900 Office of Enterprise Development, Department of Veterans Affairs

1
Office of Enterprise Development
Robert Howard Assistant Secretary for Information
and Technology Office of Information and Technol
ogy
VeHU 21 August 2007
2
Topics of Interest

• Success of clinical software in VA
• How VA success was built on clinical end users
  providing feedback to development
  
• How reorganization of IT resources can enhance
  this for clinical end users
  
• New functionality rapidly
• Feedback to ensure new functionality meets
  end-user needs
  
• Governance for processes in developing clinical
  software

3
Agenda

• OIT reorganization
• Single IT Authority and OED organizational design
  
  
• Class III-Class I development
• Program governance
• VA IT governance
• Business transformation, business process
  modeling, and functional requirements

4
IT Transformation
Transforming organization requires more than new
organizational design. It requires
Implementation of strong governance practices
Standardization of management system processes
Management of internal and external stakeholders
to drive new actions and behaviors
Strengthen Program Management discipline
All are linked to success of new VA IT Management
System
5
OED Organization Design Strategy
Centralize development community (Mass Detail)
Standardize the organization to greatest extent
possible Merge remaining development activities
into OED Evolve the organization as OIT estab
lishes and matures new processes
Integrate capabilities
1 2 3 4 5
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
6
Centralize Development Community
An interim organization was created to facilitate
the mass detail of staff. Features of the
interim organization include
Same reporting structure (same supervisor)
Same functional structure (same job)
Continuity of operations and service
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
7
Centralize Development Community
Total on board (1 April) 872
OFFICE OF ENTERPRISE DEVELOPMENT
RM and One VA Initiatives
VHA IT
VBA IT
NCA IT
VETERANS HEALTH IT DEVELOPMENT PEO
VA RESOURCE MANAGEMENT IT DEVELOPMENT PEO
VETERANS BENEFITS IT DEVELOPMENT PEO
VETERANS MEMORIAL IT DEVELOPMENT PEO
564
249
12
43
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
8
Standardize Organization
Next step is design and implementation of
standardized organizational structure. Features
of this structure include
Uniform structure and terminology to promote
Cross-PEO collaboration Future integration of cap
abilities
Terminology consistent with industry
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
9
Standardize Organization
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
10
PEO for Veteran Health IT (VHIT)

• Mission
• Manage lifecycle cost, schedule, performance of
  VistA HeV development
  
• Deliver product that meets veterans health
  informatics needs
  
• Our Customers VHA
• VHAs Customer is Care Providers
• Care Providers Customer is Veteran
• Interface to VHA is Office of Information
• User requirements OI/ESM
• Enterprise System Managers
• Managed by Susan Lloyd
• Policy and legislative requirements OI/HIIR
• Health Informatics and Information Resources
• Managed by Gail Graham

IDMC
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VHIT Core Functions and Key Responsibilities

• Define Health Segment within VA Enterprise
  Architecture
  
• Define health segment architecture compliance
  requirements
  
• Establish software engineering policies
• Identify common services
• Manage change control
• Identify Technical Solutions for Meeting Customer
  Requirements
  
• Translate user requirements from VHA-OI into
  functional and system requirements
  
• Conduct business case analysis to include cost,
  return on investment, and make/buy technical
  decisions
  
• Identify infrastructure requirements to OIT
  Operations and Support
  
• Determine Acquisition Plan
• Establish development plan aligned with
  requirements
  
• Develop contracting and spend plans
• Build integrated master plan and schedule
• Incorporate regulatory, statutory, and VA policy
  compliance
  
• Manage Design, Development, Test, and Fielding
• Utilize risk based management and earned value
  management for monitoring development
  

