Federal Reports

This joint audit led by the DoD OIG examined actions taken by the DoD and VA regarding the Cerner Millennium electronic health record (EHR) system being deployed throughout VA and DoD. The audit assessed internal controls and compliance with legal requirements, as well as actions by DoD, VA, and their joint Federal Electronic Health Record Modernization (FEHRM) Program Office to help ensure that health care providers serving veterans can access a patient’s complete EHR. The audit focused on whether those actions would achieve interoperability between DoD, VA, and external health care providers. The joint audit found that DoD and VA took some actions to achieve system interoperability, but there are remaining challenges. DoD and VA did not consistently migrate information from legacy systems into Cerner Millennium to create a single, complete patient EHR; develop interfaces from all medical devices to the system; or ensure users were granted access to Cerner Millennium only for information needed for their duties. A contributing factor for these deficiencies was that the FEHRM Program Office did not develop a clear plan to achieve full interoperability or actively manage the program’s success. The audit report recommends that DoD and VA review FEHRM’s actions and direct the program office to comply with its charter and applicable laws. The FEHRM should also coordinate with DoD and VA on implementing recommendations that include (1) determining the type of health care information that constitutes a complete EHR; (2) implementing a plan for accurately migrating legacy health care information; (3) create medical device interfaces to directly transfer health care information to Cerner Millennium; and (4) implementing a plan to modify system user roles to ensure their access is restricted to only information needed to perform their duties.

The COVID-19 pandemic accelerated efforts by the Veterans Health Administration (VHA) to expand veteran access to telehealth. Accordingly, VHA’s Connected Care Office created a new digital divide consult to issue iPhones to veterans experiencing homelessness who were enrolled in the Department of Housing and Urban Development VA Supportive Housing (HUD-VASH) Program. VHA was already loaning iPads to other veterans who lacked telehealth capable devices through the digital divide consult process. The VA Office of Inspector General (OIG) initiated this review to evaluate whether purchases of iPads and iPhones for veterans met mission needs while minimizing waste during fiscal year (FY) 2020 and through the first two quarters of FY 2021.In July 2020, Connect Care officials purchased 10,000 iPhones with unlimited prepaid data plans for the homeless veterans enrolled in the HUD-VASH program. However, 8,544 of the 10,000 iPhones remained in storage as of July 2021, as demand for the iPhones was much lower than anticipated. The OIG found that this resulted in an estimated $1.8 million in wasted data plan costs. The OIG also identified opportunities for improvement regarding data plans for nearly 81,000 iPads purchased. Because Connected Care did not have strong enough oversight procedures for reducing or eliminating data plan waste, it incurred approximately $571,000 in additional wasted data plan costs.The OIG made two recommendations to the under secretary for health. The first was to establish a realistic goal for days in storage and a process for monitoring days in storage. The second was to determine the viability of initiating data plan charges only when a device is issued to the veteran.

The VA Office of Inspector General (OIG) evaluated allegations that Portland VA Medical Center (facility) staff “inappropriately discharged” a patient with “severe cognitive impairment,” then “turned away” the patient, and failed to provide the patient’s records to Adult Protective Services (APS). The OIG identified a concern regarding discharge coordination with family.In 2021, the patient, with a history of alcohol use and cognitive impairment, presented to the facility’s Emergency Department with gangrene and homelessness. Throughout the patient’s 33-day admission, staff evaluated the patient’s cognitive functioning, communicated with the patient’s family and APS staff, and pursued placements.Approximately an hour after discharge, the patient presented to the facility’s Emergency Department. A social worker provided the patient with a bus ticket “to return to the shelter.” Within an hour, the patient returned and the social worker reprinted the instructions and advised the patient to board the bus.The OIG substantiated that the patient was discharged to a non-VA homeless shelter by cab but did not substantiate the patient was “inappropriately discharged.” Staff determined that direct transport was preferable to the more complicated bus route.The OIG was unable to determine whether staff discussed the patient’s final discharge plan with family due to an absence of documentation and conflicting reports.The OIG substantiated that staff did not establish a safe transportation plan after the patient returned to the Emergency Department after discharge.The OIG did not substantiate that staff failed to provide the patient’s records to APS. However, staff returned requests without providing information regarding specific missing elements.The OIG made three recommendations related to consideration of requiring staff to document family contacts, a review of the Emergency Department social worker’s care coordination of the patient, and consideration of Privacy Office staff communicating the missing element(s) when returning a release of information request.

Our office, through a partnership with the Pandemic Response Accountability Committee, obtained data from the United States Small Business Administration (SBA) related to their Economic Injury Disaster Loans (EIDL) and Paycheck Protection Program (PPP) loans. We scheduled this audit after identifying potential matches between the SBA data and TVA employees. Our audit objective was to determine if TVA’s policies and procedures are effective in assuring outside employment of TVA employees is properly approved. Our audit scope was limited to TVA employees identified as having potential outside employment or business ownership through review of EIDL and PPP loan data received from the SBA. We found TVA’s policies and procedures are not effective in assuring outside employment of TVA employees is properly approved. Specifically, we found TVA employees are not consistently submitting their outside employment or business ownership on TVA Form 15570 prior to accepting outside employment or opening a business. In addition, we found TVA’s (1) review for potential conflicts of interest and (2) application of 5 CFR § 7901 requirements could be improved. We also found (1) the TVA Forms 15570 on file were not updated as required and (2) roles and responsibilities in the outside employment approval process could be clarified.

As of March 31, 2022, there are 71 open recommendations, 7 of which were reported as implemented by management but remain open per third-party (CLA/other Independent Public Accounting firm (IPA)/OIG) determination; and none of the remaining 64 were considered “Overdue.”