VA Information Technology: Pharmacy System Needs Additional Capabilities for Viewing, Exchanging, and Using Data to Better Serve Veterans
Highlights
What GAO Found
The Department of Veterans Affairs (VA) has system capabilities through multiple computer applications that support its clinicians and pharmacists in prescribing and dispensing medications to patients. However, pharmacists cannot always efficiently view necessary patient data among Veterans Health Administration (VHA) medical sites. In addition, pharmacists cannot transfer prescriptions to other VHA pharmacies or process prescription refills received from other VHA medical sites through the system. As a result, the system does not provide important capabilities for pharmacists to make clinical decisions about prescriptions efficiently, which could negatively affect patient safety.
In its efforts to establish and increase interoperability with the Department of Defense (DOD), VA has developed capabilities to exchange certain patient and medication information. For example, VA's pharmacy system has the ability to check prescription drug information from DOD. Nevertheless, limitations impede interoperability with DOD: (1) VA clinicians and pharmacists cannot always view DOD patient data and (2) VA pharmacists do not always receive complete information from DOD to perform prescription checks on new medications. Also, VA has not assessed the impact of its pharmacy system interoperability on service members transitioning from DOD to VA, and VHA officials stated that doing so would be difficult because there are other personnel related-factors that could affect patient-care outcomes. Without assessing the impact that pharmacy system interoperability is having on veterans, VA lacks assurance regarding the effectiveness of the system to adequately support its mission of providing health care to veterans.
VA's pharmacy system capabilities align with three of six identified health care industry practices. Specifically, the pharmacy system (1) provides the ability to order medications electronically, (2) enables prescription checks for drug-to-drug and drug-allergy interactions, and (3) tracks the dispensing of controlled prescription drugs. However, the pharmacy system lacks capabilities that align with three other practices which could enhance its usefulness:
Pharmacists cannot electronically exchange prescriptions with non-VA providers and pharmacies. Therefore, veterans need to obtain paper prescriptions from external providers or have the providers fax the prescriptions to their local VA pharmacy to fill the prescriptions, which is time consuming and inefficient.
VA's system does not include certain clinical decision and workflow capabilities that, among other things, could improve clinicians' and pharmacists' ability to provide enhanced medical care to veterans. VA has indicated that it plans to implement such capabilities, but its plans for doing so are incomplete.
VA's system does not maintain a perpetual inventory management capability to monitor medication inventory levels. Therefore, pharmacists cannot effectively track when to reorder medications.
In the absence of these capabilities, VA is limited in its ability to interoperate with private providers, provide additional clinical decision support, and more effectively track medications that could impact veterans' patient safety.
Why GAO Did This Study
VHA provides health care services, including pharmacy services, to approximately 6.7 million veterans and their families. To do so, clinicians and pharmacists rely on VA's health information system. The National Defense Authorization Act for Fiscal Year 2003 required VA to ensure it has a pharmacy system that is interoperable with DOD's system.
A provision in Senate Report 114-57 required GAO to examine VA's acquisition and use of a pharmacy system. GAO determined whether (1) VA currently possesses a functioning pharmacy system and the extent to which the system enables data to be viewed, shared, and transferred among VHA pharmacy locations; (2) VA's pharmacy system is interoperable with DOD's, and whether this system, or the absence thereof, is impacting service members who transition care from DOD; and (3) VA has implemented its pharmacy system in accordance with health care industry practices. GAO analyzed documentation describing VA's pharmacy system; observed system demonstrations; analyzed plans and actions taken to achieve interoperability with DOD; and identified industry practices related to pharmacy systems, and compared them to VA's system capabilities.
Recommendations
GAO is making six recommendations including that VA update its pharmacy system to view and receive complete medication data, assess the impact of interoperability, and implement additional industry practices. VA generally concurred with GAO's six recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to establish and implement a plan for updating the pharmacy system to address the inefficiencies with viewing patient medication data in the Outpatient Pharmacy application and between the pharmacy application and viewers. |
Closed – Implemented
VA concurred with our recommendation and in August 2017 stated that it had identified $4 million in fiscal year 2018 to establish a pharmacy graphical user interface. In fiscal year 2021, the department had established and begun to implement its plan for developing a pharmacy graphical user interface to address the inefficiencies in viewing patient data from pharmacy applications. As a result, VA has taken significant action towards addressing inefficiencies with viewing patient information to provide pharmacists improved ability to review patient data while processing and dispensing prescriptions.
