Documentation Deficiencies for Electronic Health Record Interface Testing at the Lovell Federal Health Care Center in North Chicago

This management advisory memorandum outlines the OIG’s findings and observations about whether VA and Oracle Health followed electronic health record (EHR) interface testing procedures at the Captain James A. Lovell Federal Health Care Center, where VA had to synchronize its system rollout with the Department of Defense’s (DOD) system rollout before going live on March 9, 2024. The interfaces the OIG considered provided a connection between two devices, applications, or networks or a boundary across systems that communicate.

The OIG confirmed VA and Oracle Health conducted the correct tests and applicable retesting for the 24 interfaces reviewed. Although the correct tests were completed, the OIG team observed inadequate documentation. Sufficient documentation is needed to verify proper implementation, operation, and security requirements critical to future EHR deployments.

For example, the required repository for recording problems identified in testing did not show testing had been done before the healthcare center went live with the Financial Management System interface, which bridges the EHR system and VA’s payment and billing system. Testing was delayed by a cyberattack, and results were recorded in another system.

Further, some procedures did not clearly detail what to do when testing results and notations conflicted: The notation “no run” means no test steps were run, but it was used together with the notation “passed” for four of 24 interfaces. These four EHR interfaces exchange clinical health information involving imaging, patient movement, bed management, and surgical instruments.

Finally, the OIG confirmed a lack of functionality with two interfaces between VA and the DOD. For at least these two, documentation showed testers had not accounted for the joint nature of workflows at the Lovell facility.

This memorandum conveys information to VA so that VA can determine whether additional actions should be taken.