VA’s Health Records Digitization Backlog Is 5 Miles High

Continued digitization of veterans’ health records has the potential to revolutionize the way Veterans Affairs doctors administer treatment. But none of that is possible if the records never get entered into the system.

The Veterans Health Administration currently has a backlog of almost 600,000 documents in a queue to be digitized as of July 2018, with the oldest records dating back to October 2016, according to the agency inspector general. Stacked up, that backlog would reach more than five miles into the sky.

Auditors with the Office of the Inspector General visited eight VA medical facilities and interviewed officials from another 78, finding a significant backlog, staffing shortages, poor training and quality assurance, and a general lack of oversight when it comes to processing paper records.

“VHA needs to improve the management of scanning activities—including importing, indexing and legibility checks—and ensure related resources and staffing are adequate,” the IG determined. “These steps would facilitate medical records being scanned and indexed to [electronic health records] in a timely manner and support appropriate quality assurance monitoring throughout the scanning process. In addition, VHA needs to establish and implement an adequate training program for personnel performing scanning and indexing roles within medical facilities. These actions are necessary to help ensure veterans receive appropriately informed quality care in a timely manner.”

The biggest impediment to clearing the backlog appears to be staffing, according to the IG.

“Staffing levels should be proportional to the volume of scanning to be completed; however, staffing levels and productivity standards varied significantly among the facilities reviewed, even between facilities with comparable veteran populations, demonstrating that VHA facility directors are not consistently assessing staffing needs based on scanning demand,” they wrote.

VHA officials have been responsive to this issue, according to the report, including looking at potentially bringing in contract staff to help reduce the backlog and approving overtime for VA employees where necessary.

The audit also found the degree to which managers reviewed the quality of data entry varied greatly from one facility to the next.

“Quality assurance monitoring practices ranged from reviewing 0% of all scanned and indexed records at one facility to 100% at another facility,” the IG wrote.

The lack of quality assurance is a significant problem, according to both VHA staff and a recent report from the OIG Office of Healthcare Inspections: “These issues put patients’ continuity of care at risk because the lack of current medical documentation makes it challenging to ensure they receive accurate diagnoses and timely quality care.”

The audit notes these issues are only going to intensify as the department implements the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks, or MISSION, Act, which expands the network to include non-VA providers.

“The MISSION Act has the potential to significantly increase the volume of documentation VA medical facilities will receive from outside providers for scanning, as well as any related backlog,” the IG said.

Auditors made nine recommendations split into three buckets:

• Define and promptly reduce backlogs.
• Assess staffing resources to account for scanning demand.
• Develop monitoring roles, controls and procedures.

VHA officials agreed with all nine recommendations and “submitted acceptable corrective action plans” for each.

The department has had troubles with digitization beyond the backlog, as well. The main electronic health records management platform, the Veterans Information Systems and Technology Architecture, or VistA, has been developed incrementally over more than three decades. The system is notoriously disjointed, to the point where VA IT leaders aren’t sure how many instances of VistA currently exist at VA facilities.

VA is preparing to launch the first rollout of its new records platform at hospitals this spring and has already moved the most pertinent medical records for all veterans currently in their care—about 23.5 million records covering some 78 billion data points.

That platform, developed by Cerner, is expected to take 10 years and at least $10 billion to fully deploy. Once established, the system will be designed to be fully interoperable with the health records management platform being deployed by the Defense Department, MHS GENESIS, which is also being developed by Cerner.