The Office of Inspector General (OIG) has made 10 recommendations to the Veterans Health Administration (VHA) to improve processes by which the VA retrieves and documents the medical records from community providers and imports the records into the veterans’ electronic health records.

The OIG report explained how the process for community care works: VA can authorize veterans to receive care in the community in specific circumstances, such as when Veterans Health Administration (VHA) medical facilities do not provide the requested services, or a veteran must drive an average of at least 30 minutes for primary care or mental healthcare or 60 minutes for specialty care at a VHA facility. 

In these instances, the veteran’s VA healthcare provider submits a request for a consult, and responsible staff in a VHA facility’s community care department help the veteran schedule medical appointments with providers in the community. After the care occurs, the community provider must return associated medical records to VHA. Community care staff complete the consult once medical records are received by VHA.

Contractual language with third-party administrators—entities that provide and manage VHA’s network of community care providers—requires community providers to return medical records to VA within 30 days of an appointment. If records are not received, VHA policy requires community care staff to administratively close consults and make three requests for the records within 90 days of the appointment. Closing a record administratively not only allows facilities to show the veteran received care but also completes the consult without a medical record.

The OIG conducted a review to determine whether VHA staff took appropriate action to retrieve and document the medical records from community providers and import the records into the veterans’ EHR. 

The OIG found that while some facilities received nearly all community care medical records, others struggled to retrieve records from community providers. Staff said competing priorities reduced the amount of time available to request and process incoming records. Once records were received, community care staff did not always use the Consult Toolbox to document the receipt, and the administrative closure policy was both unclear and inconsistently used. After the medical records arrive at a VHA medical center, policy suggests the community care office has two business days to review the records, and Health Information Management (HIM) or community care staff have three business days to import the records into the EHR. VHA facilities varied in meeting these timeliness metrics because some facilities implemented tools to improve the timeliness of processing records and others faced technological barriers.

Staff at several facilities where OIG conducted interviews said they had agreements to access some electronic medical records from community providers via secure internet portals or the Veterans Health Information Exchange to pull records themselves. Other facilities’ staff said the return of records improved when VHA community care offices built strong relationships with community providers, such as by assigning a liaison to communicate with outside providers.

Some VHA facilities received records for 98 percent or more of consults. However, for closed community care consults with scheduled appointments between October 1, 2023, and April 1, 2024, staff at 11 facilities imported the records into the EHR for 60 percent or fewer of the consults.

Community care staff reported challenges with retrieving records because of competing priorities. In addition to requesting and processing medical records, community care staff gather documents for referrals, review eligibility determinations, contact veterans, schedule appointments, and complete authorizations. Staff explained they did not always have time to make the three required attempts for medical records or had backlogs of records they needed to process first.

The Consult Toolbox is software used for consult management that standardizes the documentation process and workflow for VHA staff. When updated correctly, the software identifies which steps are completed in the consult process. VHA staff did not mark records received in the Consult Toolbox for about 630,000 of the approximately 2.4 million consults (26 percent) with records imported into the EHR. Starting September 12, 2023, VHA’s Office of Integrated Veteran Care (IVC) required the use of the Consult Toolbox by community care staff to document the return of medical records. However, the OIG team determined that IVC has not ensured medical facilities fill out required elements in the Consult Toolbox and that facility staff input information correctly. OIG said that correctly inputting information into the Consult Toolbox is critical to know which consults still require follow-up actions to retrieve the medical records and which have had records returned.

The OIG team found the Consult Toolbox did not have enough controls to ensure staff input information consistently and correctly. IVC’s failure to implement controls led to incomplete data, the report said. 

Each of the five facilities the OIG team visited in person had delays in processing or importing records because of technological barriers. At the time of the review, the largest number of records came back via electronic fax, which is inefficient because of issues with fax systems not working for periods of time. During interviews with the team, staff at five facilities cited issues with electronic faxes in processing community care medical records. The VHA portal available for community providers to return records to VHA was generally not used because of the complexity for the individual providers. Facilities that used tools to improve processing shortened the time it took to import records into the EHR.

The OIG report recommended that the IVC evaluate which staff should have access to and should update the Consult Toolbox when records are requested or received and update policies and controls around closed consults. 

Among the other OIG recommendations were that IVC evaluate the workload of community care staff to decide how best to structure and execute duties and evaluate ways to increase use of provider electronic records portals, as well as considering implementing technologies to improve records processing and ensure records from the Joint Longitudinal Viewer are uploaded into the VHA EHR.

The acting under secretary for health concurred with the recommendations and provided an action plan detailing steps for implementation.