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VA must fix problems in electronic health record upgrades, GAO says


The federal watchdog points to problems in migrating data and the need to get more feedback from stakeholders. The Department of Veterans Affairs has been struggling to modernize its patient records for years.

The U.S. Department of Veterans Affairs needs to address some problems with its long-running effort to upgrade its electronic health records system, a federal watchdog says.

The U.S. Government Accountability Office issued a report Feb. 1 outlining issues in the modernization of its electronic records system, which tracks key data about patients. Some of those issues could potentially affect patient safety. The GAO, a non-partisan office, monitors the performance of government agencies and their use of public money. The VA contracted with Cerner to modernize its electronic health record system.

The VA is having difficulty in migrating some patient data to the new electronic record system, posing risks for patient safety, the GAO said. The VA is rolling out the system gradually to different medical centers.

Specifically, an analysis found errors in allergy, medication and immunization data in some electronic health records. Medications, allergies and immunizations were “frequently duplicative or contained errors,” the GAO report said.

“Clinicians we interviewed echoed the concerns with the accuracy of the migrated data,” the GAO report stated. “For example, a clinician noted instances where migrated data required manual clean up, though this clinician had not encountered migrated data that were mistakenly associated with the wrong patient.”

Another clinician said inaccuracies in records required the manual entry of the data, adding to workloads and creating barriers to caring for patients, the report said.

The GAO report said some clinicians didn’t know which data could be accessed with the new electronic health records system. The watchdog also said some data that was expected to be migrated wasn’t always accessible.

“One clinician provided us with an example, noting an inability to view patients’ migrated immunizations data as a result of user roles within the system. The clinician added that the inability to view immunization data in the new system had resulted in confusion and raised patient safety concerns,” the GAO report stated.

The GAO spoke with staff and reviewed trouble tickets in its report.

The VA has taken steps to improve the quality of the data migration, the GAO said in its report. The VA has also taken feedback from clinicians that will be used as the modernized system goes live in more medical centers.

Still, the GAO said it is recommending the VA identify and use performance goals to evaluate the quality of the data migration to the modernized system.

“Until VA does so and uses resulting performance information to ensure that migrated data meet clinicians’ needs for accessibility, accuracy, and appropriateness, the department will be challenged to objectively measure the success of planned actions to improve migrated data quality. It also risks deploying a new EHR system that does not effectively support the continuity,” the GAO said.

While the VA is taking feedback from clinicians, the GAO said some stakeholders have expressed their concerns about their level of engagement. The GAO is recommending the VA develop a register to identify all relevant stakeholders in the modernization effort to ensure their needs are being met.

The VA has concurred with the recommendations to improve, the GAO said.

After years of planning, the VA first deployed its new electronic health record center in Spokane, Wash. in October 2020. The launch has had problems, including errors that have affected patient care, according to an investigative report by The Spokesman-Review in Spokane, Wash.

The VA had planned to deploy its new electronic health record system at the VA Central Ohio Healthcare System on March 5, but pushed that back to April 30, due to the surge of COVID-19 cases this winter, the agency said last month. The VA also expects to launch its new system in Walla Walla, Wash. early this year.

For years, the VA has engaged in efforts to revamps its health information system, which has been used for more than 30 years. The GAO has noted those efforts have been beset by a host of problems.

The modernization effort has been more costly and complicated than anticipated. In 2018, the VA awarded a $10 billion contract with Cerner to upgrade the system. The VA later revised the cost to $16 billion. However, a GAO report issued in July 2021 said the VA likely underestimated the costs for information technology upgrades by $2.5 billion.

In December, tech giant Oracle announced it was acquiring Cerner in a $28 billion deal.

The VA said it hopes to have the modernized system used across the entire department by the 2024 fiscal year. Eventually, the VA plans to link its modernized system with the Department of Defense’s upgraded electronic health record system to provide better care for veterans.

Last week, the GAO also issued a report with sharp criticisms of the U.S. Department of Health and Human Services over its response to the COVID-19 pandemic.

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