What's going on with the Veterans' Administration (VA) these days? The VA, with its vast electronic health record system, seemed ahead of the curve. It was a trendsetter, spearheading patient access to EHRs with the adoption of its MyHealtheVet access pilot. It increased veterans' access to mental healthcare by launching a videoconferencing program. Veterans, who have long suffered with overcrowded emergency departments, understaffing, and other problems in accessing care, finally were getting an innovative, sophisticated health benefit.
Until they weren't. Now it seems that the VA has gone rogue on us when it comes to EHRs.
In October we learned that EHR workarounds and bad documentation caused the deaths of patients at the Memphis VA. Now we hear that the San Francisco VA's failure to properly document opioid prescription refill requests into the EHR has caused at least seven patients to be hospitalized for opioid-related problems, including attempted suicide.
On a related note, an investigation finds that the VA is plagued with privacy and security violations of its EHR system, ranging from snooping to patient identity and prescription drug theft.
Granted, it's difficult to work in a VA facility. But providers can still follow policy on EHR use and documentation. The Institute of Medicine found that the VA and U.S. Department of Defense weren't even tracking their treatment of post-traumatic stress disorder, a huge veterans issue, despite the ability of their EHRs to do so.
And the VA doesn't appear to be taking significant steps to police itself. Yes, the VA's Office of Inspector General does impose corrective action. But some VA hospitals seem to continually run into compliance trouble.
What's worse is that evidently, there's not much external recourse against these incidents. The U.S. Department of Health & Human Services can investigate the VA for HIPAA violations, but it can't impose any penalties. Veterans can sue the VA for malpractice stemming from poor EHR use, but lawsuits are always unpleasant and the outcomes uncertain. It's also more complicated to sue a governmental entity such as the VA, since first the veteran has to file a claim with the VA and wait for the VA to evaluate it; only after it's been denied can the veteran file a lawsuit.
The worst part? Much of this patient harm was preventable. Had the EHR in Memphis been properly used, an aspirin allergy would have been flagged, a different medication substituted and a death averted. Had the VA in San Francisco used its EHR's Narcotics Administrative Note template, inputted opioid refill requests into the EHR before shredding them, and documented whether they tested veterans for misuse and addiction, perhaps some patients could have been treated for their substance abuse and avoided hospitalization.
It's hard enough to be in the service. But obtaining medical treatment should not be an additional occupational hazard.