GAO Makes Recommendations on VA Data Migration
The U.S. Government Accountability Office (GAO) has made two recommendations regarding the VA’s EHR modernization data management plans. GAO reviewed VA’s plans and progress reports discussing data migration from its legacy EHR and reporting continuity as it transitions to the Cerner system.
After comparing VA’s efforts to applicable federal guidance for data management and relevant project management practices, GAO also interviewed knowledgeable VA officials. It is recommending that VA establish and use performance measures and goals to ensure the quality of migrated data. It also recommended use a stakeholder register to identify and engage all relevant stakeholders to meet their reporting needs. VA concurred with GAO’s recommendations.
The GAO found that although VA made plans for migration 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 clinicians’ quality needs. It noted that the Office of Management Budget’s Federal Data Strategy highlights the importance of validating data quality, including their accessibility, accuracy, and appropriateness. Using performance measures to assess the quality of a product such as migrated data against established goals is a generally recognized project management practice and can help ensure that stakeholder needs and expectations are met. The GAO said its prior work has also stressed the importance of performance measurements for assessing the actual results of a program or activity.
GAO’s review of VA’s post-deployment analyses and Cerner progress reports, corroborated by its reviews of trouble tickets and discussions with VA officials and clinicians at the initial system deployment site, revealed challenges with the quality of migrated data, including their accessibility, accuracy, and appropriateness. For instance, one clinician noted an inability to view patients’ migrated immunizations data as a result of user roles within the system. The clinician added that the inability to view immunization data in the new system had resulted in confusion and raised patient safety concerns.
Another clinician noted instances where migrated data required manual clean up, though this clinician had not encountered migrated data that were mistakenly associated with the wrong patient. According to another clinician, inaccuracies in the data required additional steps to verify and manually enter the data, which had 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 rely on health data to support the department’s patient care, operations, and research functions. The department began to implement these plans and took steps to identify and engage stakeholders for reporting continuity. Apart from VA’s stakeholder management efforts, the use of a stakeholder register could have helped identify and engage stakeholders who were overlooked. Until VA uses a register to help identify and engage all relevant stakeholders, it risks not meeting the reporting needs of certain EHR modernization stakeholders, GAO said.
