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Pay-offs and Risks of IT Capital Investments
As a capital investment, Veterans Administration (VA) hospitals such as VA Southern Nevada Healthcare System VASNHS have been wanting to integrate advanced Information Technology (IT) into its infrastructure for the purpose of better implementing its mission, vision, and Core Values of caring for the veteran and the veteran’s beneficiaries through providing seamless and integrated service (Department of Veterans Affairs (DVA, n.d., p. 5; pp. 9-11; US Department of Veterans Affairs (USDVA), 2017; US Department of Veterans Affairs (USDVA), November 15, 2016, p. 9; p. 12; Rand, September 1, 2015, pp. 59-60). To this purpose, VA hospitals such as VASNHS want to use advanced IT for both virtual healthcare technology and for information storage, retrieval, and transmission, especially as concerns finance and budgeting, in the latter case (DVA, p. 5; p. 9; USDVA, 2016, p. 12; p. 27; p. 33; Rand, pp. 59-60). Versions of such advanced IT exist for both virtual healthcare (Panangala & Jansen, 2013, pp. 1-2; Jayanti, 2014; Pavarini et al., 2014; Rand, p. 294) and finance and budgeting, inclusive of general information storage, retrieval, and transmission (USDVA, 2016, pp. 24-25; Rand, p. 294). Such advanced IT is such that both forms of IT could have sustainability for the delivery of seamless and integrated healthcare delivery for well over a year if not for years-to-come (Rand, p. 294). The risk is that preparing for dependency upon such items when congressional allocations and internal budgeting might not allow for the best IT could make things worse if inferior IT is instead delivered to take on pivotal roles in a people-centric theme (DVA, p. 9; Rand, pp. 59-60). There is also the risk that some veterans may not have the necessary skills for virtual healthcare IT or else not have necessary internet access (Rand, p. 203). Such concerns if they arise would call for mitigation (Rand, pp. 297-299).
Advanced IT for an infrastructure of seamless and integrated service delivery
The advanced IT for healthcare could increase accessibility by allowing for ongoing stats readings in the hospital from wherever the patient happens to be, thereby eliminating backlogging, overscheduling, overcrowding, unnecessary visits, confusion as to whether a patient is eligible for a visit as concerns designation, distance, General Practitioner (GP) on-duty, etc. (DVA, p. 9; Kupersmith, 2014; Kupersmith, 2016; Auerbach, 2013; Rand, p. 294; p. 203; p. 298; pp. 157-206). Also as concerns accessibility and how IT may augment it, as there has been a major concern with improper payments (USDA, 2016, pp. 168-228) and budget imbalances such that liabilities are higher than assets so as to call for Corrective Action Plans (CAP’s) (USDVA, 2016, p. 27; p. 33), it would be best to have utmost efficiency in finance and budget when there is a crucial need of workforce resources, especially physicians (Rand, pp. 293-294). Even if the move is made forward to increase accessibility through IT (Rand, pp. 297-298), there is still the risk to be mitigated of getting proper equipment that does not further skew the budget to deny accessibility by sending funds in the wrong direction (Rand, pp. 59-60). Also, there is the risk of veterans who cannot manage IT’s benefits (Rand, p. 203).
The risks of IT as a capital investment for VASNHS
The system that provides projections for congressional allocations for VA hospitals such as VASNHS starts with the Veterans Equal Resource Allocation (VERA) (Rand, pp. 53-56). VERA makes different assessments across the country to account for differences in demographic solvency (Rand, pp. 53-56). VERA then provides data that is years old, without concern for present fluctuations of hospital activity, to the Veterans Integrated Service Networks (VISN’s). (Rand, pp. 53-56). VISN’s send the antiquated data to the Enrollee Healthcare Projection Healthcare Projection Model (EHCPM) (Rand, pp. 53-56). The outdated data extrapolated as projections then transmutes into the inflexible congressional allocations that may not provide sufficient funds in real time (Rand, pp. 56-57). These funds are not fungible across categories (Rand, pp. 56-57). The result is that even in something as dynamic as a hospital with all its different cases, emergencies, and vacillating patient volumes, etc., money cannot be shifted across categories to where it is most needed at the moment, as to beneficial, advanced IT to provide increased accessibility (Rand, pp. 56-57; p. 294).
Further risk in IT as a capital investment
Further restricting funding’s going to where it is most needed, appropriations for maintenance and IT come from a separate source (pp. 58-60). After applying for funding for advanced IT to promote accessibility, the IT that Central Processing Contracting allows to be funded may be of such insufficient bandwidth as to be worse-than-worthless for being depended upon to provide immediate hospital accessibility to preserve and save lives (Rand, pp. 59-60). Like may be said of allowably funded IT for finance and budget (Rand, pp. 59-60; p. 294). Then there is the concern for the veteran patient who may not be amenable to virtual healthcare IT anyway (Rand, p. 203). The following mitigations are then necessary with regards to IT to allow for accessibility through healthcare monitoring and proper financing and budgeting (Rand, pp. 294).
Mitigations to make use of IT for accessibility
VA hospitals such as VASNHS need to make more use of their outreach, interorganizational collaborations with other agencies, such as the Department Of Defense (DOD) (USDVA, 2016, p. 11), and non-VA healthcare providers, as all these agencies make use of proficient IT and functional organization (Rand, p. 294; p. 298). In-the-course-of-this, the VHA needs to attempt to organize things for its hospitals such that proper direction along with proper IT becomes available (Rand, p. 294; p. 298). The more organized agencies can also accommodate the veteran who is mystified by advanced IT (Rand, p. 203; p. 294; p. 298). While an unbalanced budget is not always indicative of inefficiency (Mikesell, 2014, p. 675), the convoluted restrictions of budgeting in the Veterans Health Administration (VHA) (Rand, pp. 51-62) and the want of organization therein (Rand, p. 294; pp. 297-299) can create risks for IT as a capital investment in what could otherwise generate immense advancements to be made in accessibility and finance and budgeting in the hospitals such as to provide seamless and integrated service delivery (DVA, p. 5; Rand, pp. 51-62; p. 294).
In meeting its mission, vision, and Core Values of caring for the veteran and the veteran’s beneficiaries, VASNHS could definitely benefit from the capital investment of gaining access to advanced IT in virtual healthcare technology and finance and budgeting (Rand, p. 294; USDVA, pp. 24-25; p. 9; DVA, p. 5; p. 9). Still, because of the risks presently imposed by restrictive budgeting (Rand, pp. 51-62), VASNHS is best off for the sake of its stakeholders in not requesting funding for such IT from Central Processing Contracting unless there can be surety that the IT so-funded will prove reliable as concerns output of value for the veterans and their beneficiaries (Rand, pp. 51-62). Also, there is the risk of the veteran who may not have enough technological skill or computer access to benefit from depending upon virtual healthcare IT (Rand, p. 203). If the risks prove to outweigh the benefits, VASNHS, along with the other VHA hospitals, needs to seek support from its collaborating interorganizational agencies and non-VA healthcare facilities regarding the benefits of genuinely advanced IT for an output of value for the stakeholders (Rand, p. 294; pp. 297-299).
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