GAO makes recommendations on VA data migration

The US Government Accountability Office (GAO) has made two recommendations regarding VA EHR modernization data management plans. GAO reviewed VA’s plans and progress reports regarding data migration from its old EHR and reporting continuity as it transitions to the Cerner system.

After comparing VA’s efforts to applicable federal guidelines for data management and relevant project management practices, GAO also interviewed relevant VA officials. It is recommended that VA establish and use performance metrics and targets to ensure the quality of migrated data. He also recommended using a stakeholder register to identify and engage all relevant stakeholders to meet their reporting needs. VA agreed with the GAO recommendations.

GAO found that although VA developed migration plans and performed data testing activities identified in its plans, the department did not ensure that the quality of data migrated to the new EHR system sufficiently met the quality needs of clinicians. He noted that the Federal Data Strategy of the Office of Budget Management emphasizes the importance of validating the quality of data, including its accessibility, accuracy and timeliness. Using performance metrics to assess the quality of a product such as migrated data against established goals is a generally accepted project management practice and can help ensure that stakeholder needs and expectations are met. . The GAO said its previous work has also underscored the importance of performance measures in assessing the actual results of a program or activity.

GAO’s review of VA’s post-deployment analyzes and Cerner’s progress reports, corroborated by its reviews of trouble tickets and discussions with VA managers and clinicians at the initial system deployment site , revealed issues related to the quality of the migrated data, including its accessibility, accuracy and relevance. For example, one clinician noted an inability to view migrated patient immunization data due to user roles within the system. The clinician added that the inability to view vaccination data in the new system had caused confusion and raised concerns about patient safety.

Another clinician noted instances where migrated data required manual cleaning, although this clinician did not encounter migrated data mistakenly associated with the wrong patient. According to another clinician, inaccuracies in the data required additional steps to verify and manually enter data, which created barriers to patient care, inefficiencies in workflow, and a significantly increased workload.

VA’s EHR modernization data management plans also reflected the importance of reporting capabilities that leverage health data to support the department’s patient care, operations, and research functions. The ministry has begun to implement these plans and has taken steps to identify and engage stakeholders for continued reporting. In addition to VA’s stakeholder management efforts, the use of a stakeholder register could have helped identify and engage stakeholders that have been overlooked. Until VA uses a registry to help identify and engage all relevant stakeholders, it may not meet the reporting needs of some EHR Modernization stakeholders, the GAO said.

Sean N. Ayres