Veterans Health Administration IT transformation through the T4NG program

Transformation Twenty-One Total Technology Next Generation (T4NG) Request for Information
1. Introduction
The Veterans Health Administration (VHA) in the Department of Veterans Affairs is mandated with providing specialized care, primary care, and other social and medical support services for veterans. As of 2017, the VHA operated 168 health facilities and over one thousand outpatient facilities spread across the country. According to these numbers, the Administration is one of the largest care providers in the country (US Government Accountability Office, 2017). Veteran affairs experts and commentators expect the demand for the Administration’s services to go up in the medium term and in the long term. This is because of the expected increase in the size of the military, the expected increase in the prevalence of lifestyle diseases, and the changes expected in the U.S. veteran population. The expected increased demand for medical and social support services, the expected changes, and other changes in medical care delivery and technology, will most likely affect the current plans and approaches the VHA is using to provide services to U.S. veterans. And even before the expected changes affect how the Veterans Health Administration operates, the federal body is already grappling with serious problems including management failures, insufficient coordination between veteran and non-veteran health care providers, appointment scheduling issues, and long wait-times. This work is a project management proposal presentation of the Transformation Twenty-One Total Technology Next Generation (T4NG) program that is meant to provide solutions to some of the problems currently affecting and expected to affect the VHA. More specifically, the T4NG is a comprehensive IT services contract developed to provide telecommunications, health information technology (IT), and general IT support to the VHA. It includes both software and hardware for client requirements in the present and the future IT environments. The main elements in the contract include the provision of program management, strategic planning, IT facility support, maintenance, cyber security, enterprise network, software engineering, and systems engineering services.
1.1. Background
The mission of the Department of Veteran Affairs (VA) is to enhance the dignity, welfare, and health of all U.S. veterans. It does this through providing health care services, social support services, benefits, and through organizing memorials. Like most other Federal Departments, the VA is located in Washington, D.C. and has branches across the length and breadth of the country. The Department provides services through three main bodies, the Veterans Health Administration (the VHA), the National Cemetery Administration (the NCA), and the Veterans Benefits Administration (the VBA) (Farmer, Hosek & Adamson, 2016). The VHA is primarily responsible for the provision of medical care services including specialized and primary care. It also provides social support services and does studies to help veterans lead healthier lives. The VBA is primarily involved in the provision of benefits to veterans and to their dependents. The benefits include life insurance, help with mortgages, educational opportunities, and disability compensation. While the NCA, is involved in the provision of memorial benefits and burial benefits to veterans and to their dependents.
2. Program management
Because of the comprehensive nature of the T4NG and how expansive it will be, almost all the offices in the VA will eventually be involved in the design, the development, the deployment, and the implementation of the program.

