VA failed to ensure data quality during initial EHR rollout, GAO finds

The Department of Veterans Affairs failed to ensure that data transferred during the rollout of its new electronic health record (EHR) modernization platform met clinicians’ needs, according to a new audit by the Government Accountability Office.

In a wide-ranging report published Tuesday, the watchdog found that the department failed to sufficiently monitor the accessibility, accuracy and appropriateness of clinical information as it was transferred in segments from one system to another.

GAO recommended that the department establish performance measures for migrated data and that it use a stakeholder register.

“Although VA performed data testing activities identified in its plans, the department did not ensure that the quality of data migrated to the new EHR system sufficiently met clinicians’ quality needs,” GAO said in the report. In some interviews conducted by the watchdog, clinicians reported being unable to access patient information such as allergies, medications and immunizations, and also reported data errors.

The concerns were raised in relation to a staging environment used as data was transferred from the VA’s National Data Center in Austin, Texas, to a data center operated by contractor Cerner in Kansas City, Missouri. GAO’s performance audit was conducted over the period August 2019 to February 2022.

A greater-than-required volume of certain patient data, such as medication data, was also selected for initial migration, according to the watchdog. It found also that while VA implemented a feedback system to address concerns, it did not use a stakeholder register to help identify and engage all relevant stakeholders for reporting continuity.

“A stakeholder register is intended to help identify and engage all relevant stakeholders. Until VA uses such a tool, the department risks overlooking EHRM stakeholder needs for reporting on patient care, operations, and research functions,” the watchdog said.

The Office of Management and Budget’s Federal Data Strategy highlights the importance of validating data quality, including their accessibility, accuracy and appropriateness.

The new findings come after sustained criticism from lawmakers late last year following the department’s decision to push ahead with the rollout of the EHR platform at a new location despite safety concerns from frontline staff.

Last month, the VA announced a further delay to the rollout of the program, citing surging COVID-19 cases at its medical network in central Ohio. The system will now go live at the location April 30 instead of the previously set date of March 5.

Cerner’s Millennium platform and Cerner HealtheIntent cloud platform form the backbone of VA’s health records modernization strategy, which relies on transferring patient data off the VA’s legacy Veterans Health Information Systems and Technology Architecture (VistA).

In a statement, VA said that it concurred with the recommendations in GAO’s report: “The Electronic Health Record Modernization (EHRM) Integration Office will establish and use performance measures and goals, aligned with and integrated into the VA Data Strategy, to ensure the quality of migrated data meets stakeholder needs for accessibility, accuracy and appropriateness prior to future system deployments.

“This aspect of EHRM will meet enterprise data quality and reliability standards. The EHRM Integration Office will also use a stakeholder register to improve the identification and engagement of all relevant EHRM stakeholders and address their reporting needs,” the agency added.

In a statement, general manager of Cerner Government Services Brian Sandager said: “Supporting the VA in its efforts to provide veterans with safe, effective, holistic care is our top priority.” He added: “We are committed to working with our VA partners to quickly identify and aggressively address any concerns, as they implement a new electronic health record system that will give veterans and their providers a single record to support a lifetime of seamless care.”

Editor’s note: This story was updated to include additional comment from VA and Cerner.