See all three parts of this series on our VAS Federal page

Introduction

Modernizing digital infrastructure is crucial for organizations to maintain strength and competitiveness in the 21st century. New technologies arise, creating both new opportunities and threats. Moreover, these technological advancements are evolving ever more rapidly, forcing organizations to continuously work to improve their digital capabilities just to keep pace. 

Undergoing technical updates is arduous for even smaller organizations, and they are extremely complex in large organizations with legacy infrastructure like government. The complex systems of integration, security, legacy systems, and reporting structures create a labyrinth of a process and dependencies. To be successful, project managers must have a deep understanding of the current IT systems in place, as well as the complex political powers at play. 

In this series of Insights, we will explore the challenges that unlay digital transformations within government organizations. In this first Insight, we unpack the issues related to coordination, communication, and training. Next, we will look into different options when updating a legacy system and the challenges with internal and external compatibility. In the third and final Insight, we will discuss the goal to stabilize people, processes, and systems, examining how Organizational Change Management (OCM) can be instrumental in facilitating the modernization effort. 

Upgrading Invisible Infrastructure

Our digital world has become almost as important, and in some ways more important, than our physical world. Yet, when undergoing a major change in our physical infrastructure, it is often easier to appreciate the challenges and complexity of the task at hand. Our digital infrastructure, however, remains invisible and is therefore difficult to fully appreciate or even understand. These challenges are compounded by internal politics, external compatibility, and different communication and reporting structures of executive leaders, managers, and the people performing the detailed technical work. 

In this Insight, we will look at one large-scale digital transformation the US government is currently overseeing. By examining both challenges and opportunities, we can learn from this experience to create a better process for digital transformation in government.

VA Transitions to EHR

One of the best major examples of unique challenges to government is happening now. In April 2020, the Department of Veterans Affairs (VA) launched a joint health information exchange (HIE) in partnership with the Department of Defense (DOD) and the Federal Electronic Health Record Modernization (FEHRM). With a $16 billion dollar contract with Cerner, the VA is transitioning to an Electronic Health Record (EHR) system that connects VA medical facilities with the DOD, the U.S. Coast Guard and participating community care providers, allowing clinicians to easily access a Veteran’s full medical history in one location. With a planned completion date in 2028, the VA will have one of the most sophisticated EHR systems in the country. 

The advantages of such a modernization effort are easy to digest. From the service member perspective, once the program is fully implemented, service members will be able to transition seamlessly from DOD to VA health care, instead of needing to carry around stacks of paper forms. Leadership is able to act much more effectively and quickly when responding to the medical needs of their service members. Not only that, but the columination of the vast data will surely allow for greater insights and discoveries. 

Not so Easy Transition

The modernization effort is scheduled for completion at the end of 2028, but there have been major issues thus far. The program recently underwent a 12-week strategic review that found an overall lack of coordination in the program’s rollout that had led to poor training, a lack of testing and resulting “patient safety issues,” such as mismanaged prescriptions. 

User training is a major theme of many of the changes that need to be made to improve the way clinicians and patients use the new system, VA Secretary McDonough said during a Senate Veterans’ Affairs Committee hearing. Secretary McDonough continued, “Gaps remain in our ability to govern and manage data between the two EHRs and with DOD to ensure seamless veteran and employee-centric information sharing and provision of managed, trusted data”. 

Such challenges are unfortunate, though not entirely unexpected. Such a transformation with many connecting points is a vast undertaking for any organization. But governments face excessive difficulties when it comes to technology modernization, because different understandings of completion and progress from IT professionals.

Speaking Different Languages 

In IT development, developers often do the best work using Agile methodology. In essence, leadership dictates what needs to be done, and developers decide how something should get done. Government organizations, however, are often structured in a more hierarchical fashion. They will often need a more detailed step-by-step plan for how a goal is to be achieved and what the end result should be. Software development, however, often focuses on keeping the engagement Agile to adapt to new opportunities and challenges.

The problem with having different reporting structures and styles is that it often leads to miscommunication. For example, leadership needs regular updates on progress of the engagement, but government leaders are not far enough “in the weeds” to understand issues with coding. Similarly, developers have a hard time reporting their progress to leadership because they are focused on individual sprints of work and do not have a high-level enough view to point to their specific location on a wider plan. 

PMs must be able to speak both “code” and “politico”. These two different languages are often very different and require special training and experience to be able to speak both fluently. But being “bilingual” is essential in order to coordinate with all internal and external stakeholders. A practiced PM must be able to translate code into effective reporting to government workers. 

Bridging the Gap in Communication and Coordination

To avoid unnecessary strain on the project, an organization’s program and project managers must understand both IT and the unique structures of government. They are the lead communicators and coordinators throughout the engagement. Project managers able to communicate with stakeholders from all sides will be able to identify challenges and bottlenecks that could be missed by both IT and leadership.  

These PMs have the necessary skills and technical background to be able to understand exactly how the work will be done in order to provide more accurate delivery estimates, and handle scope creep such as "little requests" not part of the original scope. Also, by being able to understand outcome focused political requirements and manage functional and technical activities, they are able to navigate communication differences between government leaders and IT teams to keep everyone aligned and on track.  

Training 

One of the biggest issues that occurs when a legacy system is either replaced or upgraded, is a lack of prioritizing training for the staff that will ultimately use the new system. It is not enough to build the system if staff are unfamiliar and uncomfortable with the new system. Establishing a general training plan is important at the beginning of the engagement, but to build a truly effective training system, there must be a deep understanding of where each role will have to adapt the way they work. This means working closely with staff in understanding what their needs are and how this new system is going to be different from their legacy system. It also means prioritizing the time and resources for training staff. Too often, technical leadership is focused on building the system, and does not think about the day to day changes staff will experience after the system is implemented. The result leads to even greater inefficiencies and reduced morale. Effective training will increase staff adoption of the solution and help ensure the full return on investment for the organization.

Conclusion 

Investing in a major system upgrade is both exciting and risky, especially at the scale at which government functions. Looking at our example, once the VA has completed its EHR modernization effort, the improvements will be felt not only at all levels of the Department, but also the veterans it serves. Bringing together such an ambitious effort requires skilled technical staff, visionary leadership, and adaptive project management. Having all three can make even the most complex projects a success.

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