Orders Sent to the Unknown Queue — Java Bug Hunt

Briefing

Modelled on the VA's Oracle Cerner EHR rollout, reviewed by the VA Office of Inspector General in 2022: at the first site to go live, the Mann-Grandstaff VA Medical Center in Spokane, the new system sent orders that it could not match to a known location to an "unknown queue" that clinicians did not know existed. Thousands of orders sat there without anyone acting on them, and the OIG linked the problem to patient harm.

This reconstruction routes orders to clinic queues by location code; anything unmapped is parked in a queue nobody works.

Fix OrderRouter.route so no order is ever silently parked.

Bug report

BUG-OIG-UNKNOWN · Priority: Critical (patient safety) · Reported by: clinical informatics

route(orderId, location, orderedBy, store) returns the queue the order was put in. The location code is normalised first: trimmed and upper-cased (null -> "").

• mapped location: enqueue in LocationMap.queueFor(code), notify nobody
• unmapped location: enqueue in QueueStore.TRIAGE (a monitored queue) AND notify the ordering clinician with exactly store.notifyUser(orderedBy, "order <orderId> not routed: location '<code>' is not mapped")
• every order must end up in a queue listed in QueueStore.MONITORED; there must never be a queue named "UNKNOWN"

Observed: orders for unmapped locations are put in "UNKNOWN", which no worklist shows, and the ordering clinician is never told.

Logs

[orders] O-88121 location=SPK-PT -> UNKNOWN
[orders] UNKNOWN queue depth 11,204 (no subscribers)

The code as shipped

src/orders/OrderRouter.java (editable)

class OrderRouter {
    static String route(String orderId, String location, String orderedBy, QueueStore store) {
        String code = location == null ? "" : location.trim().toUpperCase();
        String queue = LocationMap.queueFor(code);
        if (queue == null) {
            queue = "UNKNOWN";
        }
        store.enqueue(queue, orderId);
        return queue;
    }
}

Read-only context: src/orders/LocationMap.java, src/orders/QueueStore.java.