Review of Generative Artificial Intelligence Chat Tools for Clinical Use

The VA Office of Inspector General (OIG) conducted a national review to address VA's use of generative artificial intelligence (AI) chat tools in clinical care and documentation. The OIG previously issued a preliminary result advisory memorandum, Review of VHA’s [Veterans Health Administration’s] Use of Generative Artificial Intelligence, identifying a patient safety risk associated with generative AI use.

VA provides access to two general-purpose chat tools, VA GPT and Microsoft 365 Copilot Chat, for work that may involve patient information; staff demonstrated broad engagement with these tools.

The Office of Management and Budget’s 2025 memorandum, “Accelerating Federal Use of AI through Innovation, Governance, and Public Trust,” directs agencies to identify high-impact AI use and implement risk management actions. VA did not identify VA GPT or Copilot Chat as high-impact. During interviews, leaders described the tools as analogous to search engines and emphasized user-level responsibility. By contrast, VA identified Ambient AI Scribe (a targeted clinical documentation tool) as high-impact, triggering safety requirements such as pre-deployment testing and human oversight. The OIG inspection team also found limited coordination with VA’s National Center for Patient Safety, and no AI-specific reporting mechanism existed to identify safety events related to AI-generated documentation.

The OIG made three recommendations to the Under Secretary for Health concerning oversight of generative AI chat tools, implementation of AI safeguards, and integration of AI-related risk monitoring into existing patient safety programs. The Under Secretary for Health concurred in principle with recommendation 1 and concurred with recommendations 2 and 3. Action plans described future guidance on requirements for clinical use of general-purpose AI chat tools and corresponding quality assurance processes, and referenced ongoing efforts to develop educational resources on AI governance and update patient safety reporting systems.