Veterans Health: Improvements Needed to Achieve Successful Appointment Scheduling Modernization

Fast Facts

The Department of Veterans Affairs schedules tens of millions of health care appointments for veterans each year, using dozens of systems to support appointment scheduling. These complex systems have contributed to delays in providing care. The department has begun efforts to modernize these systems.

However, we found VA's project schedule for its modernization program was not comprehensive. For example, it didn't include all IT work needed. We also found that VA didn't have a plan that fully describes what needs to be done to deliver on the new system requirements.

We recommended that VA address these issues.

Highlights

What GAO Found

The Department of Veterans Affairs (VA) has dozens of systems to support appointment scheduling for veterans. It has acquired these systems over time to address needs, such as for online scheduling and virtual appointments. VA schedulers experience challenges navigating VA's complex systems environment, while veterans experience challenges with online scheduling. To address these, VA's Veteran Health Administration (VHA) and Office of Information and Technology (OIT) are collaborating to modernize systems.

VA has partially met key practices in the areas of project scheduling and requirements management. Specifically, VA's project schedule substantially met two elements of a reliable schedule and partially met two others. For example, it does not include all IT work needed for the effort, which limits VA's ability to ensure VHA and OIT agree on what work needs to be completed and when.

Characteristic

Assessment

Comprehensive

Partially Met

Well-Constructed

Substantially Met

Credible

Partially Met

Controlled

Substantially Met

Legend: Substantially Met = VA provided evidence that satisfies a large portion of the criteria. Partially Met = VA provided evidence that satisfies about half of the criteria.

Source: GAO analysis of VA's enterprise scheduling modernization program documentation as of May 2024. | GAO-25-106851

VA implemented three of six key practices for effectively managing requirements, and partially implemented three. For example, VA has not fully developed a requirements management plan and does not fully monitor and control requirements by maintaining bi-directional traceability between them and the deliverables. Developing a plan agreed to by VHA and OIT would reduce the risk of failing to support the work needing to be done. Tracing requirements forward and backward would help VA demonstrate that the solution meets requirements and that veterans' online scheduling challenges are addressed.

Practice

Assessment

Needs Assessment

Implemented

Requirements Management Planning

Partially Implemented

Requirements Elicitation

Implemented

Requirements Analysis

Implemented

Requirements Monitoring and Controlling

Partially Implemented

Solution Evaluation

Partially Implemented

Legend: Implemented = VA provided complete evidence that satisfies the criteria. Partially Implemented = VA provided some but not all evidence that satisfies the criteria.

Source: GAO assessment of VA documentation and information. | GAO-25-106851

Why GAO Did This Study

VA schedules tens of millions of health care appointments for veterans each year. However, it has faced challenges related to appointment scheduling systems, which have contributed to delays in providing health care. The department has initiated efforts to modernize these systems.

GAO was asked to examine the systems VA uses to schedule appointments and its plans to modernize them. This report (1) describes the systems VA uses to schedule appointments and monitor wait times, (2) describes the challenges VA facilities and veterans experience using these systems, and (3) evaluates the extent to which VA has met key planning practices for its scheduling systems modernization.

GAO reviewed VA documents that identified scheduling systems and challenges with them and interviewed a select non-generalizable sample of schedulers and veteran organization officials regarding challenges. GAO also interviewed relevant VA officials and assessed VA's schedule and requirements management for its scheduling system modernization against practices developed by GAO and the Project Management Institute.

Recommendations

GAO is making two recommendations to VA to develop a schedule that meets best practices and to fully implement key requirements development and management practices. VA concurred with GAO's recommendations.

GAO Contacts

Media Inquiries

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Topics

Recommendations

GAO is making two recommendations to VA to develop a schedule that meets best practices and to fully implement key requirements development and management practices. VA concurred with GAO's recommendations.