Draft OIG Report Finds VA EHR Patient Safety Issues Have Harmed 100+ Veterans

The VA continued to roll out the EHR at additional facilities despite warnings from a patient safety team, according to a draft OIG report. A draft report from the Department of Veterans Affairs (VA) Office of Inspector General (OIG) revealed that the Cerner EHR system at Spokane’s VA hospital has put patient safety at risk, causing harm to at least 148 veterans, according to reporting from The Spokesman-Review. The draft report also claims that EHR vendor Cerner knew about a flaw that caused the harm but failed to fix it or inform the VA before the system went live at Mann-Grandstaff VA Medical Center in October 2020. However, the draft report revealed a VA patient safety team briefed the VA’s deputy secretary in October 2021 about the harm and ongoing risks. While the draft OIG report notes that the VA and Cerner have taken steps to limit the number of orders that get lost in what users describe as the “unknown queue,” it calls those mitigation efforts “inadequate.”