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Merge VA-Wide Development Activities
We are in the process of identifying development
projects, and bringing those resources under OED
control. Efforts presently being reviewed
include
OneVA Programs Registration Eligibility Contact
Management Personal Identity Verification FLITE
HRIS eHRI
E-Authentication E-Signature E-Gov DCMS Exec V
A
Soft Certificate VA ID VIP
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
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Evolve the Organization
OED is implementing process improvement
infrastructure built on principles of CMMI.
CMMI method prescribes
Understand current process, then fill gaps using
goals and practices of CMMI Pilot proposed solut
ions Implement solutions where and when appropria
te Analyze each activity, learning from each expe
rience, and adjusting process improvement process
accordingly
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
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Evolve the Organization
Management Steering Group (MSG)
Approve project objectives and scope
Authorize staff, budget and resources
Prioritize activities empower teams
Review plans and status Engineering Process Group
(EPG) Develop overall improvement approach Faci
litate action team plans and activities
Technical Working Groups (TWG)
Develop and perform action plans
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
15
Evolve the Organization
OED
MANAGEMENT STEERING GROUP (MSG)
ENGINEERING PROCESS GROUP (EPG)
PEO
PEO
PEO
TECHNICAL WORKING GROUPS (TWG)
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
16
Integrate the Organization
An on-going objective of the Office of Enterprise
Development is to maximize effectiveness of its
workforce through integration of its
capabilities. Integration will be achieved
through
Standardization of process Collaboration through
integrated project teams Centralization of common
functions
1 CENTRALIZE 2 STANDARDIZE 3 MERGE 4 EVOLVE
5 INTEGRATE
17
OED Highlights
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OED Highlights
Identity Management Tiger Team
Class III Software Strategy OPS-OED Weekly Confe
rence Project Dashboards Procurement Advisory Bo
ard FY 09-10 Budget Formulation Process Model-Ba
sed Business Requirements Pilot
People CMM for OED Standard Development Environme
nts Rational and Web-Logic Program Governance M
odels Scheduling Alpha version delivered to gov
t for evaluation Alpha site September 2007
19
Mainstreaming Class III Development
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Many SW Orphans

• Many local initiatives in VHA
• Fee Support (FBCS)
• Insurance Card Buffer (ICB) System
• VECNA Patient Registration Kiosks
• Patient Flow Control Software Systems
• Mental Health Initiatives
• Nighthawk Radiology Project
• Anesthesia, Postoperative and ICU Clinical
  Information Systems
  
• Others (see following)

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DSS, Inc.s Clinical / Patient Safety Applications
Many SW Orphans
Many local initiatives in VHA

• Clinical Note Templates (CNT)
• Dental Record Manager (DRM Plus)
• DocManager - document imaging
• Mental Health Treatment Planner (MHTP)
• Provider Assistive Templates (PAT)
• SAVLink - electronic anesthesia documentation
  system
  
• TeleCare Record Manager for Triage (TRM)
• Voice Record Manager (VRM)

22
DSS, Inc. Partner Clinical / Patient Safety
Applications
Many SW Orphans
Many local initiatives in VHA

• CAS Medical Systems - vitals monitors with DSS
  RTV
  
• Welch Allyn - vitals monitors with DSS RTV
• DocuSys - DocuSafe with DSS SAVLink
• Draeger Medical - Innovian with DSS SAVLink
• DSHI Systems, Inc. - Veterans Health Guidelines
  (VHG) with TRM, access treatments protocols
  
• IntrinsiQ Research, Inc. - IntelliDose, oncology
  decision support
  
• Philips Medical Systems DSS CareVue, Intensive
  Care
  
• PocketMD - PocketMD, CPRS via PDA
• ProVation Medical, Inc. - ProVation, procedural
  notes for Imaging procedures
  
• Sage HMS - RadWise, radiology decision support
• TheraDoc, Inc. - TheraDoc, medical decision
  support and infectious disease

23
DSS, Inc. Financial / Revenue Applications
Many SW Orphans
Many local initiatives in VHA

• Encoder Product Suite (EPS) - Partners
  QuadraMed, Unicor Medical, Megas Corporation
  
