Lance's Corner

GAO Highlights VA EHR Problems

Mar 18, 2025

Per the notice below, the United States Government Accountability Office (GAO) is highlighting the many problems the Veterans Administration (VA) is having implementing a new electronic health record (EHR) system.

Veterans Affairs’ Ongoing Struggle to Modernize Its Electronic Health Record System

After three unsuccessful attempts, the Department of Veterans Affairs is currently on its fourth effort to modernize its outdated electronic health records system.  VA relies on its electronic health record system to manage the health care needs of nearly 9 million veterans and their families.  But the department’s latest attempt to modernize this system is also delayed and faces similar issues seen in prior efforts.  Today’s WatchBlog post looks at our new report on the status of VA’s efforts and its challenges.  GAO’s Carol Harris also testified before Congress about this issue in February.  Learn more in the video below.

What’s going on with VA’s electronic health records rollout?

The current electronic health record system used by the VA is more than 30 years old, complex, and costly to maintain.  VA’s efforts to replace its aging legacy system began in 2001.  Its first three attempts were abandoned due to concerns about project planning, high costs, and undelivered capabilities.  VA’s fourth attempt began in 2018 and a new system was deployed to six medical centers at a cost of about $12.7 billion.  The rollout was paused in April 2023, after users reported concerns including patient safety and system reliability issues.  Many of these users are medical professionals and administrators who need the system to support providing health care to veterans.

An emergency room nurse reviews the patient status board

An emergency room nurse reviews the patient status board

We have issued several reports about VA’s modernization efforts throughout the years.  One concern highlighted in our earlier work was that the department did not have adequate measures for assessing the extent to which users' needs were addressed.  Since then, user feedback has improved slightly.  But in 2024, 75% of users disagreed that the modernized system made them as efficient as possible.

Electronic Health Record Survey

What’s next for VA?

Since pausing the rollout of its fourth attempt, VA has made incremental improvements to its new system.  But much more needs to be done.  For example, as of June 2024, VA had implemented more than 1,500 configuration changes to the system.  But it still has not addressed about 1,800 additional changes that have been requested.  VA also has not assessed the impacts of its pause of the new system's rollout on deployment schedule and cost.  In 2019, the estimated 10-year cost of implementing and maintaining a new electronic health record system was about $16.1 billion.  In 2022, an independent source estimated costs of $49.8 billion.  However, these estimates do not reflect the full magnitude of changes to VA’s investment.  Over the years, we’ve made 18 recommendations to improve VA’s efforts, including 3 new recommendations in our latest report.  Of the older recommendations (15 of them), VA has implemented just one.  The remaining 14 and our newest recommendations are critical to reducing risks involved with rolling out a new electronic health record system, as well as delivering a quality system that meets users’ needs.  Learn more about this issue in our latest report.

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Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

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Long COVID, Disability and Underserved Communities: Recommendations for Employers

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Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

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Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

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  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

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https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc