OIG: Veterans Administration's $16B Cerner EHR scheduling tool had significant known limitations

The Department of Veterans Affairs' $16 billion Cerner EHR deployment rolled out despite significant challenges reported by employees, according to a Nov. 10 report by the Office of Inspector General.

Cerner's scheduling tool was perceived as more user-friendly, but VA hospital employees reported facing challenges using it, the OIG reported. The OIG found that the Veterans Health Administration and the Office of Electronic Health Record Modernization knew there were "significant system and process limitations before [and] after implementing the new scheduling system at the Columbus [Ohio] and Spokane [Washington] facilities without fully resolving them."

Eight things to know:

  1. Cerner began training Columbus employees in February 2020 and some Spokane employees in January 2020 but had to pause training because of the COVID-19 pandemic. Columbus locations were slated to roll out the system in August 2020, but internal OEHRM documents and survey feedback found employees did not feel they had sufficient training. 

  2. Employees reported they had not been training to handle real or complex scheduling scenarios, that the training was not tailored to their roles and they did not have enough practice using Cerner's scheduling tool. Cerner resumed training, and the VA still rolled out the EHR in the summer of 2020, the OIG reported.

  3. Cerner, the VHA and the OEHRM conducted assessments before the rollout from November 2018 to July 2020. The reviews helped the OEHRM identify issues with the new scheduling system, but the department did not fully address the issues before rolling it out in Columbus.

  4. The OIG cited four major areas of concern: VA employees were unable to automatically mail appointment letter reminders; they had difficulties changing appointment type; there was no guidance on how to measure patient wait times; and oversight tools were not available to track wait times, accuracy in patient scheduling.

  5. The OIG found that certain VA clinics were unable to schedule appointments and did not learn of the limitations until the EHR was rolled out. Employees said it took at least one week to schedule appointments until the issue was resolved. In a survey of 213 schedulers, 58 percent said they were able to provide feedback before the tool was rolled out and 9 percent reported that their concerns resulted in changes.

  6. After the rollout in Columbus facilities, new scheduling issues arose but were not resolved before the VA rolled out the EHR in Spokane, according to the report. The OIG said the system was not configured completely, data was not migrated completely or accurately and appointment reminder calls were misleading.

  7. The limitations reduced the system's effectiveness and risked delays in patient care, according to the report. When VA employees began working with Cerner to resolve issues, they experienced long ticketing process times without status updates. The OIG also found that there was no system to assess whether Cerner was complying with its contract timeliness requirements.

  8. "Cerner takes our responsibility to veterans and [the] VA providers seriously," Brian Sandager, general manager and senior vice president of Cerner Government Services, told Becker's. "The new system should aid VA staff to improve access to care for veterans. The report noted schedulers praised the system for being more user friendly and highlighted the ease of scheduling video visits. We remain engaged on-site in Spokane and Columbus gathering feedback and implementing changes as directed by VA. It’s important to get this right and we remain committed to this mission."

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