitals. This portion of the bill, called the Health Information Technology for Economic and Clinical Health (HITECH) Act, sent a strong message that the U.S. government firmly believed in the benefits of using EHRs and was willing to invest in its use.

VA cancels RSA development.

VA introduced the Virtual Lifetime Electronic Record (VLER) Health program to share select parts of a Veteran patient's medical record electronically, safely, and privately with other approved health care facilities that are members of a secure Internet network known as the eHealth Exchange.

VA announces a change in the way it planned and managed IT projects. Every IT project would now be managed through the Project Management Accountability System (PMAS). Agile Development is a collaboration-based methodology introduced to improve PMAS and support on-time delivery of IT capabilities. Prior to 2009, VA only delivered about one-third of its projects on time and new functionality every three to seven years.

The Veterans Benefits Management System (VBMS) was launched as the primary technology solution of Veterans Benefits Administration (VBA) Transformation.

VA engages in the national eHealth Exchange network.

The VA-Kaiser Permanente partnership was established to develop a health record pilot program that allows for the protected exchange of patient records between Kaiser Permanente HealthConnect and VistA, two of the nation's largest EHR systems.

Veterans Relationship Management (VRM) was initiated as an enterprise-wide, multi-year initiative to improve a Veteran's secure access to benefits and services administered by VBA.

95% of all VA prescriptions were placed through computerized physician order entry. This was regarded as benchmark for EHR success.

The Virtual Regional Office (VRO) was created to initiate software design processes.

President Obama signs into law the Patient Protection and Affordable Care Act (PPACA). Among the provisions to take effect over a four-year period were those prohibiting denial of coverage or claims based on pre-existing conditions, expanding Medicaid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide health care benefits, establishing health insurance exchanges, and supporting medical research.

VRM initiative was launched as a multi-year initiative to improve Veterans' access to health care and benefits information.

VA begins regional reorganization of its Office of Information and Technology (OIT).

VA Enterprise Visibility gives VA real-time visibility to all devices connected to its network. VA has the ability to view, measure, and secure all IT assets connected to the VA network. This protection, which began implementation in 2010 and completed in 2012, allows VA to protect Veteran information by ensuring devices connected to the network meet VA security standards and are free of vulnerabilities.

VA establishes the Open Source Electronic Health Record Alliance (OSEHRA) as the central governing body that oversees the community of EHR users, developers, and service providers.

The Interagency Program Office (IPO) was established to develop and implement an integrated EHR capability for both VA and DoD.

Office of Enterprise Architecture (EA) re-established the OneVA EA Program to serve as a strategic planning and management tool that helps VA's leadership chart the course for the Department's transformation into a 21st century organization. Near-term focus was on aligning and integrating the component architectures and transition plans of VHA, VBA, and National Cemetery Administration (NCA), supported by a robust and secure IT infrastructure.

VA CIO established the Ruthless Reduction Task Force (RRTF) initiative and designated the Deputy CIO for Architecture Strategy and Design (ASD) to lead a standing team for ensuring that VA pursues all possible options to reduce IT spending.

An internal review of OIT by Deloitte showed that IT at VA was understaffed with fewer than 8,000 IT staffers supporting VA's 320,000 employees.

VA begins conducting business with external stakeholders through the Stakeholder Enterprise Portal (SEP). SEP uses a single secure entry portal that provides stakeholders access to Web-based systems needed to assist Veterans, Service members, their families, and survivors, allowing Veterans Service Organizations (VSO) to prepare electronic claims and upload supporting documents safely.

According to VA figures dated April 20, 2013, the number of claims pending for more than 125 days was 613,469, while the total number of pension and entitlement claims was 886,345.

VA began Personal Identity Verification (PIV) card-based access enterprise-wide with Homeland Security Presidential Directive 12 (HSPD-12) implementation.

VBMS deployed to all 56 regional offices, increasing efficiencies for the disability claims process, improving security for Veterans' personal information, and helping ensure timely and accurate delivery of $3.6B in disability benefits paid each month.

VA implements Trusted Internet Connection (TIC) and other tools/processes to continuously monitor, evaluate, and address risk status to devices and systems. TIC improves ability to monitor external connections and identify potentially malicious traffic by reducing and consolidating external connections.

Tripler Army Medical Center and VA Pacific Islands Health Care System partnered to develop the Joint Legacy Viewer (JLV), a web application that provides a common view of patients' health information from VA and DoD EHRs.

RiskVision is a comprehensive risk management platform developed to automate Governance, Risk, and Compliance in agencies subject to regulation, and allows monitoring for information security technical policy compliance, threats and vulnerabilities, and business impact. Based on the near real-time visibility into VA's systems, risk exposure can be immediately identified and efforts to reduce risk can be prioritized allowing the most critical issues to be addressed first, thereby mitigating threats.

The VA Point of Service (VPS, aka Kiosks) Project which was completed in 2014, resulting in approximately 5,500 total VPS kiosks deployed to 146 VAMCs nationwide.

My HealtheVet accessibility improves from 16 percent to 95 percent.

VistA Evolution Program, a partnership effort to modernize VistA, launches with a goal of providing essential health information technology to Veterans and clinicians and allows Veterans to have a seamless access to their health record.

President Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014 (VACAA).

VBMS received and processed its 1 millionth Disability Benefits Questionnaire (DBQ) in collaboration from OIT and VHA.

11,200 mobile devices were distributed to selected VA facilities in support of the VA Mobile Health Provider Program, which aims to put mobile technology into the hands of health care providers to enhance patient care.

VistA scheduling enhancements were deployed to ensure Veterans do not have to wait for access to care.

JLV allows the user to configure displays to support various workflows. JLV maps data to standard national codes in seven clinical domains, making it easier to compare data between systems, understand trends, and develop a more complete picture of a patient's history.

Digital Service Experts (DSE) team formed to re-design and re-build crucial digital interfaces.

The first of four Feature Sets to modernize VistA and move towards full implementation of VistA 4, a product of VistA Evolution is delivered.

VA awards contract for resource management dashboard, aggregated view of clinic profile scheduling grids, and single queue of request lists.

VA and Walgreens establishes a partnership to provide needed vaccines and education to Veterans to improve immunization rates and keep Veterans healthy.

Telehealth Intensive Care Unit (ICU) solution was implemented at two Veterans Integrated Service Networks (VISNs) with implementation underway at two more. Tele-ICU connects VAMC ICU staff with Tele-ICU central monitoring center staff for real-time interaction and patient monitoring around the clock.

VA successfully completes VistA migrations to 25 data centers.

Clinical Video Teleconferencing (CVT) system released nationwide. CVT is a web-based system that allows scheduling staff to perform scheduling for CVT appointments.

Medical Appointment Scheduling Solution (MASS) target service architecture and conceptual system architecture, based on VistA Evolution design pattern was delivered.

VA releases Request for Proposal (RFP) for long-term Medical Appointment Scheduling Solution (MASS).

VBMS achieves record number of simultaneous unique end-users (11,388).

Specific plans for 21 projects to address continuous improvement of information security at VA.

Secure, robust wireless networks deployed to 126 of 177 VA medical facilities, with the remaining sites scheduled to finish deployment by the end of FY15. This updated infrastructure allows medical center staff more flexible access to VistA and other electronic information systems, as well as enables the wireless transfer of information amongst medical devices such as electrocardiograms carts, vital signs monitors, and infusion pumps.

New policy initiated to evaluate open source solutions (along with larger enterprise solutions) when acquiring or developing new software. This policy requires that the use of open source development practices are considered when VA or a VA support contractor develops software.

VA delivers the Affordable Care Act (ACA) required real-time, IT-based interface with Centers for Medicare and Medicaid Services (CMS) systems. The interface verifies that individuals seeking insurance through healthcare.gov are not enrolled with VA for health care services.

CRISP Unauthorized Software Remediation removes, updates, or replaces unauthorized software.

VA began implementing the State Prescription Monitoring Program VistA patch in phases across VAMCs.

LaVerne Council officially sworn in as the new Assistant Secretary for IT and CIO for VA, replacing former CIO Roger Baker and acting interim CIO Steph Warren.

VA OIT Product Development is developing the Airborne Hazards and Open Burn Pit Registry (AHOBPR), targeted to deploy at the end of Q3 2015.

New feature release will include improved infrastructure and clinical enhancements.

New CIO aligns OIT core values with VA core values and announce TrAIT

• Transparency
• Accountability
• Innovation
• Teamwork

Assistant Secretary for Information and Technology and Chief Information Officer Laverne Council announces sweeping transformation iniative with three primary goals:

1. Stabilize and streamline processes
2. Eliminate material weaknesses
3. Institutionalize new capabilities that drive improved outcomes

The Veteran-focused Integration Process (VIP) is a Lean-Agile framework that services the interest of Veterans through the efficient streamlining of activities that occur within the enterprise.

VIP is the follow-on framework from Project Management Accountability System (PMAS) for the development and management of IT projects which will propel the Department with even more rigor toward Veteran-focused delivery of IT capabilities. The VIP framework unifies and streamlines IT delivery oversight and will deliver IT products more efficiently, securely and predictably. With VIP, VA takes another generational leap forward in its commitment to serve our nation's Veterans.

DHP is an entirely new approach to healthcare. It leverages public-private partnerships and VA's vast data stores to create a new paradigm for health services delivery and public services delivery across every Federal agency.

VA Infrastructure Operations (IO) creates the VA Enterprise Cloud (VAEC), a multi-vendor, highly secure cloud environment, which allows VA to leverage cloud services, tools, and economies of scale to more rapidly deliver Veteran-centric technology solutions.

VA Secretary announces Lighthouse API initiative and the API Pledge

VA Announces Launch of “Lighthouse Lab” at Health Information & Technology Conference

VA Infrastructure Operations (IO) creates the VA Enterprise Cloud (VAEC), a multi-vendor, highly secure cloud environment, which allows VA to leverage cloud services, tools, and economies of scale to more rapidly deliver Veteran-centric technology solutions.

VA Launches New Health API for Mobile, Web-based Apps

After a two-year vacancy, James P. Gfrerer confirmed as new Assistant Secretary for Information and Technology and Chief Information Officer

VA announces streamlined Software as a Service (SaaS) initiative and reaches out to vendors at HIMSS

VA MISSION Act sees new IT capabilities to support community care for Veterans.

VA successfully migrates two instances of VistA, VA’s legacy Electronic Health Records Management (EHRM) system, to the VA Enterprise Cloud (VAEC), enabling VistA to take advantage of the cloud’s scalability, reliability, and flexibility. This effort was recognized with a FedHealthIT Innovation Award