Evidence of meeting #28 for Veterans Affairs in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was information.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Susan McCrea  Liaison Officer, Intergovernmental Affairs, United States Department of Veterans Affairs
Keith Pedigo  Associate Deputy Under Secretary, Benefits for Policy and Program Management, United States Department of Veterans Affairs
Steve Muro  Director of Field Programs, United States Department of Veterans Affairs
Gail Graham  Director, Health Data and Informatics, Veterans Health Administration, United States Department of Veterans Affairs
Linda Fischetti  Acting Chief, Health Information Office, United States Department of Veterans Affairs

4:30 p.m.

Conservative

The Chair Conservative Rob Anders

Thank you very much.

At this stage I'll end my time and pass it over to the Conservative Party of Canada, to Mr. Shipley for seven minutes.

May 29th, 2008 / 4:30 p.m.

Conservative

Bev Shipley Conservative Lambton—Kent—Middlesex, ON

Mr. Sweet is next.

4:30 p.m.

Conservative

The Chair Conservative Rob Anders

Mr. Sweet, excuse me.

4:30 p.m.

Conservative

David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON

Thank you, Mr. Chairman.

Thank you very much for taking the time to share with us some of the strategies of the VA in the United States. I was very impressed with the electronic records, and particularly with the fact that the veterans are able to make additions and track their own records. It's fascinating, and really gets the patients involved in their own long-term health.

You mentioned interoperability, but it seemed that was strictly around electronic records and health. A concern of ours has been the interoperability between Defence and Veterans Affairs in places where there's obvious dovetailing. Are there other places of interoperability? Specifically, do you partner with DOD in preconditioning soldiers to help them deal with the trauma and stress of a theatre prior to deployment, to avoid PTSD?

4:35 p.m.

Acting Chief, Health Information Office, United States Department of Veterans Affairs

Linda Fischetti

In terms of interoperability and who else we partner with for that, we currently have some national work taking place that's looking at creating the health information technology standardization through which we can then partner and move this information wherever the veteran seeks care, whether that's within the VA or outside. We're not yet at the point at which we have broad interoperability with the private sector. That work is being led by the Department of Health and Human Services. It's similar in some ways to the Infoway activity within Canada. We need that to be successful before we'll have broad interoperability.

We do, though, have some interoperability for public health reporting, so since we do have all our diagnoses and our symptomatology captured electronically, we're able to send that to our Department of Health and Human Services and the Centers for Disease Control and Prevention. They are then able to aggregate that information across the country from other entities that are sending in similar information. They are able to do some tracking across the country. That information, once it leaves, is sent to CDC and then is aggregated; of course, it's completely anonymized as to who it came from.

In terms of working ahead of time--and this sounds more like the clinical process of trying to pre-screen people--we really don't do that. I'll defer to my colleague, Gail Graham, who may add to this.

Very much we are trying to increase our transparency into the DOD process for them as well as us at the time of hand-off, which is very much toward the end of service, so once someone has returned from the theatre and is being treated--for example, at Walter Reed Army Medical Center--they will actually meet a VA employee who will help with that transition point.

I'll defer to Ms. Graham to see if she has anything to add.

4:35 p.m.

Director, Health Data and Informatics, Veterans Health Administration, United States Department of Veterans Affairs

Gail Graham

We have several collaborative groups between the Department of Defense and VA on different disease processes. They develop clinical guidelines, so we're both using the same sets of clinical guidelines as we deliver treatment to patients. The proactive measures would come at that point.

The other thing we do is participate with the Department of Defense in what's called the PDHRA, the evaluation and assessments that they do within 30 days, 60 days, 90 days, and a year from deployment. In this engagement it has been very different for both the Department of Defense and VA because so many of these people are National Guard and reservists, and they're going back and forth and back and forth, so we've all had to interject some different practices because of that.

Dr. Katz, who is our mental health officer, could go into a lot more detail about collaborative clinical groups that are taking place.

4:35 p.m.

Conservative

David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON

You mentioned specifically about benefits and that someone who feels they have post-traumatic stress disorder would have to fill out an application. Although it was somewhat difficult, we had the good fortune to have two sessions with people who had served and were suffering from post-traumatic stress disorder, sessions that were more casual than this very structured meeting right now. For reasons of privacy I won't go into any kind of identification, but it was a commissioned officer who said that when they suffered post-traumatic stress disorder, even the capability of being able to bring oneself to fill in an application brought on a great deal of distress.

We have also had a session here with our own Veterans Affairs staff about having professionals who can ask good questions to see if that level of support is required. Have you found that, and do you provide professional assistance when you have someone who is quite drastically affected by PTSD?

4:40 p.m.

