VHA Fixes Rules of Engagement

By David Spark  |  Posted 2006-12-14 Print this article Print

Case Study: A broken process for continuous veteran benefits enrollment gets a rules-management overhaul from Ilog.

Veterans enrolled in the Veterans Health Administration, part of the Department of Veterans Affairs, have to answer a variety of questions regarding compensation, pension status, military service and more. Based on those answers, a veteran is given a priority group status label (from 1 to 8) within the VHA's continuous enrollment system.

It sounds simple, but that wasn't always the case. There are 40 questions, and they must be implemented by the system and answered by the veteran in a very specific order. If not, the worst-case scenario happens: Veterans who should have stayed enrolled become unenrolled, warned Lynne Harbin, associate director at the Health Eligibility Center for the VHA, in Atlanta.

It took Harbin's team six months to understand and fix all the issues with continuous enrollment. Problems ranged from coding issues, unclear business logic and improper sequencing. Harbin admitted it took an incredible amount of software development time to rebuild the process to make sure it worked.

Policies were ingrained in the VHA—the largest health care organization in the United States, with 7.6 million enrolled participants. Continuous enrollment was just one of many of the VHA's rules-based applications that were in constant jeopardy of breaking down.

The collapse of rules resulted from their lack of visibility.

"It was very difficult to maintain. There's very little documentation," said Harbin. "Everything is hard-coded."

Quite simply, "It's difficult to identify what the changes are in the context of our existing system," Harbin said. "The system is poorly documented, and memory only goes so far. That's where we tend to run into trouble."

To help reveal the business specifications of rehosting and modernizing its legacy enrollment system, the VHA brought in Philip Matkovsky, principal with Macro Design Group, of Arlington, Va.

Matkovsky is a systems consultant with plenty of experience in the public sector. More important, he has worked with the VHA. It was his job to discover problems with the rules engine. Given that there was a major gap between documentation and code, this job wasn't going to be easy.

"The rules sit all over the place," said Matkovsky. When changes were made, documents often were not updated. Just figuring out what the current rules are in the VHA's embedded system became a challenge in itself, he continued.

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Resolving problems has been a daily chore for the VHA. Unfortunately, a simple change in the past was unnecessarily complicated. Given the current system-coded, IT-driven, rules-based environment, it is impossible to be agile among the VHA's world of changing policies.

For about seven years, Harbin and the team had looked at deploying a BRMS (business rules management system) to take control of the rules and regulations of the VHA.

Read the full story on eWEEK.com: VHA Fixes Rules of Engagement.


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