Electronic Health Records: VA Needs to Address Data Management Challenges for New System
Fast Facts
The Department of Veterans Affairs relies on electronic health records for patient care, risk management for its patient population, and health research. VA started transferring records to a new system, which went live in October 2020.
We found problems with the quality of the transferred data and with how the new system was working for some users. For example:
- VA identified errors in allergy, medication, and immunization data, which may pose risks for patient safety
- VA started making reports from the new system available without consulting all users, so VA can't be sure the reports meet their needs
Our recommendations address these issues.
Highlights
What GAO Found
The Department of Veterans Affairs (VA) relies on health data in its electronic health record (EHR) system and Corporate Data Warehouse to support its mission. VA has undertaken an effort to replace its legacy EHR system with a commercial system developed by Cerner Government Services, Inc. (Cerner). As shown in the figure, health data management activities planned for the department's EHR modernization (EHRM) include the following:
- Migrating data from the legacy EHR system to the new system.
- Supporting the continuity of reporting by preserving existing or delivering new reporting capabilities.
Planned Data Management Activities Supporting the Department of Veterans Affairs (VA) Electronic Health Record (EHR) Modernization
VA has made progress toward implementing its planned data management activities. Consistent with its plans, the department migrated selected data to the new EHR system prior to the initial system deployment in October 2020. Although these efforts included testing intended to help ensure migrated data were accurate and matched expected results, VA's analyses and GAO's work indicated that clinicians experienced challenges with the quality of migrated data, including their accessibility, accuracy, and appropriateness. For example, a VA report issued after the initial deployment identified risks to patient safety in the new system related to incomplete data migration. The challenges occurred, in part, because the department did not establish performance measures and goals for migrated data quality. 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.
In addition, consistent with its plans, VA began preserving existing reporting capabilities and delivering new ones. The department also took steps to identify and engage stakeholders, including incorporating their requirements into plans for reporting continuity. Nevertheless, the department did not use a key tool known as a stakeholder register to identify and engage all key stakeholders. Consequently, certain relevant stakeholders were overlooked. By using a stakeholder register, the department would be better positioned to meet their continuity of reporting needs.
Why GAO Did This Study
VA clinicians use health data to provide health care services to the nation's veterans. Stakeholders across the department also rely on health data to support reporting capabilities that can help monitor patient safety and measure the quality of care, among other things.
GAO was asked to review VA's EHRM data management plans. The objectives of this review included describing the department's plans for (1) migrating data to the new EHR system and determining the extent to which VA has implemented its plans and (2) continuity of reporting and determining the extent to which the department has implemented its plans.
To do so, GAO reviewed VA's plans and progress reports discussing data migration and reporting continuity for EHRM. GAO also compared these efforts to applicable federal guidance for data management and relevant project management practices. In addition, GAO interviewed knowledgeable VA officials.
Recommendations
GAO is making two recommendations to VA that it (1) establish and use performance measures and goals to ensure the quality of migrated data and (2) use a stakeholder register to identify and engage all relevant EHRM stakeholders to meet their reporting needs. VA concurred with GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Secretary of VA should direct the Deputy Secretary to establish and use performance measures and goals to ensure that the quality of migrated data meets stakeholder needs for accessibility, accuracy, and appropriateness prior to future system deployments. (Recommendation 1) |
Open
In its comments on our report, VA concurred with our recommendation. VA's Electronic Health Record Modernization Integration Office (EHRM IO) has taken steps to decrease the amount of manual data migration, which is expected to improve data accuracy. However, as of May 2023, the office had not yet demonstrated it has established and is using performance measures and associated goals to help ensure the accuracy, accessibility, and appropriateness of migrated data to the new EHR system. According to VA, the department has established specific performance measures for the migration of data from the legacy system to the new EHR. However, it is unclear, whether these metrics have been met given the data provided. For example, we are unable to determine whether the error rate is measured for automated transferred data and validation of data transferred from the documentation provided. We will continue to monitor VA's actions to address this recommendation.
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| Department of Veterans Affairs | The Secretary of VA should direct the Deputy Secretary to use a stakeholder register to improve the identification and engagement of all relevant EHRM stakeholders to address their reporting needs. (Recommendation 2) |
Open
In its comments on our report, VA concurred with our recommendation. In August 2022, EHRM IO officials stated that the department was continuing to develop the stakeholder register and anticipated completion in December 2022. As of October 2023, GAO had not received documentation for a stakeholder register. VA officials have described a database that includes information on all staff with access to EHR and target communities that are involved with developing reports. However, we have yet to see evidence of how these groups have been actively engaged in the report process. We will continue to monitor how VA has identified all relevant EHRM stakeholders and how the reporting needs of those stakeholders are being addressed.
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