Scanning Backlog for Medical Documentation Could Jeopardize Quality of Veteran Care

Since August 2014 veterans have had more than 70 million medical appointments with non-VA providers under the Access, Choice and Accountability Act. Non-VA providers are not electronically connected to VA’s Electronic Health Record (EHR), VistA. They send medical documents or electronic files to VA medical facilities for scanning or importing into the system.

In order to provide complete, accurate and timely veteran health care, VA providers need access to the most recent medical information for a veteran. VA standards and guidance dictate that this information should be imported or scanned within 5 days of the instance of care with the non-VA provider. But the VA OIG found that medical documentation was not entered into patients’ health records in a timely manner. In fact they found documentation and files that dated back as far as October 2016 that had not yet been entered into the system.  The OIG also found that quality assurance monitoring and training for scanning and importing was not adequate.

The situation becomes even more disconcerting due to the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act, signed into law in June 2018.  The law expands veteran access to community care, potentially generating even more medical documentation that will need to be scanned or imported into VA’s EHR.

More specifically, the VA OIG found:

• Facilities’ medical document backlogs have been significant.
• VHA lacked oversight of medical document scanning.
• VA medical facilities inadequately managed medical documents.
• Facilities struggled with Health Information Management (HIM) vacancies and had varying authorized staffing levels.
• Failures by scanning staff to comply with quality assurance procedures.
• Inadequate training for scanning staff.

The OIG made nine recommendations to VA in three key areas:

• Define and promptly reduce backlogs.
• Assess staffing resources to account for scanning demand.
• Develop monitoring roles, controls, and procedures.

VA concurred with all nine recommendations and submitted acceptable corrective action plans, according to the VA OIG.