Figure 1. Prototyping cycle of the T4NG (adopted from Edwards, 1987)
2.1. Project management approach
The general responsibility and authority for implementing and overseeing this project rests with the Project Manager. Of course, the manager should provide management according to this project plan. The entire project team for this project will include coders, quality control personnel, technical writing personnel, and testing personnel (Kerzner, 2017). The manager will guide the team and use everything at their disposal to make sure the project takes off and goes according to plan. The project management plan and subsequent/ subsidiary management plans must be evaluated and okayed by the sponsor of the project – the Department of Veterans Affairs. The funding decisions must all be evaluated and okayed by the sponsor. In case the sponsor opts to delegate approval of funding authority to manager of the project, the Department should do it in writing and should sign the approval of authority letter. The team to execute the project will work in a matrix – the members will continue to be responsible for their jobs and to answer to their superiors in the organization throughout the project even while they contribute their expertise to the project. The performance and progress of each project team member and project resource will be dutifully reported to the organizational managers by the project manager (Meredith, Mantel Jr. & Shafer, 2017).
The scope of this project is to:
· To analyze and evaluate the user requirements;
· To structure Communities and Collections in the VA especially with regards to the key focus area;
· To determine metadata elements for Collections with the help of individuals representing focus areas;
· To structure workflow in Collections with the help of individuals representing focus areas;
· To provide continuing support and training to clients;
· To store materials in the many offices of the VA;
· To supply system recovery, system backup, and monitoring;
· To provide an online service that will offer customers both access and support;
· To market the new program within the VA;
· To report progress to VA’s management committee;
· To determine what needs to be enhanced or upgraded by the VA or through innovation.
2.2. Strategy
This project’s scope encompasses, the planning, the design, the actual development, the testing, and the implementation of the Transformation Twenty-One Total Technology Next Generation software. The computer program will exceed the VA’s software standards in addition to the requirements contained in the charter. The project scope also entails the completion of all the training aids, the manuals, and the documentation to be utilized with the T4NG. The project will be considered completed when both the computer program and its related documentation are successfully implemented. While the majority of the T4NG project will be handled internally, in cases where specialized services are needed, the work will be outsourced. But even in cases where there will be outsourcing, it is the contracting party that will supervise, evaluate and test the quality of the work to ensure it is good quality (Shenhar, 2004). This project’s scope includes not changes to the standard OSs (Operating Systems) and how they operate.
The strategy for the project will be as follows:
· The Analysis: A needs assessment will be performed to make sure that the Department’s fundamental needs are met.
· The Design: This pertains the structural design and not the graphical one. The design and the customization of the T4NG computer program will be done to meet the requirements, the mission and the strategies of the VA.
· The Development: The T4NG development will be done with the aim of ensuring it meets all the VA community needs. It will be done in conjunction with the Department.
· The Implementation: The software will be implemented by deploying the developed digital projects in the focus areas.
· The Evaluation: Both the formative and summative evaluations will be done to ensure the software meets the client requirements and needs.
2.3. Milestone list
The chart below details the significant milestones for this project. Only the most significant project milestones are included. Smaller but also crucial milestones are not included here but will be found in the work breakdown structure. The project schedule will also contain such milestones. In case significant milestone-delaying scheduling issues occur, the manager of the project has to be notified as soon as possible so that they can initiate proactive measures to mitigate the delays. In case changes to the dates below are proposed and approved, the manager will promptly communicate the same to their project team.
Milestone
Description
Date

Successful Gathering of All Requirements

The determination of all the requirements for the T4NG software. Requirements to be used for base design.
3 September 2019

Successful T4NG Design
The complete theoretical designing of the computer program and how it will work.
3 December 2019

Successful T4NG Coding
The complete coding of the computer program to build a functioning prototype.
3 February 2020

Successful T4NG Testing and Debugging
The complete testing of all of the program’s functionalities and correction of any errors identified.
3 March 2020

Successful Transition of software to the Dept.’s functions
The complete transitioning of the T4NG software and its accompanying technical documentation from the project team to the Dept.’s operations.
3 June 2020


2.4. Enterprise architecture
The Veterans Affairs Enterprise Architecture (in short VA EA) IT solution is intended to offer access to important information relating to the VA’s health services, general services, capabilities, and business operations and IT systems that operate them via a portal. The concept graphic below is a depiction of the aforementioned Veterans Affairs Enterprise Architecture and how it efficiently combines different “domains” of information and data for the purpose of aiding Solution Design Investment Management, and Strategic Planning processes. The managers, the staff, and policymakers at the Department can access the combined and reliable information for the purpose of increasing resource use efficiency, increasing interoperability, and enhancing service delivery (US Department of Veteran Affairs, 2019).

