The Department of Veterans Affairs Office of Inspector General released two reports this week evaluating the VA's now-delayed Cerner EHR deployment at Mann-Grandstaff Medical Center, claiming the agency had not been adequately prepared for various issues such as staffing and patient access.
VA was initially scheduled to deploy the new $16 billion EHR, which is designed to be interoperable with the Defense Department's Cerner system, at the Spokane, Wash.-based VA medical center on March 28. The agency delayed the rollout in mid-February because it needed more time to finish building the system. With a new deployment date set for July, the VA announced earlier this month it would further postpone the go-live indefinitely to focus on its COVID-19 response.
The VA OIG reports evaluate the agency's first Cerner go-live at Mann-Grandstaff VA Medical Center and the VA's decision to delay the project in February.
Seven report insights:
1. VA anticipated that patient access to care would decrease by 30 percent for one to two years after the go-live, based on the Defense Department's experience. However, as of Feb. 11, facility leaders had not received instruction on how to mitigate these care risks. Risk reduction strategies included adding facility staff, enhancing clinical space and extending clinic hours. By Feb. 5, the VA facility had only hired 48.5 of the 108 planned additional staff to support the transition.
2. OIG found that the VA facility had more than 21,000 open care consults and an average wait time of 56 days as of Jan. 9. To try and help clear the potential backlogs, VA asked staff to work an additional eight to 10 hours each week to manually copy and paste information from one system to another to process consults.
3. VA intended to move ahead with the EHR rollout despite not completing "critical physical and IT" infrastructure upgrades. Some infrastructure upgrades, such as modifications to telecommunications rooms, were not expected to be completed until months after the previous March 28 go-live date. In October 2019, 31 percent of end-user devices needed to deploy the new system still had yet to be upgraded.
4. OIG said the infrastructure upgrades were not completed at the medical center in a timely manner primarily because VA lacked initial comprehensive site assessments to determine an adequate go-live date, appropriate monitoring mechanisms and adequate staffing.
5. VA concluded in July 2019 that some EHR features would not be available by the March go-live, including requesting online prescription refills via the MyHealtheVet patient portal. The function was created for the new EHR patient portal, but activation would not be available until later waves of capability sets were deployed.
"Although the facility's initial go-live date has been postponed, the OIG determined that going live at a later date with decreased capabilities and the need to employ necessary mitigation strategies still presents a significant risk to patient safety beyond the inherent risk of deployment of an EHR system," the report states.
6. OIG made 16 recommendations between the two reports, including ensuring there is clear guidance for facility staff on what EHR capabilities will be available at the go-live date and working with facility leaders to address all operational needs ahead of the transition. VA leaders agreed with all recommendations.
7. The first three waves of site deployment originally scheduled for August, October and November of 2020 are also postponed until 2021.
To view the full reports, click here and here.