Abstract \"The United States Department of Veterans Affairs operates the nation's largest integrated health care system, with more than 1,700 hospitals, clinics, community living centers, domiciliary, readjustment counseling centers, and other facilities\" (V.A, 2016). \"In response to serious and longstanding problems with veterans' access to care, which were highlighted in a series of congressional hearings in the spring and summer of 2014, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 (Pub. L. No. 113-146, 128 Stat. 1754), which provides $15 billion in new funding for Department of Veterans Affairs (VA) health care\" (GAO, 2016). To this day, appointment wait times at the Department of Veterans Affairs are still long. Despite billions of dollars poured into the agency in the last couple of years and numerous reforms intended to improve veterans' access to care, VA facilities continue to grapple with appointment wait times of months or more. The focus of this course project will be to provide the V.A., a new way to process and schedule patient visits. I will focus on functionality and scheduling aspect that will make it easier for Veterans to be seen by their doctors in a more productive way. Brief Company background \"The U.S. Department of Veterans Affairs (VA) is a United States executive department formed in 1989 to, in President Abraham Lincoln's words, care for him who shall have borne the battle and for his widow and his orphan. The department stems from the Veterans Administration formed on July 21, 1930 by President Herbert Hoover. The current secretary is Robert McDonald, who was confirmed on July 29, 2014. The Department of Veterans Affairs employs 312,841 people as of 2014. Among the agencies overseen by the department are the National Cemetery Administration, the Veterans Benefits Administration and the Veterans Health Administration\" (BP, 2016). Discussion of business problem(s) \"In May, 2014 The Department of Veteran Affairs had a scandal when it was revealed that 1,700 veterans were put on secret waiting lists at their Phoenix VA hospital. The lists were made to hide the length of time it took for veterans to see a doctor. Fourteen-hundred more veterans had to wait more than 90 days to see a primary care doctor at the Phoenix facility. VA hospitals all around the country were found to have similar problems. The biggest problem for the Department of Veterans affair was and still is their poor patient schedule system but if we dig deeper we find that unfortunately, software isn't the only problem behind the vast VA scandal\" (Gold, 2014). One of the main issue that got overlooked is that the VA had unworkable policies, managers had unreasonable expectations, and workers faked goals when they couldn't meet them (Gold, 2014). \"An audit showed 57,000 veterans were waiting at least three months for a first appointment which cause some patients to die while waiting\" (Gold, 2014). This lack of management caused the former VA Secretary Eric Shinseki to resign (Gold, 2014). \"As mention the VA's scheduling system, which was and is supposed to keep tabs on the balance of supply (doctors) and demand (patients seeking care) at its facilities around the country, failed because the V.A. current system the VA's electronic health records system, the Veterans Health Information Systems and Technology Architecture, or VistA, is 30 years old; its scheduling component that dates back to 1984\" (Verton, 2014). \"Even though it has undergone many upgrades and changes, VistA remains an outdated system incapable of keeping up with the massive increase in patient demand that has resulted from the wars in Iraq and Afghanistan as well as an aging veteran population\" (Verton, 2014). The current number of veterans enrolled in the VA health care system has increased from 5.1 million in 2001 to more than 9 million in 2013 and probably more today (Verton, 2014). \"The VA currently employs over 50,000 schedulers who make over 113 million appointments per year covering 154 medical centers and more than 700 community-based outpatient centers (Verton, 2014). \"But the inability of VistA to provide a single, enterprise wide view of scheduling means these tens of thousands of entry-level workers must deal with multiple appointment types that cut across medical disciplines, are only accessible through different screens on their system and must accurately match patient requests to one of VA's 125,000 physicians\" (Verton, 2014). \"The core problem we're trying to solve is that we do not know what our provider supply is," Davies said. Because of VistA, the VA is one of the only medical organizations of its size that currently cannot determine how many appointment slots those doctors are staffing, he said (Verton, 2014). This is clearly a huge problem that the VA has not been able to fix and must fix so their patient stop suffering or even worse dying before they get the necessary medical treatment. Below is a