Healthcare // Policy & Regulation
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6/13/2014
10:15 AM
David F Carr
David F Carr
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VA Backlog: Technological Solution Was Subverted

Computerized reporting is useless when data is kept off the books.

5 Mobile Apps For Visiting Washington, D.C.
5 Mobile Apps For Visiting Washington, D.C.
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The technological solution to scandalously long wait times at Veterans Administration health clinics arrived a dozen years ago. Sadly, it's an example of how IT systems fail to solve problems when they are out of sync with how work actually gets done.

An internal audit released earlier this week showed that at more than 70% of facilities at least one staffer admitted they didn't always log veteran requests for appointments in the official online system for tracking the requests. Instead, those requests were kept off the books, tracked by some alternative means. Although this amounts to only about 8% of staffers admitting to these omissions, the fudging of data added up. At last count, the VA is now saying, 57,000 new patients have waited more than 90 days for an appointment.

Just as bad, 13% of VA staffers responsible for scheduling reported being told to enter false data into the "desired date" field -- the requested date for an appointment. The essence of the scandal is evidence that managers encouraged the falsification of data to make their statistics look better in reports.

[Want to be untrackable? Read 13 Ways To Beat Big Brother.]

The VA has had an Electronic Wait List system since 2002 to supplement the scheduling component of its VistA electronic medical records system. EWL was conceived of as a solution to the complaints about long waits for appointments that were already an issue at the time -- or, at least, a way of tracking how many veterans weren't immediately scheduled for an appointment.

"Current waiting time measures reflect the experience of veterans already 'in the system' and do not accurately portray waiting time experiences of new enrollees or patients without a scheduled appointment," Laura Miller, then Deputy Under Secretary of Health Operations and Management, wrote in a memo at the time, quoted in the EWL documentation to explain the need for the software.

Mean ratings of barriers and challenges to providing timely access to care. Higher number means greater challenge to staff members. (Source: VA audit.)
Mean ratings of barriers and challenges to providing timely access to care. Higher number means greater challenge to staff members. (Source: VA audit.)

"Whether due to absence of appointments or other reasons, ad hoc 'waiting lists' of new veteran enrollees to be entered into the scheduling system are known to exist, and waiting times for new enrollees seeking care are anecdotally reported to be long," she wrote. "We will attempt to formalize an 'electronic waiting list' in VistA to more consistently and accurately reflect demand across VHA, and reduce the risk to enrollees lost to follow-up due to clerical error."

So the VA created EWL, a data gathering and reporting system to help it track and manage its backlog. But any performance management system can be subverted by those determined not to let their performance be tracked. The VA

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David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio
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Alison_Diana
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Alison_Diana,
User Rank: Author
6/16/2014 | 5:32:22 PM
Re: Is this problem beyond the reach of IT?
The VA needed an internal audit system, too -- one that was not then reviewed internally. And giving bonuses, hither and yon, is a practice that really, really needs further scrutiny in a tax-funded organization. Obviously it didn't work. It just generated greed and contemptible behavior, not a smoothly running institution. That is not IT's faulty at all. Garbage in, garbage out; if the systems don't have accurate data, they can't provide accurate answers.
Gary_EL
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Gary_EL,
User Rank: Ninja
6/14/2014 | 2:38:47 PM
Re: Is this problem beyond the reach of IT?
No computer system in the world can make more doctors and nurses appear out of nowhere, without an external additive called money. No computer system in the world can stop employees from lying, if their bosses say do it or get fired. So, yes, this is not a problem that IT, by itself, can fix or even improve.
David F. Carr
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David F. Carr,
User Rank: Author
6/13/2014 | 2:45:50 PM
Restoring trust in VA health care
Analysis: Restoring trust in VA health care http://buff.ly/1hU5pVN



Quoting the authors of the report from UC Davis and Harvard:

"And though there can be no excuse for falsifying data, we believe that VA leadership created a toxic milieu when it imposed an unrealistic performance standard and placed high priority on meeting it in the face of these difficult challenges. They further compounded the situation by using a severely flawed wait-time monitoring system and expressing a 'no excuses' management attitude," they wrote.
David F. Carr
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David F. Carr,
User Rank: Author
6/13/2014 | 11:00:43 AM
Is this problem beyond the reach of IT?
Do you see any way that IT can be at least part of the solution to making a more honest accounting of the VA health system's performance - and ideally improving it?
Research: Healthcare IT Priorities
Research: Healthcare IT Priorities
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