Secretary for Information and Technology and Chief Information Officer Kurt DelBene says his goal is to make the U.S. Department of Veterans Affairs the model of what it means to be a modern IT shop in the federal government.

Joined by Charles Worthington, CTO of the VA, Luwanda Jones, deputy chief information officer in the office of strategic sourcing and Carrie Lee, acting executive director of product engineering, DelBene laid out his vision orientation – the processes working to make Vision 22 a reality in a media roundtable on Friday.

DelBene said that as a first step after being appointed last November, he sought to reduce the layers of management across the organization to increase collaboration and speed decision-making.

"Very flat organizations are typically the most effective ones," he said.

The second step was to set a vision of what great IT looks like in order to deliver for the needs of veterans and their care-stakeholders. 

DelBene described the VA's overall IT strategy as having four elements: It is vision-driven; it aims for operational excellence; it delivers "delightful" end user experiences; and it invests in OIT teams, including by looking at what the value proposition and the career path are for the VA's IT employees. 

"I think that's really what digital transformation is all about at its heart. It's a recognition that these core systems are now the key to achieving the outcomes of the organization," he said. 

Driving vision with zero trust

DelBene said when the VA stepped back to define a technology vision, they connected it to a two-to-three-year road map and are defining the resource allocation for that road map for all major portfolio areas within the VA. 

That means the agency is prioritizing work by first focusing on being a zero trust network as the way of thinking about securing the VA organization overall. 

"Zero trust – the strength of that framework is that it cascades directly into a set of measures of security, it helps you make decisions between the plethora of products that are out there that people are trying to sell to you and say, 'No, we have a set of objectives that represent our journey towards zero trust," he said.

The zero trust effort under DelBene means organizing and getting aligned on a set of milestones, on the metrics that drive success and on resource allocation. 

It's also constantly honing to improve execution as a modality for the VA's operational excellence, which supports 500,000 desktops, 900 systems and 2,000 different locations.

"We're always dealing with the fragility of these systems," he said, and measuring system performance and reviewing detailed analytics when incidents occur to figure out how to improve operations moving forward.

DelBene described other areas of cybersecurity focus, including endpoint and vulnerability management. 

By employing man-in-the-middle cybersecurity systems, which address eavesdropping attacks where cyberattackers interrupt an existing conversation or data transfer, the Office of Information and Technology aims to address third-party access security challenges, for example, token stealing.

"The whole premise of you know who it is you are talking to, you know it's a valid endpoint you are talking to as well," said DelBene.

With multiple layers of threat detection and avoidance in place at the VA, OIT is looking at rich monitoring to catch potential incidents as they occur, "but we need to amp up our monitoring to overall," said DelBene. The agency is looking at how artificial intelligence can analyze patterns of communications to evaluate end user points outside of the VA network. 

Overall, zero trust for the VA is an ongoing process. "It's a journey, not just a destination you get to," he said.

Changing the way VA develops

Lee's summary of low-code approaches that are solving some of the VA's greatest digital modernization challenges provided real-world examples of the VA's drive to improve operational excellence for veterans. 

She said that the key enablers for Vision 2022 and the VA's digital modernization are the new intake process VA product developers are creating and their use of low-code and no-code platforms for software development.

Lee said her team is in the first phase of launching the new intake process after finding that there were more than 40 intake processes across the VA's digital space, which "caused a lot of [veteran] confusion and frustration in the past," she said. 

By streamlining a single entry point, the VA can accelerate veterans' requests.

With a centralized entry point, "Our customers (veterans) only need to know they need to go one place. It's going to be an integrated team where we will quickly analyze requests and make appropriate decisions on where to funnel the request and facilitate the hand-offs to the product lines," she explained.

The goals include shortening the time of intake for veterans, improving agency efficiency and becoming more agile. By working with requirements management teams, veterans, product administrators and others, the VA can be "agile, get decisions made quickly and start our projects quickly, whether it's a custom solution, it's a SaaS solution or a low-code solution," she said.

The VA's low-code, no-code practice has exploded over the last few years by leveraging cloud providers and giving veterans and VA clinicians the digital tools they see in the commercial world, Lee said.

Right now the VA's Digital Transformation Center in the product engineering group uses this practice "to accelerate solution-delivery and business outcomes while maintaining compliance with VA's policy and standards," she said.

The cache of 150 low-code solutions accelerated the time-to-value for low-code products by six times over the traditional software development at the VA, which can take up to a year and a half. They also change the way veterans experience care, she added.

"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, describing the VA Health Connect Program, which is the modernization of the clinical contact centers currently being rolled out.

The 50 regional call centers have to switch between screens and applications to serve veterans calling in. 

The new low-code solution now provides access to veterans' medical information and history through a single-integrated view and interface, capturing and documenting veteran information in progress notes that write back to the VA's electronic health records system.

