Lack of stable IT leadership at the Department of Veterans Affairs will prove a major hurdle for the agency's technology modernization efforts, including its $10 billion electronic health records project, according to witnesses who testified at a House subcommittee hearing Tuesday.
The Subcommittee on Technology Modernization under the House Committee on Veterans Affairs convened representatives from the Government Accountability Office and the VA Office of Inspector General to discuss the agency's Office of Information and Technology, which is tasked with implementing technology projects such as the Cerner EHR overhaul.
"Many decades of oversight by the Government Accountability Office and the Office of Inspector General have found and documented systematic leadership and management challenges at OIT," said Chairwoman Susie Lee (D-Nev.). "I'd like to explore the root causes of these challenges and identify the barriers for improvement."
The VA declined the House subcommittee's request to send its chief information officer, James Gfrerer, or a representative to speak for the Office of Information and Technology to the hearing. Gfrerer appeared before the House Committee on Veterans Affairs at a separate Tuesday hearing on the MISSION Act's Veterans Community Care Program later in the day.
Gfrerer, a former Ernst & Young executive, was confirmed as the agency's CIO in January. He is the first permanent CIO at the agency in nearly two years.
A major challenge lawmakers and witnesses noted was IT leadership turnover at the agency. That poses a management challenge for an agency with an extensive IT budget, at more than $4 billion each year, according to the GAO.
The VA has had five separate CIOs in four years, according to Lee. Carol Harris, director for IT acquisition management at the GAO and a witness at the hearing, added that the VA has had 10 CIOs since 2004, and the average tenure for these positions has been less than two years.
Harris said there's been high turnover in CIO leadership across federal agencies in recent years, but "the tenure of less than two years makes the VA one of the most challenging of the bunch."
"Our work has shown that the CIO needs to be in office roughly three to five years to be effective," she said. "For a large, change-management program like the EHR Modernization program, you're going to want Mr. Gfrerer to be there at least three to five years, hopefully longer, five to seven years."
Not having a consistent, central IT lead makes it difficult for the VA to innovate, according to Brent Arronte, deputy assistant inspector general at the Office of Audits and Evaluations at the VA OIG. "When it's time to make final decisions about an initiative, there's no one there to do that," he said.
In a statement to Modern Healthcare after the hearing, a VA spokesperson said, "Our primary goal has always been to find the right permanent leader for this critical leadership role rather than simply fill for expedience. We have found that leader in (Gfrerer), who brings a wealth of private sector and military IT experience to the department."
Witnesses at the hearing also commented on the importance of groups that supervise the department's technology modernization work. Harris highlighted the need to define the scope of the Defense Department-VA Interagency Program Office, which the two agencies established to coordinate interoperability between the DOD and the VA's EHRs.
"They should do that as soon as possible," Harris said. "(That's) the most important action the VA can take to ensure the EHRM program is a success. If they don't fully define that process with the DOD, they are going to fail."