• Veterans In-Patient Encoder (VIP) - Partners
  QuadraMed, Unicor Medical, Megas Corporation
  
• Insurance Capture Buffer (ICB) - Partner CMS
• Patient Account Management System - VA (PAMS
  -VA), Partner Informatix Laboratory Corporation
  (ILC)
  
• DocManager - Explanation of Benefits (EOB)

24
Class III Class I Migration ProcessInnovation
in Development

• VHA has tradition of fostering local innovation
  to improve quality of clinical care and
  streamline business processes
  
• OIT fully supports these concepts with
  appropriate governance and oversight processes
  
• New projects coordinated between VHA OI and VA
  OIT to continue this tradition
  
• One key effort in promoting rapid/innovative
  deployment of functionality is Innovation Sandbox
  concept
  
• Cross-organizational workgroup between OIT and
  VHA

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Class III Class I Migration ProcessInnovation
in Development

• Sandbox concept allows innovation in any form to
  be more easily and visibly managed
  
• Focus on collaboration puts users at center of
  application design
  
• Start before end of 2007
• Discussed in more detail in Thursday session The
  future of innovation from field

26
Class III Class I Migration ProcessInnovation
in Development

• Joint effort between VHA and OIT
• Together, we determine strategy, establish
  approach and implement solutions
  
• To promote innovation, VAMC staff determine
  functional focus of Class III efforts
  
• Quick-hits for VA-DoD collaboration

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Motivations Why Are We Doing This?

• Leverage value inherent in Class III development
• High end-user acceptance
• Short development cycle and time to market
• Relevant to high-priority needs
• Highly responsive to changing requirements
• Less technical risk in small SW packages
• Less cost risk in small SW packages
• Migration pathway to agile SW management (rapid
  application development)
  
• Formalize Class III as OIT and VHA asset
• Manage Class III development and deployment
  process
  
• For VHA-wide benefit
• Promote standardization and uniformity of quality
  of health care services across VHA
  
• Ensure systems are secure and performing as
  required

28
IT Governance Board Structure
Policy
VA Executive Board
Decision
-
-
Making
Operational
Management
Strategic Management Council
Review and
Coordination
Strategic Planning and Policy Formulation Proc
ess
Budget Formulation Process
Management
of Specific
Operational
Processes
Information Technology Planning and Implementat
ion
Process
Capital Asset Planning and Investment Process
Workforce Planning Process
Legislative Development Process
Information Technology Leadership Board (ITLB)
Business Advisory Committee
Planning, Architecture, Technology and Services
(PATS) Board
Business Needs and Investment (BNI) Board
Note Green represents the influence of
IT Governance on VA-wide governance
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FLITE Governance Framework the Model
User Groups
Contracted Services
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VHIT and Customer Feedback

• Success VA Health IT Related to Incorporation of
  Clinician Feedback to System Designs
  
• But developers must be able to develop
• Needed method of documenting and tracking
  feedback with development process
  
• Enterprise System Management (ESM) Office
  Established
  
• Focus on business owner/customer
• Close relationship with VHIT, mirroring
  structures
  
• Represent end users in requirements development
• Work with IT personnel to incorporate business
  owner feedback

31
Summary Topics of Interest

• Success of clinical software in VA How VA
  success was built in our clinical end users
  providing feedback to development
  
• Close relationship with end-users short cycle
  time
  
• Class III-Class I migration process
• How reorganization of IT resources can enhance
  this for clinical end users
  
• Deliver new functionality rapidly
• Standardize processes and educate IT workforce
• One VA service-oriented architecture
• One VA Data standardization
• One VA leverage VA DoD collaboration
• Many small projects rather than few big ones
  agile development methodology
  
• Feedback to ensure new functionality meets their
  needs
  
• Program management engagement of end-user SME in
  design, development, and testing
  
• Governance of processes in developing clinical
  software
  
• Approved VA IT governance
• Individual program governance