Veterans Affairs committee  We've had some. The Office of the Inspector General is probably a better one to comment, though I will tell you we've had--on the scale that we process pharmacy prescriptions--a very minute occurrence. We have had some instances internally of pharmacists diverting narcotics in very isolated cases.

Veterans Affairs committee  Right.

Veterans Affairs committee  We do, and they're adding more all the time. Currently the systems are backed up on tape, and those tapes are stored elsewhere so that they can be restored. But also, we're moving to regional data processing centres where several systems may be collocated, and they have established what they refer to as a hot backup for those systems.

Veterans Affairs committee  You're very welcome. I wish I could have seen you, but it was great to hear from you again. Thank you.

Veterans Affairs committee  Actually, the adoption is still pretty low. It's about 20% now. It tends to be concentrated in the large integrated health care organizations such as Kaiser Permanente or Intermountain Healthcare. The small practices have been slow to adopt the electronic health records system. We've done some things at the government level.

Veterans Affairs committee  Right.

Veterans Affairs committee  I don't know if I understand your question.

Veterans Affairs committee  Oh, for veterans. Yes, that's correct.

Veterans Affairs committee  Actually, we don't have provisions today to have doctors who don't participate. This is how they access their results. This is how they order their medications. We gave them a period of time for the conversion, during which we accommodated both processing orders--non-electronically and electronically.

Veterans Affairs committee  Other organizations similar to us, like the Indian Health Service, which provides care on reservations and non-reservations, have had an electronic health records system for some time. The Department of Defense was an early adopter of the core systems and has gradually moved to the electronic health records system.

Veterans Affairs committee  No, it's real time. The only batch processing we do is this. We have national databases in Austin, Texas, and some of the more administrative data are batch processed and transmitted to Austin. But everything else in the electronic health record is in real time.

Veterans Affairs committee  For the veterans right now, we're looking at some examples of using it, for example, with the home health nurses. The local medical centre in Washington, DC, is actually using BlackBerrys to transmit EKGs from the emergency room to the on-call cardiologist so they can do an immediate reading of the EKG and start ordering interventions before they can drive to the hospital.

Veterans Affairs committee  Both. When you have this many trainees coming through--new residents and nurses--they're living off their personal devices so they're always looking for different, innovative ways they can do their work. The veterans do keep us aware and alert of things they would like to see. Certainly a lot of them are happy that things can be accessed through a PDA or through an iPhone, for example.

Veterans Affairs committee  The Department of Defense probably needs to be the one to brief you on how they use their electronic health record system in combat areas. There is a component of their AHLTA system that actually has a theatre of combat component. At the VA, we can see the notes and documentation created in that theatre-based system, but really, DOD needs to be the one to speak to you directly about how that exactly works.

Veterans Affairs committee  It's not implemented in the academic affiliates, but it's implemented in all the VA locations, yes.