Department of Veterans Affairs (VA) pharmacists cannot always efficiently view necessary patient data among Veterans Health Administration (VHA) medical sites, according to a new report from the U.S. Government Accountability Office (GAO).
What’s more, the report concluded, pharmacists cannot transfer prescriptions to other VHA pharmacies or process prescription refills received from other VHA medical sites through the system. As a result, “The system does not provide important capabilities for pharmacists to make clinical decisions about prescriptions efficiently, which could negatively affect patient safety,” according to GAO.
Per Congressional mandates, GAO is required to examine VA's acquisition and use of a pharmacy system. For the study, GAO set out to determine whether VA currently possesses a functioning pharmacy system and the extent to which the system enables data to be viewed, shared, and transferred among VHA pharmacy locations; if VA's pharmacy system is interoperable with the Department of Defense’s (DOD's); and if VA has implemented its pharmacy system in accordance with healthcare industry practices.
As such, GAO analyzed documentation describing VA's pharmacy system; observed system demonstrations; analyzed plans and actions taken to achieve interoperability with DOD; and identified industry practices related to pharmacy systems, and compared them to VA's system capabilities.
In its attempts to be interoperable with DoD, VA has developed capabilities to exchange certain patient and medication information, according to the report. As an example, VA's pharmacy system has the ability to check prescription drug information from DOD.
Nevertheless, GAO concluded, limitations impede interoperability with DOD. For instance, VA clinicians and pharmacists cannot always view DOD patient data, and VA pharmacists do not always receive complete information from DOD to perform prescription checks on new medications. Also, the report stated, VA has not assessed the impact of its pharmacy system interoperability on service members transitioning from DOD to VA, and VHA officials stated that doing so would be difficult because there are other personnel related-factors that could affect patient care outcomes. “Without assessing the impact that pharmacy system interoperability is having on veterans, VA lacks assurance regarding the effectiveness of the system to adequately support its mission of providing healthcare to veterans,” the report attested.
Although VA's pharmacy system capabilities align with three of six identified healthcare industry practices, it lacks in three others, GAO said:
- Pharmacists cannot electronically exchange prescriptions with non-VA providers and pharmacies. Therefore, veterans need to obtain paper prescriptions from external providers or have the providers fax the prescriptions to their local VA pharmacy to fill the prescriptions, which is time consuming and inefficient.
- VA's system does not include certain clinical decision and workflow capabilities that, among other things, could improve clinicians' and pharmacists' ability to provide enhanced medical care to veterans. VA has indicated that it plans to implement such capabilities, but its plans for doing so are incomplete.
- VA's system does not maintain a perpetual inventory management capability to monitor medication inventory levels. Therefore, pharmacists cannot effectively track when to reorder medications.
GAO has made six recommendations including that VA update its pharmacy system to view and receive complete medication data, assess the impact of interoperability, and implement additional industry practices. VA generally concurred with GAO's six recommendations, according to the report.