Associate Deputy Under Secretary, Benefits for Policy and Program Management, United States Department of Veterans Affairs

Keith Pedigo

With respect to the disability compensation, we do a lot of outreach to service members who are transitioning out of the military. We try to provide extensive briefings to each of them to let them know what avenues are open to them in terms of applying for disability compensation and to include PTSD, but we rely to a great extent on the veteran service organizations to try to identify the veterans in their local areas who may be in need of disability compensation for any number of disabilities, including PTSD.

We also get referrals from the U.S. veterans health administration. When they see veterans who are suffering from PTSD, they refer them over to the veterans benefits administration so that they can apply for their disability compensation. We're always willing to sit down with them and help them complete the application form, because we do recognize that for some of these veterans it is a monumental task when they're in a depressed state.

4:40 p.m.

Conservative

David Sweet Conservative Ancaster—Dundas—Flamborough—Westdale, ON

We're really asking you to educate us today. One of the things I'd have to say most impacted me was the fact that one of the major symptoms of post-traumatic stress disorder is isolation. Sometimes the only initiative they'll take is the one call, and if that means an application, then that could mean they actually don't get the treatment they have coming to them because in fact they're incapable of actually filling out the application.

Thank you very much for all of your insight and for taking the time.

Thank you, Mr. Chair.

4:40 p.m.

Director of Field Programs, United States Department of Veterans Affairs

Steve Muro

There's one thing that might help, if I could add to that. The veterans organizations and the VA medical centre partner with Stand Downs to help bring in the vets, and we also participate. It helps those veterans with PTSD to be able to go to someone for help to fill out the application.

4:40 p.m.

Conservative

The Chair Conservative Rob Anders

Thank you.

Now we go over to the Liberal Party of Canada, to Mr. Russell for five minutes.

4:40 p.m.

Liberal

Todd Russell Liberal Labrador, NL

Good afternoon. It's a pleasure to have you with us.

Like my colleague Mr. Valley, I come from a rural, remote area of Canada. I come from Labrador. We have some veterans, of course. This is not a unique circumstance given the size of Canada and its geography. I'm just wondering, in terms of the profile of your veterans, how many people would live in sort of rural or remote areas within the United States, as opposed to the number of people who live in primarily urban areas? How does that affect service delivery? We find in the rural, remote areas there are obviously fewer services, and the accessibility issues are compounded.

As well, there's a heavy emphasis here--and I appreciate your efforts, and I'm sure our country will be moving in this direction--on the technology aspect of the delivery of services, particularly with the HealtheVet program. I'm just wondering, because it's based on technology, and I'm looking at it from the rural and remote aspect again, if there is widespread Internet access out there in rural and remote parts of the United States. Do people have access to this type of technology and the hardware required so they can even take advantage of this? We tried to use technology as a bridge to overcome some of the geographic boundaries, but sometimes, for instance in some parts of Canada, there is no Internet access whatsoever, or what is there is very primitive by certain standards today.

I'd just like to understand a little better what the situation is in the United States in that regard, and how you're addressing that.

4:40 p.m.

Acting Chief, Health Information Office, United States Department of Veterans Affairs

Linda Fischetti

Certainly.

Within the United States, we as well are increasing the technical capability to have that type of access throughout the rural areas. Other departments are working on that as well. The Department of Agriculture and a couple of others have just put out some major grants to be able to extend broadband to areas that don't currently have it. It's also true that being able to reach the rural communities is very much a cooperative event. The VA can't do it alone. We need to rely on our partnerships that already exist in those communities.

When we do schedule the future meeting for mental health, you may also be interested in inviting to attend a new office that has just been started, called the Office of Rural Health. This office was created just in this last year to address many of the issues that you were talking about. They can talk broadly to not just the technology but also some of the other clinical issues.

As an example, it is true that when we work with rural areas, we need to have a different way of reaching out. Ms. Graham and her team, as well as the team that works on the personal health record and My HealtheVet, realize that.... I talked about in-person authentication as the precursor to being able to import the information from your electronic health record. They are looking at ways in which we could possibly write policy to be able to have visiting nurses or someone else who's present in the community do that in-person authentication when the veteran is in the rural community, versus our precursor at this point in time, which is bringing them into the local VA medical centre.

It is true that when you reach out to the rural community, you need to be able to adjust and be a bit more creative than you do in urban centres. My recommendation would be to have the Office of Rural Health participate in a future presentation.

4:45 p.m.

Director, Health Data and Informatics, Veterans Health Administration, United States Department of Veterans Affairs

Gail Graham

I just want to make a few comments about what we do today.

For many years we had just these tertiary facilities, some 153, depending on the kind of medical centres that veterans actually had to travel to over the last 15 years or so. That's why you see our sites of care expanded to in excess of 2,400. Many of them are located in rural cities and small municipalities around the country, where they provide mental health and primary care services locally. Some have consulting services there as well.

