Federal Reports

We audited costs claimed by the Wyoming Game and Fish Department under WSFR grants awarded by FWS and had no findings.

The AmeriCorps Office of Inspector General (AmeriCorps OIG) investigated an allegation that Teach for America (TFA) improperly exited an AmeriCorps member (member) for Compelling Personal Circumstances (CPCs) who allegedly provided a fictitious reason for a CPC exit in order to participate in a teacher strike and still earn her education award.

The new electronic health record (EHR) includes a scheduling system intended to enhance efficiency and user experience, minimize disruptions in the delivery of care, and standardize workflows that improve patient access. Having a scheduling system that routes patients to the appropriate providers in a timely manner is critical for the Veterans Health Administration (VHA) to effectively provide care for veterans. The VA Office of Inspector General (OIG) issued this management advisory memorandum to address the concern that scheduling system challenges experienced during deployment of the new EHR at smaller VA medical facilities could be exacerbated at larger, more complex medical centers.While VA has delayed additional EHR deployments until it is confident in the system’s functionality, the deployment at the Captain James A. Lovell Federal Health Care Center (Lovell FHCC) proceeded as planned. Lovell FHCC is the first large, complex VA facility to use the EHR, and the implementation presents an immediate challenge in connection with the scheduling system. This memo, provided to VHA ahead of that implementation, was meant to assist in determining whether additional actions are warranted prior to or during future deployments to mitigate scheduling system concerns.These concerns include the need for additional staffing and overtime to meet or exceed pre-deployment appointment levels, displaced appointment queue functionality, challenges related to providers and schedulers sharing information, inaccurate patient information, difficulties changing appointment type, and the inability to automatically mail appointment reminder letters. At facilities currently relying on the EHR, these issues have resulted in inconsistent workarounds and additional work, increasing the risk for scheduling errors. Consequently, at future go-live facilities, assessing staffing levels and overtime usage prior to deployment and preparing staff with approved workflow best practices may help to reduce employee resistance and facilitate successful adoption of the system.

The VA Office of Inspector General (OIG) reviewed concerns related to the care of a patient who died by accidental overdose approximately seven weeks after a missed appointment at the VA Central Ohio Healthcare System in Columbus (facility). The OIG evaluated staff’s failure to conduct minimum scheduling efforts due to an error in new electronic health record (EHR) functioning. The OIG reviewed the adequacy of mental health evaluations of the patient, supervision of a psychologist, caring communications management, and an internal review of the patient’s care.The OIG found that due to the EHR system error, the patient’s missed appointment was not routed to a queue to prompt rescheduling efforts. The OIG determined that, unlike established care standards, for sites using the new EHR, VHA required fewer patient contact attempts following missed mental health appointments. The OIG found that the nurse practitioner did not evaluate a request from the patient to restart medication nor obtain a comprehensive mental health history. The psychologist did not thoroughly evaluate or address the patient’s depression and failed to reconcile critical clinical information. The OIG would have expected a supervisory psychologist to identify concerns about the patient’s depression, substance use relapse risk, and suicidal behavior, and ensure follow-up regarding the medication request. The OIG found that staff failed to send the patient caring communications after high risk for suicide patient record flag inactivation. Facility leaders did not communicate a root cause analysis Lesson Learned to staff as expected.The OIG made one recommendation to the Deputy Secretary to monitor new EHR scheduling functionality. The OIG made two recommendations to the Under Secretary for Health to evaluate minimum scheduling effort requirements and establish Lessons Learned guidance. The OIG made two recommendations to the Facility Director to review the patient’s care and Caring Communication Program compliance.