A new report from the U.S. Government Accountability Office found that the Department of Veterans Affairs did not ensure the quality of data migrated to its new Cerner electronic health record system before the initial deployment in October 2020.  

In turn, observed the watchdog, clinicians found challenges with the migrated information's accessibility, accuracy and appropriateness.   

"The challenges occurred, in part, because the department did not establish performance measures and goals for migrated data quality," wrote the watchdog in its report. 

"Until VA uses such measures and goals to better ensure the quality of migrated data, the department could deploy a new EHR system that does not meet clinicians' needs and poses risks to the continuity of patient care," GAO warned.  

WHY IT MATTERS  

The extensive GAO report sought to describe the department's plans for migrating data to the new EHR system and to determine the extent to which those plans have been implemented.  

To do so, the watchdog reviewed the agency's progress reports, compared those efforts to applicable federal guidance and interviewed knowledgeable officials.  

The resulting report explained that VA clinicians have historically relied on data stored in the agency's legacy EHR system, VistA, to support their provision of healthcare.  

In its modernization initiative, VA had expected to manage health data using two key Cerner products: its Millennium EHR and HealtheIntent platform. As such, it planned to populate the new EHR system with the same data available in VistA and to support continuity of reporting.  

Unfortunately, it seems, those plans fell short.

Namely, said the watchdog, although the VA performed planned data migration activities for the initial system deployment at the Mann-Grandstaff VA Medical Center in Washington, it did not establish and use performance measures and goals to help ensure the quality of migrated data.  

A VA analysis after the initial deployment found that clinicians didn't know what specific data could be accessed within the new system.  

"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," read the report.  

An analysis also raised flags about accuracy: migrated data, such that for as allergies, medications and immunizations, was frequently duplicative or contained errors.  

In addition, VA had selected a greater volume of certain data for migration than clinicians needed.   

"As a result, the large volume of migrated data presented in the new EHR system made it difficult for clinicians to read their patients' records," read the report.  

The GAO recommended two executive actions in response to its findings.   

First, it advised the department to establish and use performance measures and goals to ensure the quality of migrated data meets stakeholder needs before future system deployments.  

Second, it said the VA secretary should direct the deputy secretary to use a register to improve the identification and engagement of all relevant EHR modernization stakeholders to address their reporting needs.  

VA representatives did not respond to requests for comment by press time.  

"Supporting the VA in its efforts to provide veterans with safe, effective, holistic care is our top priority," said Brian Sandager, general manager of Cerner Government Services, in a statement regarding the report.  

"We are committed to working with our VA partners to quickly identify and aggressively address any concerns, as they implement a new electronic health record system that will give veterans and their providers a single record to support a lifetime of seamless care," Sandager said.  

THE LARGER TREND  

The report is just the latest in a series of critical findings from independent entities regarding the VA's beleaguered EHR rollout.

This past year, the VA Office of Inspector General raised a series of concerns around the cost of the project, its training deficiencies and the scheduling system.  

The deployment process itself has continued to face hurdles. Most recently, the agency announced that it was delaying the go-live of the new EHR in its Ohio facility due to COVID-19-related difficulties.  

ON THE RECORD  

"The Department of Veterans Affairs concurs with the Government Accountability Office on its Feb. 1 report titled 'Electronic Health Records: VA Needs to Address Data Management Challenges for New System,'" said the VA in a comment provided to Healthcare IT News after publication. 

"The Electronic Health Record Modernization Integration Office will establish and use performance measures and goals, aligned with and integrated into the VA Data Strategy, to ensure the quality of migrated data meets stakeholder needs for accessibility, accuracy and appropriateness prior to future system deployments," agency representatives continued. "This aspect of EHRM will meet enterprise data quality and reliability standards.

"The EHRM Integration Office will also use a stakeholder register to improve the identification and engagement of all relevant EHRM stakeholders and address their reporting needs," they added.

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