It's also the reason that we have expanded the whole telemedicine approach for care in homes and the use of remote monitoring devices that monitor weight, blood pressure, and other physiologicals that feed into medical centres. So as Ms. Fischetti indicated, it's a real issue for us. I think you may beat us in the degree of rurality and the access to Internet, but it's certainly an issue for us as well.

Another benefit we give under veterans health benefits is to reimburse veterans for the travel to and from medical facilities when they require travel. Also, if there is excessive travel, which is really common, for example, in Alaska, we're more likely to pay for care to be received locally if we don't have a clinic so that we don't burden the veteran with long-distance travel.

4:45 p.m.

Conservative

The Chair Conservative Rob Anders

Thank you very much.

Mr. Perron, from the Bloc Québécois, you have five minutes.

4:45 p.m.

Bloc

Gilles-A. Perron Bloc Rivière-des-Mille-Îles, QC

Good afternoon once more. I have another problem to explore with you, but in a completely different area. I will set post-traumatic stress disorder aside so that I can talk to you a little about our aboriginal people. I am sure that you have the same problems and the same concerns as we do.

Without taking him out of his environment, how do you take care of an elderly aboriginal veteran who lives on his reserve with his nature, his customs, his language, his culture and so on? He would surely die if you put him into a hospital in a large centre. How do you take care of him? This is a problem for us.

4:45 p.m.

Acting Chief, Health Information Office, United States Department of Veterans Affairs

Linda Fischetti

We do have a close collaboration with the Department of Health and Human Services' Indian health service. So there is a designated portion of the federal government that is outside the Department of Veterans Affairs that works very closely with both the citizens and the governance of the tribes to be able to provide service to the Native Americans.

We do in fact work closely with them in terms of shared clinical service in the local areas, as well as trying to share as much as we can in terms of clinical practice guidelines, committee reports, sharing technology, sharing information as much as we can with our clinical colleagues who are in the Department of Health and Human Services' Indian health service.

4:50 p.m.

Bloc

Gilles-A. Perron Bloc Rivière-des-Mille-Îles, QC

We have had veterans here who have had some unkind things to say about how complicated our application forms are, our care requests, our compensation applications, and so on.

Are your forms as incomprehensible as ours? If not, if this is not a problem for you, could you send us some samples so that we can look at them?

4:50 p.m.

Director, Health Data and Informatics, Veterans Health Administration, United States Department of Veterans Affairs

Gail Graham

It's definitely a problem for us; we're not immune from any bureaucratic problems. We've tried over the years to decrease these, and we are working on a one-VA portal, which is not there yet, where the veteran's application would actually satisfy multiple needs and then be thoughtful enough to branch out to specific requirements that may be relative to cemetery benefits or health.

We'd be happy to share with you the multitude of application forms that we have currently and a bit about what we're trying to do to bring those to a more user-friendly format.

4:50 p.m.

Associate Deputy Under Secretary, Benefits for Policy and Program Management, United States Department of Veterans Affairs

Keith Pedigo

On the benefits side of the VA, we've been working very hard to put all the applications for the various benefits online so that veterans can go there, fill out the form, and then electronically send it into our regional offices to begin the processing of their claim. We think we've made considerable progress in that area.

Additionally, we've been working assiduously to try to simplify the process.

4:50 p.m.

Bloc

Gilles-A. Perron Bloc Rivière-des-Mille-Îles, QC

Excuse me, sir, but up here, that is a problem. About 98%, perhaps 100%, of our veterans 85 and older do not even have the Internet. Do not ask them to start surfing the Internet. You must have a problem with people who have difficulty with the Internet. I am 67 years old, and I have a hard time surfing the Internet.

4:50 p.m.

Associate Deputy Under Secretary, Benefits for Policy and Program Management, United States Department of Veterans Affairs

Keith Pedigo

Yes, and we recognize that many veterans are not computer-savvy.

We are very fortunate to have this strong network of veterans service organizations out there located in almost every community in this country, even in many of our rural communities. Their primary purpose is to try to help the veterans who are members of their organizations submit their claims, and they're able to assist the veterans in better understanding some of the more complex forms that we have.

4:50 p.m.

Bloc

Gilles-A. Perron Bloc Rivière-des-Mille-Îles, QC

Thank you very much, ladies and gentlemen. I appreciated your comments and your replies.

4:50 p.m.

Conservative

The Chair Conservative Rob Anders

Thank you very much, Monsieur Perron.

Now we'll go over to the Conservative Party of Canada, to Mr. Shipley for five minutes, with Mr. Valley on deck.

4:50 p.m.

Conservative

Bev Shipley Conservative Lambton—Kent—Middlesex, ON

Thank you, Mr. Chairman.

Thank you, witnesses, for taking part today.

I want to express to you my appreciation for the depth and the quality of your presentation to our committee today, and I want to thank you for your willingness to present.

I would like to start off with a question on the cemeteries. Is the service, and services, provided in your national cemeteries the same as for someone who wanted to be buried in a private cemetery?