Figure 2. VA EA Concept Graphic (adopted from US Department of Veteran Affairs, 2019)
The Veterans Affairs Enterprise Architecture will be a transformative and evolving entity developed through continuing collaboration between the organization’s technology and business stakeholders, the Office of Information Technology, the Architecture and Engineering Service, and the Enterprise Project Management Office. As the plans, strategies, business needs, priorities, and goals of the Agency change, the Veterans Affairs Enterprise Architecture will simultaneously be updated to ensure it remains a reliable data portal and a tool for transformation. The Enterprise Architecture offers an organizational-level perspective that is required for educated decision-making. As a reliable information portal, the architecture offers an integrated perspective of the various information and data domains across each level of the Veterans Affairs Department: Solution, Segment, and Enterprise. The Architecture’s Intranet includes the following content: repositories, tools, documents, artifacts, and models. As of now, this information is only provided four times a year.
2.5. Monitoring and analysis
The evaluation of this project will be the responsibility of the contractor, the project team, and the team of coordinators from the Veterans Affairs Department. It will be the responsibility of the manager of the project to update both the project management and the VA teams about how the project is faring. The updates will be provided on a weekly basis or as deemed necessary depending on how urgent the update is. The project management team will also have smaller teams within it to manage the various components of the project. Each team will have a leader or manager who will be responsible for its operations and will monitor and evaluate them to ensure everything is going according to plan (Bahr, 2018; Sage & Sage, 1995). Additionally, a quality assurance team will be constituted to evaluate, monitor, and ensure remedial or mitigating measures are taken in when quality issues are discovered. The members of the quality assurance team will report to both their team leader/ manager and to the project manager. Quality assurance staff will also conduct their own independent audits and tests during the design, the implementation, and the test stages of the project. This will ensure ongoing coverage, approval, and verification of processes to ensure all elements of the project are up to standard.
3. Program Management Support
MTS recognizes our drive and intention to offer all the required resources for the purpose of running the programs and systems captured on this RPS. As of now, MTS has some 7.5 FTE personnel positions at its center. The personnel are dedicated to making sure all the requirements of the project are fulfilled. These in-house personnel are supported by support personnel based in our center. The two sets of personnel will collaborate in the development of the project and provide ongoing support in the implementation of the project. Specifically, the staffs will include technical support staff, clinical staff, data analysts, administrative staff, and staff from MTS’s Network Services office. The Agency has built a workforce of capable, hardworking, and competent staff.
MTS staff have consistently been able to finding solutions for client problems and to meeting client requirements satisfactorily. They are also known for their high quality services. Those who have been chosen for the T4NG project are well experienced in delivering similar systems and are capable of working well with others to deliver set objectives. MTS has no plans to introduce any changes to its personnel. Instead the organization aims to take advantage of the experience and know-how of its staff to make sure that the Veterans Affairs Department gets services that are similar in quality to those delivered to previous MTS customers. Our personnel are well aware of how important the T4NG software is to veterans in terms of improving the services delivered to them and to the Department of Veterans Affairs in terms of enhancing their service delivery and resource use.
3.1. IT Services Management Support
Although there is only one software engineering company in this project, MTS, software engineering activities span across several personnel and teams working in the project. The responsibilities, roles, and authority of the personnel and units (technical) involved in the software development component of this project are detailed in the section below this one (Laudon & Laudon, 2016).
The Project Manager: This is the individual will oversee the entire project. He or she will ensure that every team in the project is working hard to achieve its set objective in the delivery of the T4NG program. This individual will also be the final authority in making cross-functional decisions. The authority to make funding decisions may also be delegated to the manager by the project sponsor.
The Systems Engineering Unit: This team shall be involved in the delivery of multiple software processes. The roles and responsibilities of this unit will include: The Management of Configurations; the Verification of Systems; Conducting the Acceptance Test; and Performing COTS upgrades. The Unit will also be responsible for several other roles outside the software lifecycle.
Maintenance and Operations (M&O): The designated Project Maintenance and Operations Manager will be responsible for each and every project event or process related to the successful delivery of the T4NG program to the VA. The most significant Maintenance and Operations activities include: integrating the efforts of various working groups, the operational management, and the VA for the successful delivery of the program; drafting and setting out maintenance and operations rules and procedures; playing the leading role in the sharing of information and the resolution of conflicts between units; making decisions on how to utilize the engineering budget; ensuring that maintenance releases and patches are well fed into the established baselines; and managing the set operations plan for T4NG. The most important role for the Project Maintenance and Operations Manager is to ensure that the software development unit has the information it needs to provide the required maintenance services.
Quality Assurance: There will be a quality assurance team that will be responsible for auditing and evaluating the software engineering process as contained in the design plan and according to the requirements set out by the sponsor of the project.
MTS will provide support for the software processes and will be charged with recommending the best strategies, management plans, infrastructures, systems, and practices to ensure the IT enterprise is working efficiently (Kerzner, 2018).
3.2. Task Management
The organization’s task management duties/ requirements are limited. Considering how limited they are, even an Excel Spreadsheet will be enough to track tasks. If an Excel Spreadsheet were to be used, only the following columns would be enough for task management: Creator; Assigned To; Contact Person; and Status.
When a task is created, it ought to be immediately put on the Excel Spreadsheet and the person or unit to whom it is assigned should be notified simultaneously. The task status ought to be correctly updated as time goes on. And when the task is successfully completed it ought to be sent to a separate and similarly formatted Excel Spreadsheet. Each and every task and activity carried out toward the completion of the project ought to be entered into a robust project management database.
3.3. Change Management
