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.
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.
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