VA needs to better plan appointment scheduling modernization, watchdog says

VA medical facilities use a variety of different tools to schedule appointments, which the watchdog said have proven to be challenging for both veterans and agency personnel. Veterans, in particular, have reportedly experienced issues with requesting appointments online, as well as receiving confirmation that their appointments were made and getting duplicative reminders about their visits.

GAO also noted that schedulers “must navigate a complex system environment that requires VA staff to open multiple applications to schedule a single appointment,” which has become exacerbated by the number of systems the agency operates. This includes using dozens of different systems to schedule appointments and monitor wait times, which the watchdog said VA acquired over the years “to address needs, such as for online scheduling and virtual appointments.”

VA is in the process of modernizing its current electronic health record system — the Veterans Health Information Systems and Technology Architecture, or VistA — to a new system provided by Oracle Health, although delays and technical issues with the new software have limited deployments of the system to six VA medical sites out of 170 facilities. 

Despite challenges with the EHR modernization push that resulted in VA pausing deployments of the Oracle Health system in April 2023, the agency is looking to roll out the new software at 13 medical facilities next year.

The watchdog’s report said the use of two different operating systems — VistA and Oracle Health’s new EHR system — has resulted in challenges for many schedulers, which have only been compounded by the fact that VA also employs multiple versions of VistA. 

“According to the officials, the department is working to standardize veteran appointment self-scheduling at VistA and Oracle Health sites,” GAO said, although it added that VA “has not yet determined how the modernized and updated products used for scheduling will interface and be used to pull and combine the data into a comprehensive report.”

The agency has already initiated an “Enterprise Scheduling Portfolio project to modernize its scheduling systems at sites with the VistA health information system,” which GAO said has involved launching “several concurrent efforts” to update scheduling systems across its operations. VA is also in the process of deploying a new software solution to help veterans schedule appointments online with community care providers, which was rolled out at 16 VA medical facilities in fiscal year 2024.

VA outlined a modernization program schedule in May 2024, although GAO said it “is not reliable because it did not meet or substantially meet all four characteristics” of the watchdog’s schedule estimating best practices. These include ensuring schedule assessments are “comprehensive, well-constructed, credible, and controlled.” 

VA’s Veteran Health Administration and Office of Information and Technology are jointly working on the modernization project, but GAO said both entities could work closer together to rectify unaddressed best practices. 

“Specifically, OIT development work, which is critical to developing the new scheduling capabilities, had not been fully integrated into VHA’s master schedule for the scheduling systems modernization program,” GAO said. “In addition, while the schedule was substantially well-constructed and controlled, it only partially met criteria for a comprehensive and credible schedule.”

GAO made two recommendations to VA that called for the agency “to develop a schedule that meets best practices and to fully implement key requirements development and management practices.” VA concurred with both of GAO's recommendations and said it is already in the process of working to address the watchdog’s concerns.