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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.

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