A pair of reports from the Department of Veterans Affairs Office of Inspector General raised more potential concerns about the VA's electronic health modernization program.  

The reports, published on back-to-back days this past week, flagged unreliable IT infrastructure cost estimates for the EHR modernization program as a whole, along with training deficiencies for business and clinical workflows at the first go-live site at the Mann-Grandstaff VA Medical Center in Spokane, Washington.  

WHY IT MATTERS  

In the first report, published this past Wednesday, the VA OIG's Office of Audits and Evaluations noted that the VA had reported to Congress in 2018 that the EHR modernization program would cost about $16.1 billion over the course of ten years.  

That cost included about $4.3 billion for IT upgrades, including system interfaces and updates to end-user devices such as desktop and laptop computers.   

"Reporting reliable cost estimates for these upgrades is imperative so that Congress has the information needed to make informed budgetary and investment decisions," observed the OIG.  

Unfortunately, says the OIG, complete documentation for those estimates was lacking – making it difficult to assess their accuracy.  

In addition, "the OIG found [the Office of Electronic Health Record Modernization] did not include costs for critical program-related IT infrastructure upgrades in the estimates reported to Congress, effectively underreporting program costs by nearly $2.5 billion," read the report.

OEHRM lacks formal agreements with the VA's Office of Information and Technology and the Veterans Health Administration to commit to funding those $2.5 billion upgrades. The absence of agreements can leads to problems, if OIT or VHA can't complete them.

"Without all critical IT infrastructure upgrade costs accurately presented in the life-cycle cost estimates, Congress lacks a comprehensive picture of total program costs that decision-makers need to make informed oversight and investment decisions," read the report.  

The second report, which concerned the new EHR at Mann-Grandstaff, also raised issues.  

In that report, the VA OIG's Office of Healthcare Inspections found significant gaps in staff training on how to use the new EHR – particularly in regard to context and workflow.  

"Facility leaders reported that training did not provide opportunities to test proficiency in navigating a wide variety of clinical scenarios; instead, instruction focused on the multiple steps required to complete specific tasks," read the report. The OIG found that facility leaders and staff said they had insufficient time to cover complex training topics, especially amid the context of COVID-19's other challenges.  

Two or three months after using the new EHR, more than half of facility staff said they couldn't share patient information with other clinicians without difficulty, and nearly two-thirds said they couldn't navigate the different EHR applications without difficulty.   

"Overall, the survey results showed that, after training and two to three months of new EHR use, only a small percent of facility users reported facile use with EHR core functions," said the OIG.  

Perhaps unsurprisingly, the OIG observed low employee morale and concerns regarding patient complaints and provider productivity.  

The watchdog also noted some VA staff members' apparent attempts to disguise the training issue: "Disturbingly, leaders from VA OEHRM Change Management withheld some training evaluation data requested by the OIG and altered other data prior to sending to the OIG."

"The OIG has notified VA senior leaders of this issue and is further pursuing the matter," wrote auditors.  

THE LARGER TREND  

The VA's EHR modernization rollout has been beset by difficulties for months, between COVID-19-related delays; other critical OIG reports about cost underestimations; and reports of confusion and dissatisfaction from its early users.  

The unenthusiastic response to the project's initial rollout led to a pause on the program while the VA undertook a strategic review.

But earlier this month, VA Secretary Denis McDonough said the department would stick with Cerner for the modernization.  

ON THE RECORD  

"As with any operation of this magnitude, success is dependent on ensuring synchrony of multiple, complex moving parts," wrote the OIG officials in the July 8 report. "A governance structure that ensures collaboration and engagement of all relevant stakeholders is critical to achieving that success."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.