We testified on the Department of Veterans Affairs' appointment scheduling systems before the U.S. House of Representatives, Committee on Veterans Affairs, Subcommittee on Technology Modernization.  Our testimony is based primarily on the following reports, as well as ongoing work:

• Veterans Health: Improvements Needed to Achieve Successful Appointment Scheduling Modernization
• Veterans' Community Care: VA Needs Improved Oversight of Behavioral Health Medical Records and Provider Training
• Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care

We also discuss recommendations we've made.

Highlights

What GAO Found

The Department of Veterans Affairs (VA) uses dozens of systems to schedule appointments, manage referrals, and monitor wait times for veterans.  The department is also in the process of replacing its primary health information system—the Veterans Health Information Systems and Technology Architecture (VistA)—by deploying a new electronic health record system with Oracle Health.  However, the rollout of the new system has been delayed due to technical and performance issues.  Some of those scheduling systems and tools are commonly used across the department by many VistA facilities.  Schedulers at the handful of facilities that have the new Oracle Health system also have an additional set of scheduling systems and tools available.  For example:

• VistA facilities.  Almost all VA medical facilities use the VistA health information system, which is over 30 years old.  These facilities use multiple VistA applications, in addition to other systems, for scheduling health care appointments and managing referrals for specialty care.  Both schedulers and veterans must navigate a complex environment when using VA’s systems to schedule appointments.  VA facility staff are required to open multiple applications to schedule a single appointment.  They must also run reports in different systems to identify veteran self-scheduled and self-canceled appointments and appointment requests.
• Oracle Health facilities.  Due to difficulties in rollout, very few facilities have begun to use the new Oracle Health system.  These facilities have another set of scheduling systems, as well as some of the same systems VistA facilities use for scheduling appointments and managing referrals.

In addition, veterans have experienced issues requesting an appointment online, getting confirmation once an appointment is scheduled, and receiving duplicative appointment reminders.  This complex systems environment presents challenges for VA and for veterans scheduling appointments.  VA officials acknowledge that some challenges are the result of operating multiple platforms (VistA and Oracle Health) as well as having multiple versions of VistA.  VA is taking steps to address these challenges.  VA initiated efforts to modernize its scheduling systems, which included several concurrent efforts to improve scheduling-related systems across VA’s medical facilities.  For example, one of these efforts is intended to allow provider-based scheduling, which is the ability for VA schedulers to see a provider’s schedule across multiple modalities (in-person, telephone, telehealth) in a single scheduling application.  According to VA officials, the department is also working to standardize veteran appointment self-scheduling at VistA and Oracle Health sites.  GAO has reported for many years on VA’s challenges concerning its scheduling systems and their impact on delivering care to veterans.  Although VA has generally agreed with GAO’s recommendations, it has not yet fully implemented them.  Doing so would aid VA’s progress toward providing timely, quality care to veterans.

Why GAO Did This Study

The VA schedules tens of millions of health care appointments for veterans each year.  To do so, it uses a patchwork of systems that have been developed in ways that make scheduling—with both Veterans Health Administration (VHA) and non-VHA providers—difficult for veterans and staff.  In addition, VA has experienced information technology (IT) challenges related to the outdated, inefficient nature of systems and its efforts to modernize its health information system.  VA health care was added to GAO’s High Risk List in 2015, where it remains today.  GAO was asked to testify on its key prior work on VA scheduling and the systems involved, as well as the related challenges for VA providers, staff, and veterans, and how VA plans to address those challenges.  GAO summarized the results of five prior reports.