chart of what the VA believes to be their core problem. (Verton, 2014) High level solution There are several high level solutions that will not only fix the patient relations with the VA but also repair their negative image. The solution that I think would benefit the VA the most due to the VA size and need is an ERP style system. \"Enterprise resource planning or ERP, is a business process management software that allows an organization to use a system of integrated applications to manage the business and automate many back office functions related to technology, services and human resources\" (Beal, 2016). \"ERP software integrates all facets of an operation, including product planning, development, manufacturing, sales and marketing\" (Beal, 2016). \"ERP software is considered an enterprise application as it is designed to be used by larger businesses and often requires dedicated teams to customize and analyze the data and to handle upgrades and deployment\" (Beal, 2016). \"The basic goal of using an enterprise resource planning system is to provide one central repository for all information that is shared by all the various ERP facets to improve the flow of data across the organization\" (Beal, 2016). Since ERP can be update it to handle the need of the company that is using it, it makes a perfect sense for the VA to use it along with their VistA system and other solutions to fix the VA scheduling problem. Another solution can be a Cloud based scheduling that sends notifications to all patients and love ones that the patient would want to add to their profile in case they have disabilities that can prevent the patient from remembering their appointments. The notifications will be based on smartphone push notifications utilizing Microsoft Project and a few other joined systems for maximum effect with minimum requirement. Another feature will be the use of calendar reminders from Apple IOS, Android, Windows phone and many others. Benefits of solving the problem According to the Veterans Affairs Secretary Robert McDonald, since the VA scandal in 2014, the VA has gotten more than 266,000 veterans off of wait lists and into care (Jordan, 2014). The number of veterans waiting for appointments has gone down by 57 percent since May 15 2015 (Jordan, 2014). So is clear that the more the VA tries to fix the problem the better is going to be for their patient. The VA main focus is to provide Veterans great medical care as fast and safe as possible and their biggest problem have been their scheduling system that needs a huge upgrade to be able to take the huge amount of appointments needed to make sure their patients are getting the proper medical treatment. Unlike any other business the VA problem is a great one because is all about providing medical care to their patients and saving lives. So the benefit of solving this problem is to be able to provide a service to their patients and save lives. The benefit it will provide to the VA is streamlining of scheduling and ensuring that there are no \"miss appointments\" \"double bookings\" or \"dead air.\" This will allow the VA to utilize their man power better by using productive systems and mostly free software that is usually easy to use and available in all smart phones. Business/technical approach Bringing in a new technology to any business, you have to decide how you go about it and how you will deal with any issues that can arise, so introducing it on a smaller scale would be best before tying up resources for the entire organization. In order to get things right, we are going to use Data warehouses to store patient's social security, rank, branch, next of kin and address. \"A data warehouse is a database, with reporting and query tools, that stores current and historical data extracted from various operational systems and consolidated for management reporting and analysis\" (Laudon, 01/2015, p. G-3). \"The data warehouse makes the data available for anyone to access as needed, but it cannot be altered\". \"A data warehouse system also provides a range of ad hoc and standardized query tools, analytical tools, and graphical reporting facilities\" (Laudon, 01/2015, p. 231). Since there are VA clinics in all the states in the United states. \"Each estate will use localized data mart since is a small data warehouse containing only a portion of the organization's data for a specified function or population of users\" (Laudon, 01/2015, p. G-3). This would allow a better merger between the VistA and the MASS systems along with IOS, Android and Windows applications for mobile smart phones calendar, text and messaging features. I would recommend a pilot system test in the Los Angeles VA clinic to make sure the software, program and system are working 100% before we trained and then release the system nation wide. Perhaps roll out to the Training Store Managers in the region closest to the corporate When this pilot study is complete and working to its specifications, it