VA Report Outlines Solutions to Key EHRM Patient Safety Issues

The Department of Veterans Affairs (VA) has released a report that outlines the current state of the EHR Modernization (EHRM) program and gives an update on technical fixes for key patient safety issues with the EHR platform.

In October 2022, the VA delayed upcoming implementations of its Oracle Cerner EHR until June 2023 to address system issues. After the announcement, VA leadership established the EHRM Sprint Project Team to develop recommended solutions for the most critical patient safety issues with the EHR identified by the VA Patient Safety Team (PST).

The multidisciplinary, enterprise-wide group gathered insights through field input to inform process changes across VA and identified four key patient safety issues with the EHR.

First, the team detailed the “unknown queue” issue, which led to thousands of EHR clinical orders disappearing in an unmonitored inbox, causing patients to miss follow-up care.

Sprint members conducted an “orders audit” to identify instances when the EHR did not correctly route clinician orders.

The team also noted that the EHR did not follow up and reschedule appointments for veterans who canceled or did not attend visits.

Additionally, the report revealed that the EHR did not adequately handle patient referrals.

Lastly, the report outlined EHR usability issues. For example, in some instances, providers mistake CPT Charge codes for imaging and non-imaging procedures/studies, unaware they did not order the actual clinical procedure.  

The Sprint team expects the VA will be able to implement many of the technical solutions it identified later this year.

“Anticipated execution and implementation for many solutions are expected in 2023 and will be included in the Program’s integrated master schedule,” the report authors wrote. “In addition to developing recommended solutions, the Team is developing processes to act on the recommended solutions, and future recommended solutions.”

The agency said some of the solutions outlined in the report are already complete, while in other cases, it will leverage interim solutions.

As the Sprint team develops EHR fixes, it will transition them to the appropriate business lead for review and implementation.

The report also noted that the VA is rethinking how it will make upcoming implementation decisions.

“In 2022, it became more and more evident that our structure and our processes were not optimal for successful deployments or to fix issues identified after deployments,” the authors wrote.

The VA is developing an Enterprise Site Readiness Dashboard to help the agency determine if a particular site is ready to move to the EHR.

The report acknowledged that most sites that have implemented the Oracle Cerner EHR have not returned to baseline productivity. Further, most sites have hired additional employees in efforts to maintain productivity levels pre-go-live.

“Deployment decisions for future sites should be informed by success in addressing these causes and evidenced by improvement in operations at current facilities,” the report authors stated.

Additionally, the report recommended a different approach to EHR training.

“Cerner trains VA employees on how to use its software with a focus on how to use features to do common tasks like complete documentation or place orders,” the report noted. “Given this training, users have had trouble applying this software knowledge to the accomplishment of their jobs.”

The Sprint team suggested additional adoption interventions based on best practices from other healthcare systems are required.

“These interventions include more over-the-shoulder or at-the-elbow support than is already provided, including by peers, to help users make the transition from VistA to Cerner and to understand new ways of getting work done with the new EHR,” the report explained.