The MTS will be responsible for identifying performance issues and for providing solutions. The solutions shall be provided in the form of a written document with a correction plan. The note should be created and delivered not more than ten working days from the time when the organization finds the issues or issue. The correction plan will include a description of the issue or issues and the remedial actions that ought to be taken to address it. The timing of the remedial actions, the individual or unit who shall be responsible for handling the remedial actions, and the individual or unit who shall be responsible for continued monitoring and updating the team on the issue, should also be clearly stated in the correction plan. We will then send the plan to the VA project coordinators identified by the VA. In other words, any performance issue or problem discovered will result in the Department being immediately notified (Hornstein, 2015). This will be done through us. The MTS has worked with the Veterans Affairs Department to build auditing, quality assurance, and correction plans and strategies for the project and will be chiefly responsible for the continued implementation of the plans and strategies.
Additionally, the MTS has also come up with a process for change control. The process shall be used to manage any changes requested for or approved by the VA Department. The MTS has also come up with a special sign off document that will be utilized to detail changes requested, the scope, and the mutually agreed expectations (Cameron & Green, 2015; Hayes, 2018). Also detailed in the document are the start and end dates for the changes. The document must be signed off by both the VA Department coordinating team and the MTS after its contents are mutually agreed upon. Both the MTS change control process and the document introduce accountability/ clear communication and enhance contract management. The steps below detail the actions that need to be taken in case there is a request to change any part or element of this project:
1. The instrument for communicating or initiating change is the CSR (Change Service Request). In the request, the specific change required, the reason or reasons for the change, and the desired effect or effects should be comprehensively described.
2. The manager in charge of the party requesting the change should examine the request and proposed change and make the decision on whether or not to send it to fellow project managers.
3. Each and every Project Manager will then review the CSR if it is approved by the requesting party project manager. The Project Managers can either reject or approve the CSR. The reason or reasons why they have rejected or approved the CSR should be written and sent to the requesting party.
4. In case there is consensus and the CSR is approved further investigations should be conducted by the MTS. The MTS ought to specify its fees before commencing any investigations. If the fees are approved by the sponsor of the project, the project managers will then sign the CSR as their approval for the investigation fees and then MTS shall invoice the fees accordingly.
5. MTS will then conduct the necessary investigations to find out how the implementation of the Change Service Request will affect the total price, the milestones, and other elements of the project as laid out in the original contract agreement.
6. The CSR should then be updated through sending it to the MTS managers and the VA for final approval and implementation of the requested and investigated changes.
After receiving the CSR form, the MTS must then create a preliminary report on it and then send it to the designated coordinator in the Department. The designated coordinator should review all the documented changes in the preliminary report and then sign if they approve them plus the fees indicated by MTS. The approved changes and any recommendations will then be further reviewed by the MTS personnel before being sent to the relevant parties for further research and development. Once all the required input has been successfully collected, we shall send the draft document and the timeline for the implementation of its resolutions to the VA to get the go-ahead to continue. The MTS will require a distribution list that is approved by the VA for the CSR documents (Hayes, 2018). The moment MTS receives distribution list and the approval documents, from the Veterans Affairs Department, it shall implement the changes as laid out in the documents and according to the approved timelines. The relevant documentation will also be dispatched to the relevant parties by MTS through a fax notification, an email, or the US Postal Service.
3.4. Release Management
Releasing of the T4NG is going to entail installation of correct approved databases and software, validation and conversion of present data that is to be stored in the system’s released version, as well as testing to validate proper and complete system installation. The system is going to be run from individual PCs situated in VA offices all over the VA department that is going to be connected together via the countrywide T4NG network (Jubran, Gershaft & Libenson, 2018). T4NG operation will call for contingency arrangement for actions that will be taken as a result of system malfunctions, controlling and managing system access by different users, assistance to users, monitoring the system’s performance, as well as competence planning for the system’s future expansion. In addition, recurrent internal control appraisals will be carried out to guarantee that the local nodes are run in agreement to the set operating procedures and policies.
No documentation or systems are going to be release till the CMB (Configuration Management Board) has confirmed that all approval, review, and assessment is completed successfully. Once the board is contented that the entire system together with its documentation are fully functional, complete, free from any errors, and is accepted b users, it will approve the release of the system together with documentation. After authorization, the Configuration Management Board will plan for the system’s release with the Branch of Computer Technology, publicize its availability, and supervise its execution (Jubran et al., 2018).
3.5. Configuration Management
The function of configuration management is to conduct day-to-day management of the system hardware, software, together with documentation baselines needed to create, implement, assess, and maintain the T4NG software. This office is accountable for the administration and maintenance of the hardware and T4NG hardware and software baselines (Whyte, Stasis & Lindkvist, 2016). Configuration management is accountable for conducting software configuration control on the project.
The development, design, operation, and execution of the T4NG system is going to be managed via a configuration management and quality assurance program. Quality assurance refers to a procedure that guarantees that the particular system is established in agreement to the design stipulations and set standards, is well documented, satisfies users’ needs, yields accurate and precise results, and performs well. The process of configuration management involves controlling adjustments to the system, approval of systems to be released, and management of the release of the system’s new versions.
Configuration management is basically an organized approach that is intended to sustain control of any changes that might occur in the system at every life cycle phase (Babich, 1986; Whyte et al., 2016). As a result of the huge T4NG scope accompanied by its scattered structure, a thoroughly enforced configuration management program is going to be needed to guarantee that adjustments are made to the T4NG system in a systematic and controlled fashion, and that the adjustments are tested, approved, and correctly disseminated to every operational node.
