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.