An Autoethnographic Account of Innovation at the US Department of Veterans Affairs

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dc.contributor.advisorMarciano, Richarden_US
dc.contributor.authorCasertano, Andrew Een_US
dc.contributor.departmentLibrary & Information Servicesen_US
dc.contributor.publisherDigital Repository at the University of Marylanden_US
dc.contributor.publisherUniversity of Maryland (College Park, Md.)en_US
dc.date.accessioned2020-07-13T05:32:05Z
dc.date.available2020-07-13T05:32:05Z
dc.date.issued2020en_US
dc.description.abstractThe history of the U.S. Department of Veterans Affairs (VA) health information technology (HIT) has been characterized by both enormous successes and catastrophic failures. While the VA was once hailed as the way to the future of twenty-first-century health care, many programs have been mismanaged, delayed, or flawed, resulting in the waste of hundreds of millions of taxpayer dollars. Since 2015 the U.S. Government Accountability Office (GAO) has designated HIT at the VA as being susceptible to waste, fraud, and mismanagement. The timely central research question I ask in this study is, can healthcare IT at the VA be healed? To address this question, I investigate a HIT case study at the VA Center of Innovation (VACI), originally designed to be the flagship initiative of the open government transformation at the VA. The Open Source Electronic Health Record Alliance (OSEHRA) was designed to promote the open innovation ecosystem public-private-academic partnership. Based on my fifteen years of experience at the VA, I use an autoethnographic methodology to make a significant value-added contribution to understanding and modeling the VA’s approach to innovation. I use several theoretical information system framework models including People, Process, and Technology (PPT), Technology, Organization and Environment (TOE), and Technology Adaptive Model (TAM) and propose a new adaptive theory to understand the inability of VA HIT to innovate. From the perspective of people and culture, I study retaliation against whistleblowers, organization behavioral integrity, and lack of transparency in communications. I examine the VA processes, including the different software development methodologies used, the development and operations process (DevOps) of an open-source application developed at VACI, the Radiology Protocol Tool Recorder (RAPTOR), a Veterans Health Information Systems and Technology Architecture (VistA) radiology workflow module. I find that the VA has chosen to migrate away from inhouse application software and buy commercial software. The impact of these People, Process, and Technology findings are representative of larger systemic failings and are appropriate examples to illustrate systemic issues associated with IT innovation at the VA. This autoethnographic account builds on first-hand project experience and literature-based insights.en_US
dc.identifierhttps://doi.org/10.13016/orah-dx5m
dc.identifier.urihttp://hdl.handle.net/1903/26233
dc.language.isoenen_US
dc.subject.pqcontrolledInformation technologyen_US
dc.subject.pqcontrolledOrganization theoryen_US
dc.subject.pquncontrolledHealthcare Information Technologyen_US
dc.subject.pquncontrolledAutoethnographyen_US
dc.subject.pquncontrolledElectronic Health Recordsen_US
dc.subject.pquncontrolledInnovationen_US
dc.subject.pquncontrolledOpen Source Softwareen_US
dc.subject.pquncontrolledOrganizational Cultureen_US
dc.titleAn Autoethnographic Account of Innovation at the US Department of Veterans Affairsen_US
dc.typeDissertationen_US

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