Training Deficiencies with VA’s New Electronic Health Record System at the Mann-Grandstaff VA Medical Center in Spokane, Washington

The OIG conducted an inspection to assess training for VA’s transition to a new electronic health record (EHR) at the Mann-Grandstaff VA Medical Center (facility) in Spokane, Washington. The OIG identified deficiencies related to training content and delivery; the VA Office of Electronic Health Record Modernization’s (VA OEHRM’s) attempt to evaluate training; the contractor’s work on training; and concerns with governance. The OIG observed that facility staff demonstrated a commitment to the EHR transition while prioritizing patient care during a global pandemic. The OIG identified training gaps and factors that may have negatively affected end users’ ability to use the new EHR: insufficient time for training; limitations with the training domain; challenges with user role assignments; and gaps in training support. Facility leaders and staff identified having insufficient time to cover training and that balancing training with duties was challenging. In addition, the user role assignment process resulted in inaccurate assignments that led schedulers to place users in incorrect training. Moreover, VA OEHRM completed assessments of the contractor’s work on training and identified deficits in meeting deadlines, staffing, management, and quality. The OIG determined the VA OEHRM training plan did not include an actionable evaluation of training and VA OEHRM withheld and altered evaluation training data. Further, evidence was not found in the current governance structure that the Veterans Health Administration had a defined role in participating in EHR modernization decision-making or oversight activities. The OIG made eight recommendations to the Deputy Secretary related to training content and delivery, contractor performance, training evaluation, and EHR governance. The OIG made three recommendations to the Under Secretary for Health related to optimizing workflows, tracking EHR patient complaints, and assessment of employee morale.