Lessons from VA scandal: EHR upgrades and top-level transparency

May 30 saw Eric Shinseki, the longtime secretary of the U.S. Department of Veterans Affairs, tender his resignation to President Barack Obama. After a massive cover-up of patient wait times and the negligent administration of care came to light, many called for Shinseki to step down from the post he held since January 2009, when he was appointed just after Obama's inauguration.

Many critics saw Shinseki's resignation as a regrettable but necessary move. Though he has yet to be blamed as a direct cause of the scandal, the widespread shortcomings of patient care in the VA health care system proved to be too much for him to keep his post. According to John Geyman, M.D., professor emeritus of family medicine at the University of Washington School of Medicine, the average wait time for primary care appointments was 115 days at some VA facilities, and as many as 1,700 patients were purposefully never placed into EHR systems to make it seem as if locations were turning patients around more quickly than they were.

As the Obama administration and the VA prepare to address the problems uncovered by the recent controversy, health care professionals in the civilian sector should take note of the news as well. As Geyman explained, the VA administrators at the root of the scandal did not err by failing to provide proper care with inadequate resources, but by pretending that their problems were not as bad as the reality of their situations.

Parting words and earning trust
Days before his resignation, Shinseki issued a statement that many saw as characteristic of the former Vietnam War veteran and long-time VA director's integrity in the face of difficult situations.

"I can't explain the lack of integrity among some of the leaders of our healthcare facilities," Shinseki said.

While Shinseki owned up for his department's faults, this accountability is something that could have served the administrators below him over the last decade or so, Geyman argued in a column for The Huffington Post. Though officials are still investigating the full extent of the scandal that left thousands of veterans waiting for proper care, a preliminary report discovered scheduling falsifications made by administrators at local and national levels since 2005.

However, Geyman was careful to explain that these unnamed VA administrators did not set out in the beginning to fail to provide proper care to the 9 million veterans that fall under the department's purview. Instead, improper equipment – a facility in Phoenix was using DOS-based computer software for scheduling – conspired to create backlogs in workflows that administrators knew they could not catch up with. Rather than address inadequate resources, the root cause of the issue, these people chose to falsify data and coverup their initial oversights. From there, the issue snowballed and culminated in Shinseki's resignation.

Learning from past mistakes
The refusal of low-level administrators to address institutional shortcomings points to another lesson that the civilian health care industry can learn from the VA scandal. Slate explained that 20 years ago, the VA led the country in EHR implementation rates. Though these early systems do not match the functionality of modern technology, the department never purchased new software for its facilities.

As the wars in Iraq and Afghanistan resulted in more patients in the VA's facilities, these old systems could not keep up with the strain. The private sector has now become the leading purchaser and adopter of EHR systems, but the current VA scandal came about because of the department's inability to update its technology in response to patient demands. If the civilian health care industry does not continue to utilize more sophisticated software as it becomes available, the VA may not be the only health care system facing such problems.