VA giving ‘insufficient’ training on electronic health records, IG warns

The George E. Wahlen VA Medical Center in Salt Lake City. (Veterans Health Administration / Flickr)

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The Department of Veterans Affairs is not giving sufficient training to medical staff on the new electronic health records systems it is rolling out across the country, the inspector general found in a new report.

The lack of training has stopped clinicians from using the system in the ways it was designed, the report shows. The new IT system is a part of the VA’s $16 billion electronic health records modernization program first launched in the Mann-Grandstaff facility in Spokane, Washington. The rollout has been plagued by a range of issues, from several delays due to training issue and warnings of weak testing. The program was paused while it underwent a “strategic review” by the new secretary.

In a separate report, the IG found that VA underestimated the costs associated with upgrading the IT infrastructure that will support the new EHR system, by as much as $2.5 billion. Cost overruns could bring additional Congressional scrutiny to a program already under lawmaker’s microscopes.

“During this review, the OIG found that VA OEHRM failed in that the approved curriculum had significant deficiencies in training content, training delivery, and its ability to assess the efficacy of the training delivered,” the report states.

The training software provided to staff does not closely resemble the final product being rolled out, the IG found. The discrepancy on its own would have caused confusion even if the training went smoothly, but its execution was botched by assigning users to training that didn’t fit their jobs. The training was focused on specific tasks and not on the wide-ranging clinical scenarios staff at Mann-Grandstaff have to respond to, processes called “workflows,” in the report.

“Facility staff reported an absence of workflow training content and associated reference materials that prevented them from not only understanding how to apply what little they had learned to their daily work, but also prevented a basic understanding of the meaning behind workflow processes,” the report stated.

The report found that leaders at the facility coined the term “button-ology” to refer to training as it only provided information on what button to push and now how to use the tech in real world scenarios.

The inefficient training has led staffers to have a lack of trust in the system, a survey included in the report found. A majority of users said they do not feel they can navigate the applications, access patient information or easily share it, or that they have the ability to document patient care in the new system. Only 5% of users responded positively to all four questions, the survey result said.

“Overall, the survey results showed that after training and two to three months of new EHR use, only a small percent of facility users reported facile use with EHR core functions,” the report states.

The training issues come as more reports of cost over runs question if the VA will need to ask for more money to support the system’s nation-wide roll out. The IT infrastructure upgrades for EHR system was initially projected to cost $4.3 billion, which could be as much as $2.5 billion short.

One of the challenges in understanding how much the EHR system will cost is that the money is split between general Office of IT infrastructure upgrades and those specific to the EHR system. The VA is required to file reports to Congress on the costs associated with the EHR program,

“[T]here were inadequate procedures for determining if a cost-estimate update is needed in the office’s congressionally mandated reports,” the report states.

Another recent report pointed to similar issues on the physical infrastructure cost estimates. The secretary also noted in recent congressional testimony that costs might increase if the VA needs to surge additional resources to each medical facility that gets the EHR system as the department had to do at Mann-Grandstaff.

“It does appear to be requiring a lot more people on the target in Spokane,” he told the House Veterans Affairs’ committee in March.

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Department of Veterans Affairs (VA), electronic health records (EHRs), OIG, workforce
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