Inaccurate VA EHR Training Information Impeded OIG Oversight

Senior Department of Veterans Affairs (VA) staff gave inaccurate EHR training information to OIG reviewers, according to an OIG report.

In February 2020, the OIG Office of Healthcare Inspections (OHI) began a review at the Mann-Grandstaff VA Medical Center to assess the efficacy of Veterans Health Administration (VHA) training to prepare staff for go-live of the agency’s new EHR.

OHI requested data from Mann-Grandstaff and the VA Office of Electronic Health Record Modernization (OEHRM). However, OHI experienced significant challenges in receiving timely, complete, and accurate information for VHA’s plan for EHR training evaluation and data capturing the results of trainees’ proficiency checks after course completion.

OEHRM routed these information requests to its change management group, which is responsible for evaluating the effectiveness of the new EHR training.

While OHI could complete its work, the inspectors had concerns regarding the completeness and accuracy of the data provided by the change management group.

“Because OHI’s concerns raised the question of possible misconduct on the part of senior VA officials responsible for responding to requests for data, the OIG’s Office of Special Reviews (OSR) initiated this administrative investigation in April 2021,” R. James Mitchell, acting assistant inspector general for special reviews, wrote in the report.

OSR’s review found that two of OEHRM’s change management leaders failed to provide timely, complete, and accurate information and data to the OIG.

OIG officials noted that the investigation did not reveal that the change management leaders had intentionally sought to mislead OHI staff. However, the leaders’ lack of “due care and diligence” resulted in the submission of misinformation to OHI.

Specifically, change management’s executive director and the director for training strategy presented documentation to OIG staff that outlined a training evaluation plan without disclosing that no training evaluation plan had been reviewed or approved.

Additionally, the officials delayed producing underlying proficiency check data and provided one slide with inaccurate summary statistics. The slide doubled the reported proficiency check pass rate from 44 percent to 89 percent. Later, the change management officials inaccurately explained the difference due to removing a relatively small number of data outliers.

The OIG officials also found that change management leaders did not disclose that they had excluded outliers due to concerns about data reliability.

“The requested information and access to underlying data were not promptly provided, and the change management leaders were not candid or transparent in their responses to the OIG,” Mitchell wrote. “This impeded the OIG’s ability to efficiently meet its oversight obligations.”

“This report underscores the need for the EHR program office to reinforce the requirement for timeliness, completeness, and accuracy in all responses to OIG requests for information,” he continued.

OIG recommended that the executive director for the EHRM Integration Office (EHRM IO) guide the office’s staff to support timely, complete, and accurate responses to OIG requests.

In addition, the EHRM IO executive director should consider whether administrative action is appropriate concerning the conduct or performance of the change management executive director and the director for training strategy.

VA reviewed the draft report and responded by agreeing with the finding and all recommendations.

“The OIG does acknowledge that the executive director for change management was reassigned to VHA (outside of EHRM IO) after this report was provided to VA for review,” Mitchell wrote.

“Accordingly, VA has indicated that the individual’s new supervisor in VHA will be responsible for addressing recommendation three, which calls for a determination of whether administrative action is appropriate given the conduct and performance described in this report,” he added.