The Veterans Affairs Department's process for developing its new electronic health record system is "generally effective," but sometimes overlooked involving key clinical stakeholders, according to a report the Government Accountability Office released Friday.
GAO conducted the review—which included interviewing officials from the VA and Defense Department, observing national and local workshops, and visiting the VA's scheduled initial implementation sites—after a request from Congress.
GAO determined the VA's processes for making design decisions were "generally effective as demonstrated by adherence to applicable federal internal control standards," but that the department sometimes missed involvement from key stakeholders, such as clinicians and staff from two medical facilities expected to go live on the EHR.
The VA had planned to implement the EHR at its first site in July and at its second site in fall 2020, but it held off on the EHR rollout due to COVID-19.
The first site scheduled to go live on the system was Mann-Grandstaff VA Medical Center in Spokane, Wash., followed by VA Puget Sound Health Care System in Seattle.
The VA in May 2018 struck a multibillion-dollar contract with Cerner Corp. for the EHR, which it's co-developing with the Defense Department.
To inform development of the EHR system, the VA held multiple workshops between November 2018 and October 2019, during which EHR councils comprised of VA clinicians and staff decided how to design the software. The VA also held local workshops at the two facilities scheduled for the initial EHR go-lives, to ensure the EHR system would support their workflow.
The agency said it plans to hold additional local workshops at other VA facilities in advance of their EHR go-lives, as well.
However, clinicians from Mann-Grandstaff VA Medical Center and Puget Sound Health Care System told GAO the VA did not always communicate information about the local workshop meetings.
That resulted in inadequate representation of clinicians and staff from the facilities at local workshop meetings, they said.
GAO recommended that the VA address the communication issue for future sessions, and moving forward "ensure the involvement of all relevant medical facility stakeholders in the EHR system configuration decision process."
"By ensuring that all relevant stakeholders are included, VA will increase the likelihood that it is obtaining input from a wide range of clinicians and staff who will use the EHR system and will increase the likelihood that when it is implemented, the EHR system will effectively support the delivery of care at VA medical centers," GAO's report reads.
The VA agreed with GAO's recommendation. In comments to GAO, VA Acting Deputy Secretary Pamela Powers said the agency is adjusting local workshop session agendas and descriptions at Puget Sound Health Care System to better identify local subject matter experts.
"Based on experience and lessons learned from completed national and local workshops, the Department of Veterans Affairs is further refining terminology and improving stakeholder engagement at local workshops," she wrote.
