Review of Access to Care and Capabilities during VA’s Transition to a New Electronic Health Record System at the Mann-Grandstaff VA Medical Center in Spokane, Washington

The OIG conducted a review of VA’s planned launch of a new electronic health record (EHR) system at the Mann-Grandstaff VA Medical Center in Spokane, Washington. The facility was scheduled to be the first facility to implement the new EHR system on March 28, 2020, which VA postponed on February 10 to an unspecified date. The review focused on the EHR’s initial capabilities and the potential impact on patients’ access to care. The OIG found that facility leaders are planning for a 30 percent decrease in productivity as the system is tested and learned. Although the Office of Electronic Health Record Modernization (OEHRM) made efforts to evaluate and address productivity, facility leaders were not provided written guidance to address patients’ access to care during this less productive time. Facility leaders hired just more than 48 of 108 positions needed to support roll out and addressed access to primary care, but had a backlog of 21,155 community care consults (referrals) as of January 9, 2020. The OEHRM determined in July 2019 that not all new EHR capabilities would be available for the March go-live date. The OIG determined that facility staff would enact as many as 84 mitigations for 62 systems identified as moderate or high risk to address gaps at the go-live date. In particular, work-arounds were needed to address the removal of an online prescription refill capability—presenting patient safety risks. The OIG determined that going live with decreased capabilities that require mitigation strategies risks patient safety beyond that inherent in an EHR deployment. The OIG made four recommendations regarding productivity and capabilities to the Under Secretary for Health and OEHRM, two recommendations to the Veterans Integrated Service Network Director on facility support, and two recommendations to the Facility Director related to community care consults and timely medication refills.