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. But as I stated earlier, about seven years ago we really had to make the full conversion over to the electronic environment. A lot of that was prompted by physician colleagues. It was really a dangerous situation not knowing if what you were looking at electronically was complete or having to look at both the paper record and the electronic record. Really, when you make the conversion, you have a period of time with both, but to prolong that period of time really creates a very dangerous situation.
In this country, we have an oversight body called the Joint Commission. This is really an area they watch closely to make sure that as organizations convert to electronic situations, providers are well informed about how they access information.
I'm sure there were some providers who retired during this conversion, but to say that it was only our older physicians would not be the case either. What we see now is that it's a big recruiting tool for young physicians. Many of our physicians, when they go out into private practice, are very upset that they don't have access to electronic health records, as they did during their VA experience.
We see it today as more of a recruitment tool. As I said, during the last decade I'm sure there were physicians for whom it prompted retirement from VA, but it was not a mass exodus of clinicians. Some of that may be attributed to the fact that for two decades before we moved in the direction of their actually interacting with the computers to enter their orders and their progress notes, our clinicians had been accustomed to looking up information. We still allow, in some areas, some dictation of longer reports, such as discharge summaries or operative reports or histories and physicals. And some of our clinicians use voice recognition software to enter their progress notes, for example, so that you may see different flavours in how they interact with the computer.