The Department of Veterans Affairs is unprepared to handle disruptions to medical care that would result from the massive transition to a modernized electronic health record, a new report from the inspector general found.
The report is one of two that the VA’s Office of the Inspector General released Monday. The second found critical infrastructure gaps in the foundation of the new EHR system.
The VA is two years into its $16 billion deal with Cerner to build a cloud-based electronic health record system that will be interoperable with the Department of Defense‘s EHR systems.
The two reports highlight challenges the VA has previously acknowledged but show there are still underlying problems.
Meanwhile, the VA says progress developing the EHR continues, but much of the scheduled training and eventual go-live dates of the new system have been delayed due to the coronavirus pandemic.
Disrupted access to care
The VA forecasts there will be at least a 30 percent loss in productivity after the EHR goes online at the first VA medical facility in Spokane, Washington. And according to the report on veterans’ access to care during the transition to a new system, this disruption could risk patient safety if not addressed properly beforehand.
The department’s plans to mitigate this expected fallout as of now are not enough, according to the report.
It’s not that VA didn’t have plans in place — the department developed 84 “mitigations” in anticipation of the disruption, the report says. Rather, the VA needs a better plan for the entire system rollout to avoid disrupting medical care and “minimize” the mitigations needed.
One of the systems that could be taken offline is the online portal for veterans to refill prescriptions. Without it, the department risks creating “a patient safety risk,” the report found.
“Although the facility’s initial go-live date has been postponed, the OIG determined that going live…still presents a significant risk to patient safety,” the report states.
The VA Office of Electronic Health Record Modernization also needs to better communicate what capabilities will be available at the eventual go-live date and which will come online later.
The go-live was initially scheduled for March but needed to be pushed back to July. And now it is unclear when the system will go-live at the first facility in the Pacific Northwest as medical centers focus on caring for coronavirus patients.
Cracks in the infrastructure
The underlying technology that the EHR will rely on — cabling, heating and cooling systems, and network components — needs to be solid for a successful launch and scaling. But the EHR’s infrastructure has significant flaws that could “delay the new electronic health record system implementation in VA sites nationwide,” according to the second report on the system’s infrastructure deficiencies.
The VA is well aware of its antiquated infrastructure and asked for increased funding to modernize it in its 2021 budget request. This latest report further details just how far behind the department is updating its infrastructure.
“The lack of important upgrades jeopardizes VA’s ability to properly deploy the new electronic health record system and increases risks of delays to the overall schedule,” according to the report.
As the DOD rolls out its Cerner-based Medical Health Services (MHS) Genesis system — which will connect to the VA’s EHR for seamless sharing of medical records — across the country, it offers the VA a blueprint for the challenges it can prepare for. For instance, the DOD’s launch was delayed by two years when cracks in the EHR’s infrastructure went unrepaired as it took the system live.
For the VA, infrastructure upgrades still need to be completed at sites six months before deploying systems — a standard the VA has not met and one that will likely cause more issues in the future, the report concluded.