can be installed throughout the rest of the company, either simultaneously or in stages. Business process changes The business process change is simple. Eradicate the old VistA system and the ways the VA was ran and adopt a more update, agile methodology along with investing more in software, programs, training and systems that can fix the current scheduling problem. The VA also needs to be able to have a more synchronize appointment scheduling system and a more synchronize patients records to be access from one department or clinic to another and be available to be access by any clinic around the country since a lot of patients do not live close to any VA clinic their information can be access by any third party clinic that is seen them. By revamping the scheduling system used by VA and allowing for easier access by an ERP system and a new commercial off-the-shelf (COTS) scheduling module the VA can make sure their patients are being seen by their doctors as soon as possible preventing any of their patients suffer more than they are. Technology practices used to augment the solution The technology that will be use to augment the solution, is technology VA has access to already. For the last 2 years the VA has been working hard on trying to built, acquire or find a system that can take care of their scheduling problem. \"On August 24, 2014 the Department of Veterans Affairs, Office of Acquisition Operations, Technology Acquisition, awarded a singleaward, indefinite-delivery, indefinite-quantity contract VA118-15-D-0129 on a hybrid firm-fixedprice and time-and-materials basis for the Medical Appointment Scheduling System (MASS) to Systems Made Simple, a Lockheed Martin company. MASS is one component of the Department's strategy to provide state of the art electronic health record, scheduling, workflow management, and analytics capabilities to front line caregivers serving Veterans. MASS is expected to enhance and simplify the viewing and making of appointments convenient to Veterans, along with improving the coordination of care and appointment reminders. MASS will allow clinicians to better utilize rooms, support staff, and equipment in service of Veterans' needs. The ordering period for the basic ID/IQ contract shall be 60 months from the effective date of award with two, 12-month optional ordering periods. The total contract value for ordering purposes including all Options: $623,582,928.88\" (FEDBIZOPPS, 2015). High-level implementation plan Since the VA awarded a contract to Systems Made Simple (SMS), Inc. for their Medical Appointment Scheduling System or MASS on August of 2015. The VA has planed to put in motion it new scheduling module in three phases (Verton, 2014). \"The first phase, known as version 1a, will provide immediate, short-term improvements to local scheduling (Verton, 2014). The agency plans to replace VistA's current graphical user interface with a calendar-based view that pulls everything together in one screen view. The first phase will also include connecting VistA scheduling to a recently developed clinical video teleconferencing capability\" (Verton, 2014). \"The second phase, known as version 1b, will be a commercial off-the-shelf or (COTS) which in this case is MASS implementation within VistA, this phase will give VA time to standardize and modify non-scheduling business practices to account for the new technologies\" (Verton, 2014). \"The final phase, known as version 2, will begin the full-scale switch to MASS the replacement of VistA scheduling capabilities. To this day there is no word on the exact timing of these phases, but should take several years before all VistA applications can be integrated with the new scheduling module\" (Verton, 2014). Which means that the VA will continue to add software, hardware and programs to make sure their scheduling system is perfect so their patients do not have to wait too long for their appointments. Below is a chart that shows the VA business strategy or approach. Summary of Recommendations Migrate VistA to the new MASS system as soon as possible. Hire appropriate implementation manager or specialists and other subject matter experts to aid management in developing an adequate migration and training plans Retain and hire well experience well qualified IT personnel to support the new environment. Utilize cloud based platforms to assist MASS with appointment notifications using IOS, Android, Windows, Text and messaging. Finally, the summary of the project is to find and recommend the VA new technology and a new reliable solution for them to resolve their current problems. All these solutions can be implemented, but before implementation, it should be tested whether it is reliable or not. This will help the VA to learn more about their previous mistakes they committed and help them to grow further. Using their new MASS system take care of the problem but it is imperative that they provide proper training to their staff and