OIG Report Finds VA EHR Pilot Site Lacks Quality, Patient Safety Metrics

The Department of Veterans Affairs (VA) Medical Center in Spokane lacked important quality and patient safety metrics a year after it became the agency’s Cerner EHR pilot site, according to a VA Office of Inspector General (OIG) report.

According to the report, of 103 performance metrics the department relies on to monitor care quality at its hospitals, only 13 were available from the Cerner EHR. Missing measures included those needed for hospital accreditation.

OIG is concerned that these shortfalls in EHR metrics may negatively impact organizational performance, patient safety, and access to care.

According to the report, Cerner failed to deliver metrics, and the hospital could not assess the new EHR’s metrics before go-live. Additionally, OIG found training deficits and impaired utility with the new EHR metrics.

VHA-generated metrics using new EHR data also presented challenges. In particular, VHA resources were insufficient for generating new EHR metrics and VHA metrics were unavailable.

“The OIG is concerned that further deployment of the new EHR in VHA without addressing the gap in metrics available to the facility will affect the facility and future sites’ ability to utilize metrics effectively,” the report authors wrote. “Accordingly, to address the gaps in metrics available to the facility and future sites, VA must resolve the factors identified by the OIG that affect the availability of metrics.”

Rep. Kim Schrier, a Democrat whose district includes a clinic in Wenatchee connected to the Spokane hospital, has called for the VA to fix the system before it causes an exodus of medical staff, according to reporting from The Spokesman-Review.  

“When you can’t get good data in, you can’t get good data out,” Schrier told the news outlet. “Mann-Grandstaff and the associated clinics, they can’t get any of the metrics they need to see how their veterans are doing and to improve their processes, and it’s all related to the same thing, the electronic health record.”

Schrier, who worked as a pediatrician before entering Congress, said she has used a similar Cerner system. While she expects any transition to a new EHR to be frustrating at times, the experience at Mann-Grandstaff and the Wenatchee clinic has been unacceptable.

“You go through growing pains when you adopt a medical record, but you shouldn’t have this,” she said. “Listen to the staff about whether they’re able to perform their duties, whether they’re able to see the regular number of patients, whether the computer keeps crashing.”

VA officials have acknowledged that the Cerner system has been partially or entirely unusable at least 50 times since it launched in Spokane.

Citing an internal survey in 2021 that found nearly two-thirds of Mann-Grandstaff employees considered quitting because of the EHR, Schrier said the VA might need to consider switching back to its legacy system until it solves the problems.

“When you hear morale is low, you’ve got to do something to help or you’re going to lose all your staff, and then our veterans lose care,” Schrier said. “This is the time to listen to staff and figure out what needs to change immediately. Maybe they need to rewind, go backwards to the old system until they get this figured out, just to make people’s jobs at least go back to what they were beforehand.”