Overview of VA technology projects of major importance to strategic planning

1. 13 Major Initiatives for the VA Priority Setting for EOFD James Breeling, MD May 25, 2010

2. Questions to Ask How do we set priorities for EOFD? What’s the difference between VA strategic planning and regional tactical planning? How are High Level IT Governance decisions made? How many projects/programs should be in the OIT portfolio at any one time? Why is Project Management discipline important? How did we arrive at 13 Major Initiatives?

3. Idealized Strategic Planning

4. Past VA Strategic Planning Attempts 1997 – “10 for 2002” VHA – Dr. Kizer’s ‘Journey of Change’ Highlights – VISNs and service lines 2002 “6 for 2006” – VHA Highlights – performance metrics for VHA IT Highlights – MHV, modernize DSS, teleradiology 2005 – “8 for Excellence” VA - Secretary Nicholson

5. Past Strategic Planning Shortcomings Failure to obtain firm concensus about priorities Little linkage to Capital planning More “top-down” than “bottom up” No linkage between high-level IT governance and strategic plan No linkage between regional IT governance and strategic plan Little understanding about role if IT Infrastructure in establishing Service Levels Strategic Plan of little relevance to EOFD

6. Without Strategic Planning and Priorities – What Happens?

7. What is IT Governance? Align IT investments with business objectives Ensure that the right people make the right group decisions Driven by Information Technology Infrastructure Library (ITIL)– industry best practice Standardize IT solutions Execute IT processes as efficiently as possible Manage strategy and complexity Minimize Risk, Maintain Quality

8. Who Decides What Investments To Make? Involve all opinion leaders and thought leaders The involvement of key stakeholders in the group decision is critical Balance business requirements with technical requirements Well formed business requirements must come from the line of business Provide strong organizational support of ITIL core processes Project management, Business analysis, Communications, Fiscal and procurement management SCIFD – standards, compatibility, interoperability, fiscal discipline

9. Hi & Lo-Level IT Governance Line of Business Obligated to provide needs & requirements Innovations, feedback IT community Obligated to provide speed of execution, depth of field, standards, fiscal discipline, customer focus Local, Network and Regional Dialogue are key elements

10. Group Decision Making - Causes of Failure poor articulation of clear business requirements poor involvement of key stakeholders Allowing elite interests to supersede common interests IT Appropriation limits IT budget The Tragedy of the Commons

12. Consensus Decision Making Consensus decision-making is a group decision making process that not only seeks the agreement of most participants, but also the resolution or mitigation of minority objections. Consensus is usually defined as meaning both general agreement, and the process of getting to such agreement. Consensus decision-making is thus concerned primarily with that process.

13. Transition to the 21st Century Brainstorming sessions during 2009 Urged by Secretary to think “outside the box” in order to transform VA DepSec planning team (SMG) responsible for organization and new thinking about management OIT formed team that responded thru the summer to requests for information including Program/Project review that lead to PMAS Lead to initial T21 list of programs and initiatives by each administration and staff office

14. T21 Project Review: Understanding the Study Groups 307 “efforts” identified 49 Projects in “deep dive” 242 “efforts” fitting definition of “project” 202 projects with “quick look” information completed

15. Effect of Aggregate Project Number and Complexity on Portfolio Success

16. Planning & PMAS

17. PMAS Institution of performance based project management discipline Goal – improving rate of success of VA’s IT projects Use of incremental product build techniques New functionality every 6 months Paused if miss 3 consecutive customer delivery milestones Avoids “big bang” program/project failures Emphasizes resource management (people & money) Relies on integrated teamwork (IPT)

18. Operating Plans – FY2010 Creation of FY2010 Operating Plan differs from prior years Oct thru Dec 2009 discussions with lines of business Discuss to concensus the priority rank “Wedding cake” approach to Operating Plan Definition of Sustainment activities Definition of “other DME” for development, modernization, enhancement

19. 19 DRAFT/Pre-decisionalFY 2010 Operating Plan – Cut Lines = $2.4B *Resources for organization-specific initiatives based upon presentations provided to date. 19

20. Secretary T21 initiatives Chapter 33 FLITE VLER VBMS Critical Patient Safety Preventive Care Program Veteran Centered Care Model 20 other projects

21. DepSec 13 Major Initiatives Before Mid Year Review a subset of the initiatives was identified for which very little progress was seenincluding very few dollars obligated These were promoted to ‘highest’ priority and refocused IPTs were formed and OIT staff detailed to these efforts. ~46 projects associated with the 13 Major Initiatives

22. 13 Major Initiatives - Regrouped Homelessness Call center; registry VBMS VETSNET GI Bill Chapter 33 VLER NHIN, VistA Web; AVIVA Mental Health PCMM; Suicide Hot Line; Scheduler; Patient Record Flag; Mental Health Treatment Planner VRM Identity mgmt; Call centers; knowledge mgmt New Healthcare Model My HealtheVet; rural health, telemedicine, teleradiology; NUMI Access to Care BMS; SQWM; EDIS; Kiosks IOC PIV; HSPD-12; VIRTS, VSAT Cost Accountability DSS extract data Human Capital My Pay; HRIS; WebHR IOM FM; VATAS; FLITE; eCMS R&D GENISIS; VINCI

23. EOFD Priorities for Rest of Year Sustainment FY09 funds FY10 funds Wireless, Lifecycle Refresh, Activations, PBX replacements, NDCP/Vista Augmentation EMF 13 Major Initiatives

24. Setting EOFD Priorities for Strategic Planning Infrastructure “Stack” Sustainment Lifecycle replacement Moving targets for standards as technology changes Relate Infrastructure to Service Levels Relate Infrastructure to Customer Satisfaction Emphasize Infrastructure for Operational Acceptance Final step in any project EOFD holds the “red flag” Need for Resources (people AND money)

25. Concept of Infrastructure “Stack” central to all Initiatives

26. Using the “Stack” as a Requirements Gathering Framework Example of Major Initiative

27. Facility CIO Viewpoint of Portfolio What Happens When Atlas Shrugs? National Projects Region Projects VISN Projects Facility Projects