Insufficient training at the Spokane, Wash.-based Mann-Grandstaff VA Medical Center hampered the Cerner EHR rollout, according to a July 8 report by the Office of Inspector General.
The Department of Veterans Affairs is supposed to approve Cerner's development of training plans and materials that the EHR vendor executes and provides to VA staff. Cerner is supposed to provide training coaches, and the VA is supposed to have staff trained as super-users to provide assistance during the rollout. EHR training is supposed to be spread out over six weeks. The report found that Cerner and the VA did not give staff adequate training.
Eight things to know:
- The OIG found that the VA did not approve Cerner's training content or training delivery. Mann-Grandstaff leaders said training did not provide opportunities to test proficiency in various clinical scenarios. Instead, staff reported they were just learning which buttons to use without having any context for what they were doing, the report said.
- The OIG found significant gaps in training for business and clinical workflows, the report said. Four main causes for training gaps were listed as insufficient time for training, limitations with the training domain, challenges with user role assignments and gaps in training support.
- Cerner said the training domain was a close copy of its new EHR version, but the OIG said Cerner's current EHR offerings did not closely match the VA's version. Giving the VA a different version hindered VA staff's ability to utilize the EHR, the report said.
- The OIG found that the VA is supposed to complete ongoing assessments of Cerner's work on training. The VA frequently identified "recurring deficits in meeting project deadlines, staffing, management and quality of products" while working with Cerner, the report said. Despite consistently reporting deficiencies with Cerner, the VA's contracting officials scored Cerner's performance as satisfactory, the minimum level required to keep from breaking the contract.
- As a result of these problems, the VA Office of Electronic Health Record Modernization's director of change management, a Cerner counterpart and a Cerner executive had frequent meetings that continued at the time of the OIG's inspection.
- Although the director of change management said there were "actions taken to address Cerner's inadequate performance with training, the OIG was not able to confirm whether those actions led to substantive changes in contractor performance given that Cerner continues to work on training through a no-cost extension to the contract," the report said.
- "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 report said. "The integrity and thoroughness of information provided by VA is required by law and is critical to the OIG's mission. The OIG has notified VA senior leaders of this issue and is further pursuing the matter. Because the OIG was not provided complete information as requested, end user's training experience as outlined in the VA OEHRM training evaluation plan could not be fully evaluated."
- "Cerner is fully supporting [the] VA and shares their commitment to getting this right," Brian Sandager, general manager and senior vice president of Cerner Government Services told Becker's. "Together, Cerner and [the] VA have made progress toward achieving a lifetime of seamless care for our nation's Veterans and we look forward to continuing this important mission."