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| Department of Veterans Affairs | To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to complete a plan for the implementation of an approach to data standardization that will support the capability for clinicians and pharmacists to view complete DOD data and receive order checks that consistently include DOD data. |
Closed – Implemented
VA concurred in principle with our recommendation and in May 2018 awarded a contract to implement the same electronic health record system that is being deployed by DOD, which is intended to present VA clinicians with complete DOD data and the ability to perform order checks on DOD data. In parallel, the department continued and expanded the implementation of data standardization. According to the department's September 2020 update, the agency had updated its pharmacy system to improve data standardization. In fiscal year 2021, we verified that VA had established a plan to improve data standardization of pharmacy data within its system. As a result, VA more efficiently supports clinicians' ability to view Pharmacy data and order checks.
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| Department of Veterans Affairs | To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to conduct an assessment to determine to what extent interoperability of VA's pharmacy system with DOD's pharmacy system is impacting transitioning service members. |
Closed – Implemented
VA concurred with our recommendation and stated that it planned to conduct an assessment to determine the extent that interoperability of VA's pharmacy system with DoD's pharmacy system is impacting transitioning service members. In fiscal year 2021, we verified that VA collected monthly Health Data Interoperability metrics from July 2017 to June 2020 and described efforts to minimize failure rates. As a result, VA has increased assurance that its pharmacy system is supporting its mission of providing health care to transitioning service members.
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| Department of Veterans Affairs | To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to develop and execute a plan for implementing the capability to send outbound e-prescriptions to non-VA pharmacies, in accordance with National Council for Prescription Drug Programs standards. |
Closed – Implemented
VA concurred with our recommendation and in August 2017 stated that it would review its plan for e-prescribing functionality after it had signed a contract to adopt the electronic health record system that is being deployed by DOD. In May 2018, VA awarded the contract for the new electronic health record system. In fiscal year 2021, we verified that as part of its new electronic health record system, it planned to implement the ePrescribe capability that would allow prescribing providers to electronically send Veterans' prescriptions to pharmacies set up to receive electronic prescriptions. As a result, VA has reduced the risk that a clinician's prescription will not be entered correctly at a non-VA pharmacy and avoid patient safety issues such as dosing mistakes. In addition, veterans will have the convenience of having prescriptions electronically transmitted to external (i.e. private or DOD) pharmacies.
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| Department of Veterans Affairs | To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to ensure that the department's evaluation of alternatives for electronic health records includes consideration for additional generation level 3 capability such as navigating from an alert to medication order in the electronic health record system. |
Closed – Implemented
VA concurred with our recommendation and in August 2017 stated that it had entered into contract negotiations to acquire and deploy a level 3 electronic health record system that is expected to address pharmacy functions. In fiscal year 2021, we verified that VA was in the process of implementing a new electronic health record system that provided alerts to support clinicians' decisions. As a result, VA clinicians and pharmacists should have important capabilities that could enhance clinical decisions related to prescribing medications.
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| Department of Veterans Affairs | To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to reassess the priority for establishing an inventory management capability to monitor and update medication levels and track when to reorder medications. |
Closed – Implemented
VA concurred with our recommendation and in August 2017 stated that it would reassess the prioritization of medication inventory management after a contract for adoption of the electronic health record system was signed. In fiscal year 2021, we verified that VA had established a plan to adopt a new electronic health record system with inventory management capability to monitor and update medication levels and track when to reorder medications. Specifically, VA had plans to provide capability for visibility into current inventory levels as well as system driven inventory purchasing. As a result, VA should have improved ability to monitor and update the inventory of pharmacy medications and pharmacists should have the tools to track when to reorder mediations, reducing the risk to patients' health care and safety.
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