A report by the Government Accountability Office (GAO) has found that the Department of Veterans Affairs (VA) needs to improve user satisfaction and change management activities for the EHR Modernization (EHRM) program. The report stated that while VA was partially consistent with leading practices for organizational change management, it was inconsistent with leading practices for increasing workforce skills and competencies. The report also found that most users voiced dissatisfaction with the new EHR, and VA did not adequately identify and address system issues. The GAO recommended that the program fully implement the eight leading practices for change management to avoid future challenges.
The Government Accountability Office (GAO) has released a report stating that the Department of Veterans Affairs (VA) needs to improve user satisfaction and change management activities for the EHR Modernization (EHRM) program. The EHRM program was initiated in June 2017 to replace VA’s legacy EHR system with the same Oracle Cerner platform that the Department of Defense (DoD) was acquiring.
The GAO reviewed VA’s use of organizational change management strategies for the EHRM and found that VA was partially consistent with the leading practices for organizational change management. The leading practices included developing a vision for change, identifying and managing stakeholders, communicating effectively, assessing readiness for change, identifying and addressing potential barriers to change, establishing targets and metrics for change, and evaluating the results of change.
However, the report noted that VA was inconsistent with leading practices for the change management strategy of increasing workforce skills and competencies. While the EHRM program outlined training objectives, site preparation steps, key milestones for training, and a continuous improvement process, training has been a weakness for the EHRM. The GAO officials stated that EHR training was a concern for users at Mann-Grandstaff in change readiness questionnaires. Additionally, the VA’s Office of Inspector General (OIG) identified numerous issues with training in a July 2021 report.
The report found that VA did not effectively communicate information on system changes after deployment, and one user stated that a system update caused changes to their clinical workflows without being notified before the update. The GAO officials said that until the program fully implements the eight leading practices for change management, future deployments are at risk of continuing change management challenges. These challenges hinder the effective use of the new EHR system, impede users’ knowledge of new workflows, and limit the utility of system improvements.
The GAO also reviewed the results of VA surveys to determine end-users’ satisfaction with the EHR. Officials found that most users have voiced dissatisfaction with the new EHR. VA’s 2021 and 2022 surveys showed that end-users were unsatisfied with the system’s performance or training. Additionally, only about 6% agreed that the EHR enabled quality care, and 4% of end-users said the system made them as efficient as possible. Further, VA has not created targets to evaluate user satisfaction.
The GAO’s review revealed that VA did not adequately identify and address system issues. Specifically, VA did not ensure that its contractor resolved trouble tickets for the new EHR within timeliness goals. While VA later worked with the contractor to reduce the number of tickets over 45 days old, the number of open tickets has increased steadily since 2020.
The report authors wrote that it is critical that system issues be resolved in a timely manner. Additionally, although VA has assessed the system’s performance at two sites, as of January 2023, it had not conducted an independent operational assessment. GAO said that without an independent assessment, VA will be restricted in identifying, tracking, and resolving key operational issues.
