Across the country at Department of Veterans Affairs medical facilities, there’s a massive backlog of documents waiting to be scanned and digitized that, if stacked, would stand more than 5 miles tall.
For reference, that’s taller than 18 Empire State Buildings. It’s just 2,000 feet short of the peak of Mount Everest.
Since 2014, the VA has allowed veterans to seek care outside of its facilities under the Veterans Access, Choice and Accountability Act. When that happens, those non-VA facilities generate records and send them, often as paper copies, to the VA to be integrated digitally with a veteran’s electronic health record.
Veterans have visited community providers — as the non-VA facilities are called — for more than 70 million appointments and counting, each time creating at least one new medical document to send to the VA and integrate into an EHR.
According to a new inspector general’s report, “[s]ignificant medical documentation backlogs have occurred VHA-wide in part because VA medical facility staff did not scan documentation and enter electronic medical records into patients’ EHRs in a timely manner.” The result is a “backlog of paper documentation that measured approximately 5.15 miles high and contained at least 597,000 individual electronic document files dating back to October 2016.”
To make things worse, this could just be the tip of the digitization iceberg. As of June, the MISSION Act allows veterans to see a more expanded network of community providers. With that, there’s “the potential to significantly increase the volume of documentation VA medical facilities will receive from outside providers for scanning, as well as any related backlog,” the IG says.
The IG based its calculation on self-reported “data provided by the eight facilities visited and the 78 facilities interviewed.” And there’s probably quite a bit more than that, as the “totals do not include facilities that lacked quantifiable measures for their backlogs (i.e., those without paper document or electronic file calculations, such as facilities that only noted the age of the oldest document without calculating quantity).”
The paper pileup stems from the lack of “adequate oversight or resources to support the mission of medical document scanning and indexing for quality patient care,” the IG said.
“Inaccurate EHRs put patients at risk and compromise continuity of care because accurate medical diagnoses and treatment depend on complete and current documentation,” the report concludes. “VHA needs to improve supervision and management of scanning activities to ensure medical documents are indexed to patients’ EHRs in a timely manner. This will help ensure veterans receive appropriate, thorough, and timely care.”
The backlog provides yet another layer of challenges the VA faces in developing an effective modernized electronic health records system. The department has struggled for decades to provide a system that will interoperate with the Department of Defense’s, so transitioning service members can access their files when they become veterans.
However, the VA has made progress in recent years, signing a contract with Cerner estimated to be worth $16 billion to develop a modernized system that should work seamlessly with DOD’s Cerner-based system. The VA also touted a “major milestone” this summer, saying it migrated 78 billion health records, including vital signs, lab tests and others from its legacy systems to the new EHR.