Not only a better experience for VA call center operators, but veterans see a change because they have more efficient interactions with the VA, Lee said. If they need to talk to a nurse, they can be rerouted to a nurse right away and the data is shared across interactions.

Lee also described the low-code solution for the Squares Program, a web-enabled application that allows community homeless shelters to confirm veterans' status and coordinate service to VA in 10 minutes.

"Previous to this solution, external homeless programs were not able to verify a homeless veteran's eligibility status digitally. It could take up to two months to receive an answer on whether or not a veteran was eligible."

Veterans were required to supply a copy of their Certificate of Release or Discharge from Active Duty, DD-214 forms, to prove they were eligible for VA programs. 

"And for a homeless veteran, they may not have their DD-214 in their pocket. So, it was a really challenging area that we were able to address," she said.

Delivering on the end user experience

DelBene said the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act illustrated the value of improved VA online operations.

The PACT Act expands VA healthcare to give benefits to veterans exposed to burn pits and other toxic substances of the Vietnam and Gulf War eras and of post-9/11 combat, and to their survivors.

It adds 20 new presumptive conditions and locations for Agent Orange and radiation exposure and authorizes toxic exposure screening for every veteran enrolled in VA Healthcare. 

The VA is executing comprehensive outreach to veterans to inform of their opportunities for care and benefits, he said. "This is the first place where technology plays a role," he added.

As of September 26, the landing page for the PACT Act has received over 2.4 million page views, with 1.5 million and unique users, which DelBene indicated speaks volumes about their reach.

He noted there were 88,000 clicks on the call to action to file a disability claim, and another 12,000 on the CTA to apply for benefits.

"That says not only are we educating them, some of them are starting to move towards action on the PACT Act in particular," said DelBene.

The growth of the VA's mobile app is the next chapter in digital transformation, building on the investments made in VA.gov for people applying for healthcare and filing for disability claims, said Worthington after DelBene introduced him.

When the VA sought to overhaul its online presence to respond to veterans' feedback, there was a lot of behind-the-scenes work to make that possible, given the number of technology systems built to support several product lines and programs, Worthington explained.

Because veterans see the VA as only one entity, "We hear a lot in the feedback sessions that veterans are really frustrated whenever they see the seams in our organization," he said. 

Presented as one entity with the relaunch of VA.gov, with navigation designed to find the transactions veterans need, there was an immediate uptake in satisfaction and a significant increase in the number of transactions coming in across digital channels. 

"The next chapter of that growth is represented in our new mobile app," the VA Health and Benefits mobile app, available on Apple and Android, said Worthington.

He said there have been about 800,000 downloads since it "quietly" launched last year.

"The goal of the app is really to make it super simple for people to access the most common VA transactions that they need to repeat a lot of times," and they can message their doctors, manage health appointments, check disability status and add files to claims and other features, some still in development, he said.

The mobile app also offers biometric log-in, which lets veterans speed up the sign-in process with fingerprint or facial recognition, and will also be pilot-testing alternative two-factor authentication with the YubiKey hardware authentication device.

The app also has a robust set of disability features, and it's one of the most successful products the Federal government has ever built, said Worthington.

"It's important for us to be constantly trying to meet veterans where they are," he said, noting the VA has a program for making sure veterans have devices like iPads to access VA programs and noting that not every veteran has or wants to use a smartphone.

"We know that not every veteran is going to want to interact with the VA in the same way," he said. 

But for the veterans who don't want the self-service experience, offering a great digital experience for those who do frees up the call center and creates shorter wait times for the veterans that prefer to speak to a person at the VA.

"There is no wrong door for veterans. We're trying to make it easy for them to access the services they need, whether that's in a digital channel or in-person, and we're going to need to have really great experiences for both of those," he said.

Creating transparency with transformative resources

For the VA, the sourcing life cycle is about using funds to acquire the appropriate value-driven resources, and it has an up-front role in the agency's digital transformation. 

"We work with our acquisition partners to assure that the capabilities that we are purchasing, that these are the fast-paced transformation efforts, and most importantly, they are compliant with the Federal Information Technology Acquisition Reform Act standards," explained Jones.

She said that 3,632 contract actions were awarded Friday at a value of $6.4 billion – all of which DelBene reviewed.

She added that 37.2% of the VA's contract awards are going to service-disabled-veteran-owned small businesses and veteran-owned small businesses.

DelBene has to approve all those acquisition strategies, with all required security language, she said. 

"There are two gates that are absolutely critical if you are going to enforce or up your game," said DelBene: the Federal Information Technology Acquisition Reform Act review and the Authorization to Operate (ATO). 

"Is the strategy right? Is our acquisition approach right? Is the product right, not just the first time you buy it?" he said, and noted that each optional period and task must make strategic sense.

These gates allow the VA to ask if they like the way systems and products perform, or are designed from a security perspective before the VA buys in for the long haul.

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