to continue looking for new innovated software of systems to help them stay current so no more patients have to suffer or loose their lives because of a computer glitch. Conclusions and overall recommendations The goal of this proposal was to help the VA find a system that would be easy to merge with is old system VistA and provide the VA with a more updated, state of the art system that can be use all wound the country with no issues. My original recommendation was for the VA to move to a single ERP application in order to improve operational efficiencies, reduce IT costs related to ERP systems, and improve their poorly run scheduling system. A sub-goal was to also determine if by migrating to a single ERP application the VA might be able to merge their old system with a cloud based inexpensive system fast and right. It was my personal opinion that if the VA move to a single ERP solution because it will allow all divisions to function from a common ERP platform and will remove the need to perform repetitive manual scheduling and would ensures that everyone have immediate and relevant access to meaningful data that is system driven, immediate and on demand instead of having to wait for somebody to \"manipulate\" the data into a format that may or may not be truly accurate depending upon the human error factor. \"During my research I found out that the VA on August 24, 2015 had awarded a contract to Systems Made Simple (SMS), Inc. for their Medical Appointment Scheduling System or MASS. The MASS system is expected to enhance and simplify the viewing and making of appointments convenient to Veterans, along with improving the coordination of care and appointment reminders. The system also will allow clinicians to better utilize rooms, support staff, and equipment in service of Veterans' needs which is exactly what the VA needs in order to fix the problems and scandals they have face in the last few years\" (FEDBIZOPPS, 2015). After I found out that they had awarded the contract and got the MASS system there is no doubt that the MASS system is the right tool to help the VA fix their problems. In conclusion, it is imperative for the VA to merge is VistA and their MASS systems right from the beginning. Veterans cannot continue to loose their lives because a software glitch or negligence. The government has dedicated 5 billion dollars of their 15 billion dollars to make sure the VA upgrade and update all their IT systems. Even though it has taken 2 years for the VA to finally find a system they fill it meets their standards they need to make sure that everything goes smoothly and in a timely manner because the longer it takes the longer things will work right and in this case is not only about business or profits but more importantly the live of those who served to make sure this country is the best country in the world. MIS 535 Course Project Professor: By TABLE OF CONTENT Abstract Brief Company background Discussion of business problem High level solution Benefits of solving the problem Business/technical approach Business process changes Technology practices used to augment the solution High-level implementation plan Summary of Recommendations Conclusions and overall recommendations References 3 ABSTRACT COMPANY BACKGROUND BUSINESS PROBLEM He HIGH LEVEL SOLUTION BENEFITS OF SOLVING THE PROBLEM TECHNICAL APPROACH BUSINESS PROCESS CHANGES TECHNOLOGY PRACTICE USED TO AUGMENT THE SOLUTION HIGH LEVEL IMPLEMENTATION PLAN SUMMARY OF PROJECT CONCLUSION AND OVERALL RECOMMENDATION REFERENCE Beal, V. (2016, February 15). What is Enterprise Resource Planning (ERP)? Webopedia. Retrieved from http://www.webopedia.com/TERM/E/ERP.html FEDBIZOPPS. (2015, August 25). D--Medical Appointment Scheduling System (MASS) - Federal Business Opportunities: Opportunities. Retrieved from https://www.fbo.gov/index?s=opportunity&mode=form&id=15a1662edc40008378cbeed3d94d2e 1d&tab=core&tabmode=list& = GAO. (2016, February 17). U.S. GAO - High Risk: Managing Risks and Improving VA Health Care. Retrieved from http://www.gao.gov/highrisk/managing_risks_improving_va_health_care/why_did_study Gold, A. (2014, June 13). VA fiasco: A tale of 2 software - POLITICO. Retrieved from http://www.politico.com/story/2014/06/va-schedule-software-problems-107839 Laudon, K. C., Laudon, J. P. (01/2015). Management Information Systems: Managing the Digital Firm, 15th Edition [Vital Source Bookshelf version]. Retrieved from https://bookshelf.vitalsource.com/books/9781323187944 Jordan, B. (2014, August 26). Obama, McDonald Vow to Fix VA Scheduling Practices | Military.com. Retrieved from http://www.military.com/daily-news/2014/08/26/obama-mcdonald-vow-to-fix-va-scheduling-practi ces.html V.A. (2016, January 21). U.S. Department of Veterans Affairs. Retrieved from http://www.va.gov/ Verton, D. (2014, August 5). VA poised to kick-off contract for new scheduling system. Retrieved from http://fedscoop.com/va-poised-to-kick-off-contract-for-new-scheduling-system/