GAO says VA pharmacy system could put patients at risk

The Veterans Affairs Department's pharmacy system could put patient safety at risk due to interoperability limitations, according to a federal report.

The system—which is part of the VA's soon-to-be-replaced electronic health record, called VistA—hinders pharmacists' ability to access patient data and to work with non-VA providers' prescriptions, according to the report by the U.S. Government Accountability Office. The agency recommends that the VA modernize its pharmacy services. The VA requested $7.7 billion in fiscal 2017 for these services.

In the report, released last week, the GAO wrote that the VA's pharmacy system succeeds at three industry practices—eprescribing, checks for drug-drug and drug-allergy interactions, and the tracking of controlled drugs—but fails at three others: electronic exchange of prescriptions with non-VA providers and pharmacies, comprehensive clinical decision support methods, and perpetual inventory management.

The VA is limited by the capabilities of VistA, according to the GAO. For instance, the VistA Outpatient Pharmacy application, along with the computerized patient record system, does not allow clinicians and pharmacists to electronically accept or transmit prescriptions from or to non-VA providers and pharmacies. Patients therefore must resort to paper or faxed prescriptions, "a process that is time-consuming and inefficient."

Furthermore, the VA is risking that prescriptions will be entered incorrectly at non-VA pharmacies. The GAO recommended that the VA come up with a plan for adding these capabilities.

The inability to send and receive prescriptions from non-VA providers poses a special challenge with the Veterans Access, Choice and Accountability Act, which allows some veterans to use certain non-VA healthcare providers. "According to pharmacists at our site visits, significant time and resources were required to process prescriptions for the program's patients," the GAO wrote.

Because these interoperability limitations hinder how VA providers work with non-VA providers, they could affect the VA's plan to retool the Veterans Choice program, since the new version of the program, like the old, depends on the ability of non-VA providers to provide care to veterans—and cites that ability as a way to provide more timely care.

Interoperability between the VA and the Defense Department also is a problem, according to the report. The VA and the Defense Department should be able to share patient information better. The report did not note how the VA's upcoming adoption of Cerner, which is what the Defense Department already uses, would affect this ability. In fact, though the report cited the need to modernize VistA, the GAO did not comment on how the VA's implementation of a new Cerner EHR might affect its progress. The VA will look to the GAO (and others) in the future, though, for guidance in adopting Cerner, according to a VA spokesperson.

Veterans Affairs Secretary Dr. David Shulkin wrote in the announcement of the Cerner adoption that when the two systems use the same EHR, it will "ultimately result in all patient data residing in one common system and enable seamless care between the departments without the manual and electronic exchange and reconciliation of data between two separate systems."