Healthcare // Policy & Regulation
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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.

hospitals and clinics in the Phoenix area didn't get around to implementing EWL until 2012, a decade after its inception, and then didn't use it properly. Phoenix is one of the hotbeds of the scandal, with 1,715 veterans waiting 90 days or more and 1,075 not showing up on any official wait list.

No computer system can report on data it doesn't have. A good forensic accountant can spot patterns suggestive of missing or falsified data, but that's a technique for auditing, not for ongoing management.

According to the VA audit, scheduling personnel at 90 clinic sites reported fudging the "desired date" field on appointment requests, almost always at the direction of a supervisor. At 24 sites, scheduling personnel said they believed their jobs would be threatened if they did not comply. In a couple of cases, they said they believed a supervisor was logging in and changing the dates after they were recorded to make them look better on reports.

Somewhere along the way, EWL got tagged by at least some personnel in the field as another dumb computer system designed in an ivory tower that didn't match how business got done within the agency, so it was OK to ignore it or lie to it.

Meanwhile, there is a legitimate dispute among policyholders about whether the VA's most serious problem is the dishonesty of some of its employees or the lack of resources to fulfill its mission properly. In the auditor's survey, the most common reason staffers gave for not being able to meet patient-scheduling expectations was a lack of provider appointment slots. Other concerns, such as the usability of software, were mentioned much less frequently. The audit also specifically states that the 14-day appointment goal set by the VA was unrealistic, given current staffing, and ought to be eliminated.

Suppose we accept for the moment the proposition that the VA health system is underfunded and understaffed, rather than just inefficient and corrupt. The liberal reaction to the scandal is to deplore the secret waiting lists, of course, but bounce the ultimate blame back on Congress for failing to provide the VA with the resources that it needs. This is not the place to weigh those arguments, but it does occur to me that VA personnel who might have felt neglected only hurt their own organization's cause by failing to accurately report how bad the backlogs were. Now that the problems are public, there is a lot of unproductive finger pointing, true, but also talk of solutions, such as allowing patients to go to private healthcare providers and get reimbursed by the VA if no VA physician can see them in a timely manner.

In the grand scheme of things, programming a computer system to track data or manage a business process is easy. Getting people to use the system and to use it correctly and productively -- that's the hard part.

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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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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.
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
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

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
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?
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