I haven't written much about my experience last summer as a Presidential Innovation Fellow (PIF) at the Department of Veteran Affairs (VA). I have lots of thoughts about experience at the VA, as well as participating in the PIF program, and I choose to trickle these thoughts out, as I continue to make sense of them, and bring them into alignment with my overall mission as the API Evangelist.
I was given three projects when I started work at the VA: 1) Inventory data assets 2) Inventory web services 3) Move forward D2D, a forms web service that would allow VA hospitals and Veteran Service Organizations (VSOs) to submit forms through the claims process on behalf of veteran.
The most prevalent illness I witnessed across these three efforts was a unwillingness to trust outside groups (even VSOs and hospitals), and a lack of desire to share data and resources to anyone outside of the VA (ironically except contractors), to the point where groups seem to take defensive positions around what they did on behalf of our veterans. This culture makes for some pretty toxic environments, I personally feel contributing to much of the problems we’ve seen bubble up into the public media space of late.
While work at the VA you constantly hear about the VA claims backlog, and how we need to optimize, but when you bring up sharing data, or resources to other federal agencies, trusted external partners like hospitals, and VSO’s you get pushback with concerns of security, personally identifiable information (PII), etc. All which are valid claims, but there are proven ways to mitigate these risks through Identify and Access Management (IAM), which is another whole post in itself. You start feeling crazy when you get pushback for arguing that a doctor should be able to submit disability questionnaires via an iPad application, that uses an existing VA API, in a way that securely authenticates the doctor.
As a result of other system, cultural issues, and mistakes made in the past, VA employees and contractors are extremely adverse to opening up to the outside world, even if it can help. I kept hearing references to the 2006 data breach as a reason to keep systems locked down, where an employee brought a laptop home, affecting 26M individuals. This horror story, plus a variety of other cultural issues are keeping VA staff from accepting any new way of thinking, even if it could help reduce their workload, improve the claims process, and better serve the veterans and their families.
This is a pretty fundamental flaw in how large government agencies operate, that are in conflict with the solutions API can bring to the table. I don’t give a shit how well designed your API is, in this environment you will fail. Period. I do not think I will ever fully understand what I saw at the VA, while a PIF in Washington DC, but I feel like I’m finally reaching a point where I can at least talk about things publicly, put my thoughts out there, and begin my experiences as a PIF at the VA into my overall API Evangelist message.