Agencies

Five Miles High? VA Document Backlog Is Stacking Up, OIG Reports

by Stephen Spotswood

September 20, 2019

WASHINGTON—If stacked, VA’s backlog of paper medical documents that are waiting to be digitalized—most generated by veterans’ visits to non-VA providers—would be over 5 miles high, according to a report from the VA inspector general.

The backlog also contains approximately 597,000 electronic documents that need to be input into patients’ electronic health records.

Site-Specific Results for Eight Facilities
The table that follows presents the reported and observed backlogs, estimated size of the backlogs, and quality or training concerns, for each of the eight sites visited. As mentioned previously, these medical facilities represent various levels of complexity.

These estimates, generated using data from visits to eight VA facilities and interviews with another 78, reflect the state of the backlog as of June 2018. The audit team noted that the launch of the new community care standards that are part of the MISSION Act have the potential to significantly increase the amount of documentation coming from non-VA providers, making it critical that VA take steps to address documents waiting to be scanned.

According to the report, the backlog exists in part because VA medical facility staff were slow in scanning documentation and entering digital records. Any document pending scanning for more than five days qualifies as being backlogged. The age of pending documents varied widely by facility, with one containing pending records more than two years old. Compounding the problem were documents that were scanned but not always legible.

“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 of care,” the report stated.

According to the IG, one of the sources of the problem was a lack of facility oversight in the scanning and indexing process. While health information management staff at each facility conducted annual inventories in an effort to determine training and technical needs, those inventories lacked details like the size of the backlog, the age of unscanned records and descriptions of what those records actually were.

According to VA regulations, VA facility directors are responsible for developing and monitoring processes to ensure that all EHR filing and scanning is done in a timely manner and that someone knowledgeable about health record file management and scanning is overseeing the process. During the audit team’s site visits, however, neither HIM chiefs or their designees responsible for supervising scanning always knew what the scanning process was or the size of their backlog.

One acting HIM chief was unaware a backlog existed at their facility at all until the audit team arrived. A visit to the scanning room revealed a backlog of more than 13,000 electronic records with some older than five months. This lack of awareness on the acting HIM chief’s part caused the facility to erroneously report not having a backlog in their 2017 inventory, the report said.

Lack of Oversight

The IG findings also suggested that lack of concrete oversight exists on a national level as well.

“VA’s [national] HIM leaders said they provide guidance in the form of practice briefs, fact sheets, or ‘fireside chats’ to medical facility HIM leaders. This guidance is intended to provide potential solutions to track, monitor, define, and fix backlogs,” the audit team reported. “The guidance is not distributed through official publication channels; therefore it is not consistently implemented by medical facility directors.”

Staffing shortages also had a significant effect. Of the 78 facilities where the audit team interviewed staff remotely, 57 reported personnel shortages or turnover as a cause of their backlog. Officials at one site reported that, due to budget concerns at the VISN level, the facility had adopted a ceiling on full-time equivalent hires. Healthcare provider positions received priority, while open positions for document scanners remained unfilled.

Facilities reported a significant disparity in the number of staff at each facility. One hospital had 14 authorized staff to provide scanning and indexing services for 44,000 veterans. Another facility served 46,000 veterans but had only three authorized staff.

The report included nine recommendations from the audit team, including implementing formal national controls to monitor the backlog; directing VISNs and facilities with a backlog to allocate more staff; implementing standardized quality assurance procedures to prevent illegible scanned documents; and ensuring that original documents are retained until quality of the scanning is verified. VA concurred with all of the OIG recommendations and expects to have addressed all of them by July 2020.



Related Articles

Seeing Combat Can Make Aging More Difficult for Veterans

PORTLAND, OR—Being exposed to combat makes a significant difference in how military veterans fare during aging, according to a new study, which also found that the experience increases the risk for depression and anxiety later... View Article

Top VISN 7 Officials Removed After Cancer Patient Attacked by Insects

Elderly AF Veteran Had More Than 100 Ant Bites Before Death ATLANTA—Nine VA employees, including the VISN 7 director and chief medical officer, have been reassigned following reports that an elderly patient at the Atlanta... View Article


U.S. Medicine Recommends


More From department of veterans affairs

Department of Veterans Affairs (VA)

Seeing Combat Can Make Aging More Difficult for Veterans

PORTLAND, OR—Being exposed to combat makes a significant difference in how military veterans fare during aging, according to a new study, which also found that the experience increases the risk for depression and anxiety later... View Article

Department of Veterans Affairs (VA)

Top VISN 7 Officials Removed After Cancer Patient Attacked by Insects

Elderly AF Veteran Had More Than 100 Ant Bites Before Death ATLANTA—Nine VA employees, including the VISN 7 director and chief medical officer, have been reassigned following reports that an elderly patient at the Atlanta... View Article

Department of Veterans Affairs (VA)

Women, Chronically Ill Veterans Value Veterans Choice Access Most

HINES, IL—Women and veterans with multiple comorbidities used and valued the Veterans Choice Program (VCP) more than other veterans, according to recent research by the VA.1 To help these veterans and others, the VA has... View Article

Department of Veterans Affairs (VA)

VA Facing Critical Healthcare Staffing Shortages in Near Future

Replacing Retirees Hampered by Lower Salaries WASHINGTON—Oversight agencies are sounding the alarm that VA is plagued with large staffing shortages in critical areas, including physicians, registered nurses, physician assistants, psychologists and physical therapists, as well... View Article

Department of Veterans Affairs (VA)

Processes Similar in Schizophrenia, Psychotic Biopolar Disorder

NASHVILLE, TN—Processes leading to impairment in schizophrenia and psychotic bipolar disorder might be more similar than previously assumed, according to a new study. The report in Schizophrenia Research pointed out that neuropsychological impairment is common... View Article

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up