VA knew of problems with its new scheduling system prior to its implementation at the Chalmers P. Wylie VA Ambulatory Care Center in Columbus, OH, shown here, and one other facility but went live with the program anyway, according to a report. VA photo
COLUMBUS, OH — VA knew of problems with its new scheduling system prior to its implementation at the Chalmers P. Wylie VA Ambulatory Care Center in Columbus, OH, and later at the Mann-Grandstaff VAMC in Spokane, WA, but failed to fix them before going live at the two facilities, according to a report released last month.
The scheduling system is a component of VA’s larger CERNER-developed electronic health record (EHR) rollout. Because VA sees improving its scheduling system as a high priority, the department decided to roll that component out separately and, hopefully, more quickly than the full EHR.
VA’s desire for speed might have led the agency to field a system before staff was properly trained, critics claimed.
In January and February 2020, CERNER began training some Columbus and Spokane schedulers and providers in the system. This effort was paused almost immediately, due to the pandemic. As VA prepared to go live, a VA Office of Electronic Health Record Modernization (OEHRM) internal document was created summarizing Columbus schedulers’ concerns.
“They felt that they had not been trained to handle real, complex scheduling scenarios; that their training was not tailored to their roles; and that they did not have enough time to practice using the system,” the VA Office of the Inspector General (OIG) report states.
During the previous two years, VA and CERNER conducted field tests of the system, identifying and resolving some of the potential issues. However, some problems remained when the system went live in Columbus in August 2020.
Those included:
- the inability to mail letters automatically;
- difficulties changing appointment type; and
- no guidance on how to measure patient wait times.
Key oversight reports and reviewers were not available in the new system, so if problems emerged in patient wait times or scheduling accuracy, the tracking and monitoring tools were not in place to document it.
A survey conducted by OIG found that, of 213 schedulers only 123 reported being able to provide feedback before implementation. Of those, only 9% stated that their concerns resulted in changes to the scheduling system.
‘Squandered’ Feedback Opportunity
“VA had an opportunity to get feedback from clinicians on the new scheduling system but squandered it,” OIG investigators concluded.
After the rollout in Columbus, other problems with the system emerged. There was inaccurate data migration from VA’s old scheduling system, which required staff to go in and manually “scrub” provider schedules and veterans’ data for accuracy. The system was not completely configured and was missing certain clinics, appointment types, and providers. Some schedulers also lacked the permissions required to actually schedule appointments.
“Staff said it took more than a week for CERNER to close help tickets, unnecessarily delaying some patient care,” the report states.
While this was going on, VA rolled out the full EHR in Spokane in October 2020. That rollout has been plagued with issues above and beyond the scheduling component.
The OIG report recommends that VA resolve these issues with the scheduling system as soon as possible so that the next facility to adopt the system will not face the same challenges. VA had planned to implement the system at 20 facilities by December 2021 but has since paused to conduct a full review of the entire EHR project.
Columbus staff did have some positive things to say about the scheduling system. They reported that it was far easier to schedule video visits, block clinics, and said that having an audit history of appointments was very useful.
One commenter noted, “The system seems very capable. [We] just need training/workflows/fixes in place, and I can see the system improving our quality of life and standard of care considerably.”
