OIG Report Highlights Massive Errors in EHR Rollout at VA Facility

F.J. Thomas

Sarasota, FL (WorkersCompensation.com) – According to a recent Bloomberg report, the Justice Department had a record year investigating cases of healthcare fraud, and currently investigating at least 580 new fraud cases. Due to the increase in false claims and fraud cases, the Department is now focused on fraud cases via the misuse of electronic health records (EHR).

The mandate requiring providers to utilize EHR took effect in 2014, with gradual penalties and incentives for participating. In an effort to meet the compliance requirements, practices were burdened with the expense of purchasing new software, a cost averaging $15,000 to $70,000 per provider. Additionally, practices were also left with the administrative costs for IT, as well as and training of staff as provided by the software company. As a result of the massive financial burden, as well as the regulatory and workflow changes, many physicians chose to retire early in the face of having to learn new technology that required extensive effort.

One of the health tech giants in the rush for EHR compliance was Cerner. Having been in the business for over 40 years, the company catered to large organizations in an attempt to meet regulatory requirements. As with all companies that offered EHR, Cerner provided the training on how to use the EHR software.

In 2018, the Department of Veterans Affairs (VA) signed a $10 billion contract with Cerner for their EHR. The first site to transition to the new EHR was the Mann-Grandstaff VA Medical Center in Spokane, Washington. A new report from the Office of Inspector General (OIG) reviewed the training process used at the facility, and found several issues with the training in the EHR rollout.

According to the agreement, the VA was responsible for approving Cerner’s training programs and information before distribution to employees. Cerner was responsible for providing training coaches in an effort to ensure proper usage, and certain VA staff were to be trained as super users in an effort to provide frontline assistance during implementation and rollout. The training timeline was 6 weeks.

In its analysis, the OIG found several factors that they feel hindered staff’s ability to use the new EHR. The OIG found that insufficient training time, limitations of the training domain, realistic applications in user role assignments, and gaps in training were all issues that negatively impacted worker effectiveness. According to the report, Cerner stated that the training environment was the same version as the EHR being implemented, however the training EHR was significantly different, hindering staff’s ability to utilize the live environment.

In addition to training issues, the OIG found EHR concerns involving physician productivity, patient complaints, and employee morale. While the facility wasn’t able to provide robust productivity data with the new EHR, the data that was available showed a significant decrease in productivity. Per OIG’s conclusions, the facility staff management blamed the decrease on the EHR training. Given the probable cause in decreased productivity, the regular protocol of reporting and tracking by leaders and patient advocates was not followed. The lack of protocol prevented identification of issues and trends in the implementation. Additionally, employee complaints were not taken into consideration.

According to the report, the facility manager stated that patient complaints were monitored through a morning huddle that included patient advocates, and that he was unaware of any issues. While the facility was not entering or tracking patient complaints, the patient advocates were entering the information, however due to lack of training and varied entry methods, the information was incomplete. The OIG concluded that 160 unique patient complaints had been entered into the Patient Advocate Tracking System between October 8 and November 22, 2020. Of those, a total of 43 complaints equating to 27 percent, referenced a direct issue with the EHR.

While an appropriate number of super users were trained for the EHR go live, facility staff felt that given the training quality and time period, in addition to the increased complexity of the system, that the training was insufficient. Additionally, staff reported issues with the ability to manage their clinical duties with the time required for what training they received.

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