Kurt DelBene, chief information officer at the U.S. Department of Veterans Affairs' Office of Information and Technology, hosted a media briefing Tuesday to talk about how he aims to break down silos and unify contractor and government teams to drive results.

WHY IT MATTERS

To foster collaboration and innovation and bridge the gap between government employees and contractors, DelBene said the VA's silo-breaking strategies center on joint project reviews and recognizing the critical role played by contractors.

With more than 2,000 locations nationwide – running 500,000 desktops on 1,000 different IT systems – it's essential to unify contractor and government teams to drive results across the VA's vast network of provider sites, he said.

"The dev team is outsourced," said DelBene. "Contractors are a key part of getting the work done."

DelBene said VA OIT is getting into a new rhythm where contractors are not kept at "arm's length" and are represented by staff project managers in project checkpoints. They are in the room working alongside. 

He added that, while contractors work as peers, and are looked at as the software development team for particular VA projects, the OIT is developing a culture of benchmarking to evaluate their performance, he said.

VA OIT is conducting and documenting root cause analyses across projects, in addition to assuring accountability with Federal Information Technology Acquisition Reform Act standards, DelBene said.

"We identify places where contractors are not actually performing well, and we make sure that we document that for future years and remediate against it," he said.

DelBene also said VA OIT is driving fewer "big bang" development projects, where the agency awards a large contract to a single vendor to build against requirements established at the outset. 

Instead, contracts are for a first deliverable, and if it's working the agency will scale out from there. A contractor may have five to seven months to prove a solution without committing the full project budget up front, he said.

Funding is not committed until the agency evaluates contractor performance and results, and it can catch bad deliverables or request vendors switch out teams early on, he said. As far as smaller contractors, they need to prove themselves.

"We want to bring more and more of them into the ecosystem of VA OIT, but to do that, it's kind of like we need them to show us the capabilities that they have," he said.

The Pathfinder website is the place where contractors can go to explore opportunities and communicate with operations, he said. He also noted that the VA's large technology projects will not be farmed out. 

Using the example of Healthcare.gov, he noted that breaking up such a complex and large-scale project across five vendors is partially what led to a failed integration when the site went live. DelBene was later tapped by the Obama Administration to turn the site around.

"We've got to have this cohesiveness of a team so that we get a good result in the end," he said.

As far as funding, DelBene said the agency, and not just on massive projects like the EHR modernization, is getting pushed to provide life cycle costs on projects from Congress – and "rightfully so."

That process also gives legislators "line of sight" into what the agency needs when it envisions very large-scale projects. He said the agency can then engage with legislators around appropriations that match the need, and what the priorities are overall. 

"This is also the benefit of being highly transparent with Congress," he said.

"I think we need to be in richer dialogues back and forth," he added, so legislators can ask questions about what they have been hearing.

DelBene said incremental modernization – for some systems – allows chunking up expenditures over time.

"And you can deliver functionality to end users incrementally, versus, boom – the whole new system comes in, and cross your fingers, it delivers on the need," he said.

When it comes to striking that balance, the agency is not there yet, he said. "I still see programs that come for approval where there is a big ultimate cost behind it," said DelBene. 

However, he said certain systems do require wholesale replacement – such as financial ledgers that just need to be replaced, for example. There is a discipline to understanding the road map of where you can bet on incremental modernization, according to DelBene. 

"But even there, it's not always a great idea to say 'We're going to buy the whole thing at one time and then just deploy everything,'" he said.

Certain system migrations have discontinuities that are hard to work around, he said. "[Electronic Health Records Modernization] is probably one of those cases, too – between VistA and moving to Oracle Cerner – it's a very different approach. So sometimes you face those decisions. 

"But other times, you really got to say in the past you may have replaced the whole system with the next generation, 'How are we going to incrementally modernize on that one instead?'" 

But a key point of VA OIT's new rhythm of development, DelBene said, is "so people ask those questions rather than just saying "Oh, I guess we're just going to buy a new system."

Of note, House Veterans Affairs Committee ranking member Mike Bost, R-Ill., complained this week that requests to the VA for clarification on how it documents recusals and ethics waivers held by the agency’s officials, including DelBene, were not met. 

DelBene worked at Microsoft for more than 25 years.

"In recent meetings with HVAC staff, it was requested that VA develop a formal process to document procurements or programs from which Mr. DelBene may be recused," said the agency in a statement sent to FedScoop. "VA has been working on finalizing such a formal documentation process and expects to respond to Chairman Bost and the Committee shortly."

THE LARGER TREND

During the briefing DelBene said the VA is applying software factory standardization where contractors build software in the VA’s infrastructure – so the VA has fewer and fewer platforms to avoid the "cacophony of having one of everything."

In October, DelBene and several staff members discussed their approaches to digital transformation at the VA.

Low-code approaches are solving some of the VA's greatest digital modernization challenges, according to Carrie Lee, acting executive director of product engineering.

"With our low-code platforms we're seeing an average of 90 days. It allows us to modernize in months instead of years," she said in October.

ON THE RECORD

"If we are going to make an investment that is a very large one, we better have a lot of engineering rigor behind that," DelBene said.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.