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