A new report from the Department of Veterans Affairs (VA) Office of Inspector General (OIG) reveals that community care staff did not always import records into veterans’ electronic health records (EHRs), due in part to technology limitations.
According to the Aug. 7 report, the VA can authorize veterans to receive community care in certain instances. After their appointment, the community provider must return associated medical records to the Veterans Health Administration (VHA).
“If records are not received, VHA policy requires community care staff to administratively close consults and make three requests for the records within 90 days of the appointment,” the report explains. “Closing a record administratively not only allows facilities to show the veteran received care but also completes the consult without a medical record.”
The OIG found that, as of Dec. 16, 2024, VHA closed nearly 3 million community care consults for appointments scheduled to occur between Oct. 1, 2023, and April 1, 2024. Of the 3 million, over 2.4 million (82 percent) had medical records attached, and nearly 1 million were administratively closed (34 percent).
Additionally, VHA had 71,447 open consults during the same period – almost all of which were more than 90 days beyond the scheduled appointment date.
According to the OIG’s analysis, 62 facilities each imported 90 percent or more of medical records for completed community care consults into veterans’ EHRs. However, 11 facilities imported the records into the EHR less than 60 percent of the time.
“Barriers to importing records into the EHR in a timely manner included technology limitations. Each of the five facilities the team visited in person had delays in processing or importing records because of technological barriers,” the report notes.
The OIG found that most records came back via electronic fax, which it said, “is inefficient because of issues with fax systems not working for periods of time.” Staff at five facilities noted issues with electronic faxes in processing community care records.
Community providers can also send records back through portals such as the HealthShare Referral Manager or Veterans Health Information Exchange. However, the HealthShare Referral Manager was generally not used because community care providers said gaining access to the system was too complicated.
“VHA should evaluate ways to increase the use of vendor portals to reduce reliance on electronic fax and implement other automated methods,” the report says.
The OIG made 10 recommendations to the VA related to correcting deficiencies in processes, internal controls, timeliness, and oversight.
Specific to technology barriers, the OIG recommended that VHA evaluate ways to increase use of provider electronic records portals, consider implementing technologies to improve records processing, and ensure records from the Joint Longitudinal Viewer are uploaded into the VHA EHR.
The VHA concurred with all 10 recommendations.