Evidence of meeting #9 for Veterans Affairs in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was access.
A recording is available from Parliament.
4:10 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
Right. And for us, this is something that's monitored very closely by our Congress.
4:10 p.m.
Conservative
Greg Kerr Conservative West Nova, NS
Now, I know that in any health system—and certainly I don't expect it to be much different there—amongst professionals looking at the information, there can be some difficulty in interpreting the information. Is that the case with you? By that, I mean it's been a tradition over years that a patient--in this case, a vet--often moves from one facility to another or has to go for a different kind of service. Does the new facility automatically accept the information flow, or is there a tendency to want to re-test and revisit the information?
4:10 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
No, there's acceptance. Many of our providers have a bigger concern, when they start to participate in the nationwide health information network, with getting information from non-VA, non-DOD sources. That's probably a bigger concern to them. But we don't have a lot of issues with providers not trusting the information they're getting from another VA or the Department of Defense, for example.
4:10 p.m.
Conservative
Greg Kerr Conservative West Nova, NS
That's good. That's really positive.
Basically, the information belongs to the vet. Am I correct? The file would belong to the vet.
4:10 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
Correct.
4:10 p.m.
Conservative
Greg Kerr Conservative West Nova, NS
We've heard questions about not only the confidentiality—which is a challenge in any electronic system—but also about the patient or vet's desire to control access to that information.
If the vet wanted to move into a non-VA facility, what happens? Do they have free access to take their records with them and transfer them, or is there some restriction on that?
4:10 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
No. Actually, under the Privacy Act of 1974, the veteran can always have a full copy of their record. We can also download it electronically to different media, but we can certainly print out a paper copy for them to take with them.
We're also working with both Google and Microsoft on the ability for veterans in the future to actually take parts of their electronic health record and put them on the more generic personal health record portals that Google and Microsoft operate, so the veteran can then grant electronic access to other providers or other health care facilities. But right now, we would either print all of their record or we would download it to a CD or a thumb drive at their request.
4:10 p.m.
Conservative
Greg Kerr Conservative West Nova, NS
Well, I just have to ask about something I'm really interested in. Could you explain interoperability in regard to the My HealtheVet goals?
4:10 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
Interoperability is actually what I just talked about. The veteran actually has the ability, if we put all of their lab results onto their My HealtheVet Internet site, to decide to send it to their Google health record or their Microsoft record and then share it with private sector physicians. It's partially that, and it's partially our participation in the nationwide health information network, under the auspices of Health and Human Services within the U.S. government. It's building a foundation for all health care providers to connect to this nationwide health information network, much like the U.K. Spine records service or some of the work you're doing, so that we can exchange information. All of that requires the veteran's consent and authorization to exchange that information.
So what we're doing with the Department of Defense is interoperability. We'd like to expand that out for the patient to control it and to exchange more routinely with the private sector.
4:15 p.m.
Conservative
The Chair Conservative David Sweet
Thank you very much, Mr. Kerr.
Now we have Madam Duncan for five minutes.
4:15 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Thank you.
Good afternoon, Madam Graham, and thank you for your very comprehensive deck.
I do have some questions. You mentioned that the system can be used for preventive medicine, and I'm wondering if you can elaborate on that, please.
4:15 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
Certainly. The system takes into consideration the veteran's age, sex, and chronic diseases. For example, just general preventative medicine may be reminders for the annual flu shot, or if they happen to know that this patient has congestive heart failure, it may also include their pneumococcal vaccination.
These reminders are shown to the clinician, and in My HealtheVet now, we also show them to the veteran if things are due. They also include things like talking to the patient about whether they smoke and, if they do, offering intervention to stop smoking. It may be the use of seat belts. It may be that they live in a certain part of the country and are exposed to different diseases in that part of the country. It can be logic based on any information about the veteran—their age, their sex, their personal health history, their family health history.
For example, we may do a preventative reminder for mammograms on women veterans over forty. If it takes into consideration your personal health history or your family health history, that you have a history of breast cancer in your family, it may do that reminder when you're thirty, for example.
It's the same thing with colonoscopy or colon evaluation after the age of 50, with those things that are recommended through different clinical means. We work with the Department of Defense and with the private sector on what are the interventions, at what time. This then expands into chronic care. For example, diabetics, under our quality measures, are required to have an annual eye exam and an annual foot exam.
4:15 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Thank you, Madam Graham. That gives me some good idea.
On page 16, how were the conditions chosen? Maybe it's just examples, but on the ones that are shown, only colorectal cancer shows up. For veterans, I should think there would be other cancers you might be interested in.
4:15 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
This is just an example.
4:15 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Okay. You mentioned that the system could be used for research. Could you elaborate on that, please?
4:15 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
We use it more in a way to inform the veterans about research opportunities for them, that there are research studies in PTSD, for example, and this is where they can make further contact if they'd like to participate in the research studies. We don't actually allow researchers to access the personal health record of the veteran, because we've made the commitment to the veteran that what they put in what's called their health vault actually remains at their discretion as to whether it would be shared.
We do, under certain circumstances, with approved protocols, allow some extracts of our electronic health records to be used for research. For example, if a researcher is looking for candidates for a PTSD study or cancers related to exposures or to military service, we would, under certain protocols, allow researchers to define their cohort of patients or to try to recruit patients in that manner.
4:15 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Are the veterans made aware of that when they initially sign on to the system?
4:15 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
Yes, they are.
4:15 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
What percentage of veterans use in the system and what are the barriers to use for them?
4:15 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
Are you referring to the personal health record, My HealtheVet?
4:15 p.m.
Deputy Chief Officer, Health Information Management, Veterans Health Administration, United States Department of Veterans Affairs
It's about 20% of veterans. I think some of the barriers are in largely rural areas—your colleagues brought it up earlier—where the Internet is not available or not available in an easy manner. That may be a barrier. We try to compensate for that with availability at the clinics and medical centres--for there to be computers and assistance available to them there. Certainly, we make an attempt to compensate for that. What we see is that every time we add a feature that may interest you, that would encourage you to sign up for a personal health record.