3.6. Incident Management
Incident management’s main objective is to offer protection to the live surroundings from unintentional effects that are as an outcome of the adjustments made to the different systems or any unexpected applications, occurrences, and apparatus functioning on the network. Every occurrence to the infrastructure of the T4NG system should have a RFC (Request for Change) ticket presented in Remedy. One of the duties of the MTS is to make sure that the project is not experiencing any unexpected or unnecessary interruptions in the cycle of development.
Responses to all arising occurrences will depend on the occurrence’s urgency, and not anything past 48 hours. Once an occurrence is determined, the information will reach the project manager via the proper channels of communication (Babich, 1986). As soon as project manager’s attention s gotten, with the occurrence identifying stakeholder, the urgency of the occurrence is determined, together with the resources needed to handle or mitigate the occurrence (Fisher & Oulton, 1999). In case of occurrences that are project-threatening the manager of the project can make a decision that involves converging the meeting to the specified timeframe.
3.7. Problem Management
The problems experienced during the establishment, testing, and running the system are going to be recorded by test and review teams, and shall be reported to the CMB (Configuration Management Board). This board will evaluate the suggested solutions to the presented problems and suggest corrective measures. The solutions will be recorded by the Branch of Computer Technology and then presented to the Configuration Management Board, which proceeds to conform that the issues have been properly solved.
3.8. Service Desk Management
Most of the services carried out under this particular contract are going to be accomplished at the offices of the MTS. The rest of the services are completed online. MTS regards confidentiality and security to be of the greatest importance when dealing with of our client’s information. In order to safeguard the integrity, availability, and confidentiality of information and data, MTS has set up suitable physical data and site security measures. Additionally, MTS complies with HIPAA as well as any other federal/state/client obligations concerning the confidentiality of PHI (Protected Health Information) for veterans.
3.9. Availability Management
Working hours are between 7:30 am up to 5:30 pm, from Monday to Friday, excluding holidays. MTS T4NG workers and project managers are, however, available 24 hours all through the week if need be.
3.10. Capacity Management
Personnel planning included in this proposal does not contain any adjustments to the present staffing configuration under the expert services contract that is at present held by the MTS. The MTS is not planning to make any adjustments to the distribution or number of important personnel. In case are needed during the operations or transitions phases, MTS is going to seek relevant prior written authorization from the project director of the department. Ant replacement contenders will have to satisfy the requirements of the department for skills, experience, and training as defined in the RFP (Krajewski, Ritzman & Malhotra, 1999). In instances whereby this is not possible because of resignation, termination, or death of a worker, MTS shall seek waiver of the outlined requirements from the contract administration and/or project director.
MTS provides the contract administration and/or project director with a notice of 15 days before any suggested replacement or transfer of the important employees of any of the contractors, where possible. In case we are not able to meet the notice of 15 days as a result of resignation, termination, or death of an important employee, the department is going to be immediately notified and the MTS will ask for a waiver from the contract administration and/or project director. During the period of notification replacement or transfer, MTS will present the CVs and references of the suggested replacement employees and guarantee the availability of the suggested replacement for a meeting with personnel of the department during the 10 day period of approval.
MTS also has in place a thorough system of job rotation and cross-training that imparts some redundancy levels to its operations. Personnel are competent in several positions within their operation area. The job rotation programs is not only targeted at offering sufficient coverage during absences and vacations, but also at enhancing the overall understanding of workflow and constantly enhancing operational procedures (Krajewski et al., 1999). Rotating personnel through alike jobs allows for a greater understanding of the program’s requirements and objectives, enhancing communication amidst members of the team, and helping the overall workflow.
Within the major VA’s operation working units, qualified personnel will occasionally horizontally rotate between different positions. Simply put, positions which need similar skill are going to be rotated. Even though a period of training is important at the start of operations, rotations will be carried out over time in order to maintain proper understanding of the work functions. Personnel are then capable of maintaining the imparted knowledge and are ready to step in help when necessary (Kerzner, 2018). Schedules of job rotation are going to be based on the kind of job being carried out as well as the frequency needed to maintain complete knowledge of the operational responsibilities.
3.11. Event Management
An event in this project is any occasion that occurs only once and contributes to the project execution. Events include the launch event for the program and the training events. For purpose of keep costs down, the responsibility for event management shall be given to third parties that are specialized in managing events. The third parties shall be recruited with approval from the VA Department. Examining event management through a project management prism, there are several processes and resources which are required for success (O'Toole, 2000). In the case of a significant one-time event like this one, the deliverables below should be regarded as part and parcel of the HR function. All the deliverables would be offered in an action plan document or a report.
The deliverables for the entire workforce include:
· Evaluation of the external workforce to determine skills gaps and shortages.
· Analysis of the existing laws and compliance issues so as to make sure everything is legal and aboveboard.
· Analysis of the organizational charts and other breakdown planning.
· The design of jobs and the assigning of roles and tasks to both volunteer and paid personnel.
· Provision of needs analysis training.
· Provision of occupational health and safety health programs.
· Provision of a workforce time recording program and a database management system.
· Establishment of work procedures and policies.
· Establishment of a leadership training program.
· Establishment of a communications plan.
· And setting up the HR budget.
· Writing the post-event analysis report.
For the paid personnel, the following will be the deliverables:
· The writing of a recruitment plan.
· The setting of the induction schedule.
· The gathering and delivery of training materials.
· The purchase and implementation of the payroll system.
· The purchase and implementation of a performance management computer program.
· The setting up of a promotion and benefits program.

