The Department of Veterans Affairs (VA) Office of the Inspector General (OIG) released a trio of reports today that found continued deficiencies with the VA’s Electronic Health Record (EHR) transition that has led to patient care issues in multiple areas.
The VA’s EHR Modernization (EHRM) program has been under continued scrutiny for underperformance and delays, and the OIG’s reports find issues with the EHR ticket system, care coordination, and medication management system at the Mann-Grandstaff VA Medical Center in Spokane, Wash.
Taken together, the reports represent more shortfalls for a program that has been plagued by issues including underreported costs, deficiencies in training, and diminished employee morale.
The first report looked at the allegation of deficiencies in the medication management system under the new EHR at the Mann-Grandstaff Center. OIG found deficiencies in multiple areas of medication management under the system that remain unresolved, including:
- data migration issues leading to inaccurate contacts and medication lists;
- “medication order processes erroneously discontinuing certain medications, permitting registered nurses to enter orders without authorization, and failing to notify providers of important prescribing information; and
- “medication reconciliation processes being impeded by incomplete medication lists that led to staff developing time-consuming workarounds, which increased risks of errors.”
“Although the OIG did not identify any associated patient deaths during this inspection, deployment of the new EHR without resolution of deficiencies may present risks to patient safety and affect providers’ treatment decisions,” the report says.
The second report examines the issues with EHR’s care coordination processes, finding eight areas of difficulty for patients and users, including data migration issues, issues with VA’s telehealth system, an inaccessible patient portal, and other documentation processes.
The final report explains OIG’s concerns with VA’s “ticket” process that it has been using to resolve problems and requests for assistance. The report says that after OIG examined 221 medication management tickets, 33 percent were found to be closed without documentation. Of the 210 care coordination tickets examined, one percent were found to be closed without documentation.
The report also said the following factors contributed to the deficiencies found in both the care coordination and medication management reports:
- “EHR usability problems,
- Training deficits,
- Interoperability challenges,
- Post-go-live fixes and refinement needs, and
- Problem-resolution process challenges.”
Overall, OIG made four recommendations across the three reports. In regard to each report, OIG recommends that the VA deputy secretary ensure that any substantiated unresolved allegations are both reviewed and addressed.
Regarding the medication management report, OIG also recommends that the VA deputy secretary report any subsequently identified issues to OIG for further analysis. OIG also made two more recommendations to improve VA’s ticket process, recommending the VA deputy secretary complete an evaluation of the EHR problem resolution process and take any warranted actions and ensure the EHRM deployment schedule reflects the time it will take to resolve the issues raised in the report.