Electronic Health Record Modernization: VA Needs to Address Change Management Challenges, User Satisfaction, and System Issues
Abstract: VA uses the Veterans Health Information Systems and Technology Architecture (VistA), which includes the department's legacy EHR system, to provide health care to its patients. In June 2017, VA initiated the EHRM program to replace VistA because it is technically complex, costly to maintain, and does not fully support the need to exchange health data with other organizations. Specifically, VA began to acquire the same EHR system DOD was acquiring. VA has reported obligating about $9.42 billion on EHRM from fiscal year 2018 through the first quarter of fiscal year 2023. GAO was asked to testify on its recently completed review to determine the extent to which VA has (1) used organizational change management strategies for the EHRM program consistent with leading practices, (2) assessed satisfaction with the new system, and (3) identified and addressed EHR system issues. GAO identified leading change management practices and evaluated VA's activities against these practices.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P