Health IT, Policy

Report uncovers patient safety issues with VA’s EHR go-live

Two reports published by the Office of the Inspector General shed light on why the VA pushed back its rollout of a new health record system. The OIG said the March 2020 deployment date was “likely unrealistic.”

As the go-live date for its new electronic health record system approached in March, the Department of Veterans Affairs pushed back the rollout to July, saying some key features were not ready. Two new reports released by the VA Office of Inspector General shed light on why the agency pushed back its March 2020 deployment, a timeline that the government watchdog said was “aggressive, but likely unrealistic.”

The reports highlighted patient safety concerns anticipated with the rollout of the new EHR at its first pilot site: the Mann-Grandstaff VA Medical Center in Spokane, Washington. The VA had signed a $10 billion contract with Cerner Corp. to replace its old VistA records system with one that could be integrated with the Department of Defense.

As March approached, it became clear that certain key capabilities would not be available by the go-live date. Two of them included the ability for veterans to share their data with community health providers, a feature that was implemented in late April, and online prescription refills.

To get around these missing features, staff would have to come up with multiple workarounds. For example, primary care providers would have to manually enter all medications prescribed by non-VA providers in the new EHR. For the 10,000 prescriptions filled online each month, patients would have to dial into a call center.

With any new EHR implementation, some disruption to patient care is expected as clinicians become familiar with the new system. But the VA had a template of what to expect, since the DoD had begun implementing a new Cerner EHR system in 2017.

Based on that experience, the VA expected a 30% decline in access to care for up to two years after going live. Some strategies to mitigate this included bumping up staffing, extending clinic hours and expanding the use of community care.

According to the OIG report, there was no plan from the top to address this anticipated impact, and facility leaders had hired less than half of the 108 staff they had planned to add by February. Other safety concerns reported by facility leaders and staff included “being unable to accurately predict patient safety risks because of incomplete information on which capabilities would be available,” and feeling compelled to go-live in March, even if the full set of capabilities would not be available.

In a late February meeting with the House Committee of Veterans Affairs,  VA Secretary Robert Wilkie said the go-live would be postponed to July.

“We weren’t ready to train on a system that was not 100% ready for those who are using it,” he said. “I was not going to have thousands and thousands of practitioners practice on a system that was not ready.”

Due to the ongoing Covid-19 pandemic, the July go-live date has been bumped back again. A new date has not yet been set.

Photo credit: YinYang, Getty Images

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