Figure 3. Organizational chart for event management (adopted from O’Toole, 2000)
3.12. Data & Storage Management
MTS technical personnel is responsive and experienced to our clients’ needs. The data center is positioned close to an electrical station that minimizes the likelihood of power outage. Additionally, MTS’ data center is housed in one building as the Public Safety Services, E-911 Call Center, and State Emergency Services (Hoscheck et al., 2000). MTS even has its very own generator and UPS system. Our data center comprises the latest technology and could be expanded when necessary in order to satisfy the growing demand. Currently, we are in charge of managing more than twenty databases and more than two million records daily.
In order to guarantee the continuity of processes and data in case of an unexpected disaster, MTS has a thorough disaster management plan in place. The plan includes every policy connected to the restoration and backup of data, redundant systems, backup supplies of power, likely scenarios, offsite facilities, and the processes to follow in case of disaster. We have two separate offsite facilities to house backups of important data servers as well as storage facilities for the tape backups.
3.13. Service Level Agreements (SLA)
A phased methodology will be utilized by MTS in commencing and carrying out SLA. Lawyers of MTS will predict the signing of all SLA. The two parties involved in the agreement, assumingly the third party and MTS, will be aided by MTS’ customer service and the reviews carried out at on a quarterly basis when necessary. The customer together with the leader of the Business and Technology Services will take part in the reviews.