The Department of Veterans Affairs (VA) Office of Inspector General (OIG) issued three new reports on March 21 revealing that scheduling issues within the VA Electronic Health Records Modernization (EHRM) program contributed to one patient’s death and may continue to affect deployment of the program at other VA facilities.
The first two of the three reports relate to incidents stemming from 2022 – when issues with the new EHR system caused pharmacy-related patient safety issues and contributed to the death of a patient.
Following the incidents, the VA made the decision to pause additional rollouts of its EHRM program in October 2022. In April 2023, the VA announced a “program reset,” while the VA and its contractor Oracle Cerner focus on improvements at the five sites where the EHR system is currently deployed.
The VA is still in the middle of its program reset, with all future EHRM deployments paused until this summer. The one exception to the reset is the deployment earlier this month at the Captain James A. Lovell Federal Health Care Center (Lovell FHCC) near Chicago – the only healthcare facility to serve both Department of Defense (DoD) and VA patients.
The EHRM program aims to provide a seamless experience for veterans as they transition from receiving care from the DoD while on active duty, to receiving care at VA facilities. However, replacing an EHR system that was developed by the VA in the 1980s has brought a range of technical issues.
New Scheduling Challenges Arise
In the third report, the OIG revealed that more work must be done to fix the scheduling system challenges of the EHR at the five smaller sites, which “could be exacerbated at larger, more complex medical centers.”
The OIG first revealed the limitations of the EHR’s patient scheduling system in November 2021. In its 2021 report, the OIG revealed that scheduling issues were not properly addressed before deployment.
For instance, the new scheduling system was not able to mail appointment reminders to patients as it did with the old scheduling system.
The report revealed that the VA and contractor Oracle Cerner had yet to fix this issue as of December 2023. The OIG found that schedulers “have stopped sending reminder letters unless patients specifically request them,” and now rely on other methods such as text messages.
Yet perhaps more concerning, the OIG warned in its most recent report that “new concerns continue to arise” at the five sites already using the EHR system.
“Through interviews with staff from the five facilities and the team’s review of 1,712 trouble tickets related to possible scheduling problems as of the end of FY 2023, the team learned of two additional EHR scheduling issues that had not been identified in previous reports.”
These two issues include: “the displaced appointment queue does not always function properly, which may result in appointments not being rescheduled” and “it is difficult for providers and schedulers to share information.”
The OIG was not able to identify how many patients have been affected by the displaced appointment queue, which includes a list of appointments that need to be rescheduled.
Challenges with the displaced appointment queue feature meant that veterans sometimes showed up for an appointment “when schedulers were unaware their appointments were in the displaced appointment queue and needed to be rescheduled.”
“Whatever the scope of the issue, it will be amplified when the EHR deploys at large facilities, like Lovell FHCC, where higher staffing levels will likely mean more schedule changes and appointment rescheduling,” the report says.
As for the other issue identified, the OIG said that providers and schedulers cannot easily share information within the new EHR. For example, the report found that providers cannot see schedulers’ notes, such as the reason an appointment was canceled.
“EHR’s scheduling system limitations have caused additional work and redundancies, increasing the risk for scheduling errors,” the report says. “The impact of these limitations will continue at future deployment sites unless they are resolved. They will also only become more pronounced at larger, more complex facilities that provide more services and care for more patients.”
The OIG is recommending that the VA fix previously identified scheduling issues and issue “standardized EHR appointment scheduling guidance and operating procedures” for the identified issues. The VA did not make any comments on the report.
