VA Health Care

In an April 1991 letter to the Department of Veterans Affairs (VA), an anonymous group of veterans, known as the Froelich Trust Group, made a series of allegations about the Veterans Health Administration's (VHA) medical information resources management. Included were accusations that: (1) software contained inaccurate patient records; and (2) staff submitted fraudulent time and attendance reports and abused government funds. VHA's Medical Inspector did not thoroughly address the Froelich allegations about inaccurate medical data, including the effect of VA's software integration practices on the accuracy of its automated databases. The scope of the investigation into inaccurate medical data was too narrow. The review of software integration practices merely described VA's existing processes, and the Medical Inspector did not follow up on the large number of incomplete paper medical records identified during his review. VHA did substantiate several of the Froelich Group's claims, including allegations that the Decentralized Hospital Computer Program is slow and not user friendly and that its order entry/results reporting software does not follow physician logic. VA's Inspector General thoroughly investigated allegations about employee malfeasance, including a charge that the director of one center verbally abused employees. This allegation was substantiated when more than half of the staff said that they either had seen or had been subject to verbal abuse; the rest of the allegations could not be substantiated.

GAO found that: (1) VA did not thoroughly investigate the allegation that its software integration procedures for its Decentralized Hospital Computer Program (DHCP) failed to protect medical data in existing databases because its investigative approach could not identify specific examples of software integration problems; (2) VA examination of automated and paper medical records did not verify the accuracy of its medical databases because it did not examine the medical data that were most susceptible to input errors; (3) because of the large number of incomplete paper medical records, VA has advised its facilities to ensure that all paper documents are filed in patient records, and designated DHCP as the foundation of the computer-based patient record, but did not make that designation mandatory; (4) VA thoroughly investigated the allegations of personnel misconduct and fraudulent reports, and although it found no evidence to support the allegations, it did find numerous internal control weaknesses; (5) VA did not investigate the allegation that its medical software development is mismanaged and outdated, but had already initiated efforts to improve DHCP management before receiving the allegation; (6) VA agreed with the allegations that DHCP was slow and not user friendly, and that the order entry software did not follow physician logic, but the order entry system was not meant to be used by physicians; and (7) VA is working toward developing better software.