Thank you.
So the access, for example, in our medical centres is actually governed by what your role is in the medical centre. It's done through a series of menus and keys for specific access. For example, only physicians who have medication ordering authority have a key to do medication ordering. So in many cases the electronic access gives us the ability to limit and control access in a way that we were never able to do in a paper environment. This comes not just with the technology, but we also do a lot of training with our providers on what is appropriate for them to access, what they need to know, how they determine the “need to know” of information, both by administrative staff and by clinical staff. So it's a combination of technology limiting access and educating those who use the system on what's appropriate to access.
We tried for many years moving the paper record around and trying to keep it secure, and in no way do I believe that this paper record was more secure than the electronic environment we're in today. So right now the access to the system would be limited to those who have a relationship with VA, either a VA employee or someone who's contracting on behalf of VA to provide those services. We do have mechanisms to control access down to individual patients. So for example, in this country veterans' service organizations assist the veterans in preparing their claim files, and that is done by issuing a power of attorney between the veteran and the veterans' service organizations. In those cases, they only have access to those veterans. The same is true for our quality and oversight groups. We will limit those to the “need to know”, as is also the case for research. We can limit research down to those who are participating, for example, in a research study.
On the second question, on whether there are things that cannot be put into a client file, I know there are some organizations that do not put HIV results, for example, in their electronic health record. This is not the case for VA. We do include what we would call sensitive laboratory results or test results. One area in which you may not see all of the information is mental health. Mental health may put in summaries of information but retain detailed client notes separately from the electronic health records system. So this is an area that very likely may just have summary information and not all the details.