Veterans Affairs Committee on March 23rd, 2009

[The Chair, Conservative, David Sweet]

Thank you, Madam Graham.

Mr. Dhaliwal, thank you.

I think everybody has stated that they have exhausted their questions. But I have a couple before we let you go, Madam Graham. I think you can tell by the questions that we commend you for the advancement in the area of electronic health records. I just wanted to make something clear. If I understand you correctly, there is not any state, federal, or municipal health care that's not integrated into a national electronic health care records system. Is that right?

[Gail Graham]

I don't know if I understand your question.

[The Chair, Conservative, David Sweet]

I'm referring to Veterans Affairs, your department.

[Gail Graham]

Oh, for veterans. Yes, that's correct.

[The Chair, Conservative, David Sweet]

And the other public health care agencies across the United States have electronic health records as well. Is that correct?

[Gail Graham]

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. There was a certification process established in which software had to go through a rigorous certification process to ensure that it met certain provisions of quality reporting or clinical decision support. That was established a couple of years ago. It was brought in to give providers who were purchasing these systems confidence that it would meet their needs. In fact, we're still not nationwide, or even past the 20% adoption rate of electronic health records.

[The Chair, Conservative, David Sweet]

That's interesting. That limits your capability of dealing with outside clinics, then, obviously. If someone goes to a clinic that does not have the electronic health care records, then you'd have to manually upload that from the records that would be transferred to you on paper.

[Gail Graham]

Right.

[The Chair, Conservative, David Sweet]

This gets back to the fact that it can also create serious errors. Thank you for that.

I wanted to ask you a question on the filling of prescriptions. Have you had much pharmacy fraud?

[Gail Graham]

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. There are very few cases that I know of, but our Office of the Inspector General would probably be the one that could give you a more comprehensive response. I only know of those that were elevated to me.

[The Chair, Conservative, David Sweet]

It sounds like, for the most part, it was internal, that it wasn't something where someone was actually able to create a false record and obtain pharmaceuticals.

[Gail Graham]

Right.

[The Chair, Conservative, David Sweet]

Last, how many levels of redundancy do you have for your system? You were talking about what would happen where there was a natural disaster, that you'd move the records. Do you have several levels of redundance in terms of tape and hard drive backup?

[Gail Graham]

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. So if there were an outage over about five hours, I think it is, they could revert to the hot backup. There are the local tapes; there are the backup, full-redundancy systems; there are also the local measures that they take nightly to queue summaries of information for patients who are in the hospital or have upcoming appointments. Those are stored separately from the mainframe system. And then we also have a read-only system that's available nationwide, should there be an outage, that we can get to in the interim until the hot backup is restored.

Our uptime is pretty high, about 99.5%. But as many experts have said, when you convert to an electronic health record system, it almost needs to be at that Six Sigma level, with close to zero downtime, so it doesn't interrupt patient care. That's the direction we're moving towards, but we're not there yet.

[The Chair, Conservative, David Sweet]

Thank you very much.

On behalf of the committee, I want to thank you. Your answers were very cogent and informative. We're going to have a lot of material for our report after this.

Again, if you could share this with the VA, this the third teleconference we've had, and you've been very gracious in your time investment with us for our study. Thank you very much.

[Gail Graham]

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

Thank you.

[The Chair, Conservative, David Sweet]

All right, ladies and gentlemen, we'll now go into some committee business.

Is there any need to go in camera for this? If there's someone who would like to, I will, but other than that we'll just move forward with it. Is everyone okay with that?

[Some hon. members]

Yes.

[The Chair, Conservative, David Sweet]

The first item we want to deal with is our schedule to Ste. Anne's. I understand there's some discussion to be had around that.

Monsieur André.

[Guy André, Bloc, Berthier—Maskinongé, QC]

I looked at the schedule. I had asked that we meet with a union representative from Ste. Anne's Hospital. Also, Ms. Magali Picard, the Vice President for Quebec of the Union of Veterans' Affairs Employees, is prepared to meet with the committee. It would be interesting to hear what she has to say.

It's no secret that the next budget will call for cuts to the operating budget of Ste. Anne's Hospital. The minister shared some highly relevant information with the committee. He maintained that the cuts would not necessarily compromise the quality of services provided to veterans.

I've looked at the schedule and I think we should meet with the members of the administration team at 10:35 a.m. It is critically important, to my way of thinking, that we meet with the administrators and examine the research activities taking place at Ste. Anne's Hospital.

According to our schedule, we are slated to hear a presentation on Epikura, a nutritional program of texture-controlled foods for patients with dysphagia. Because this is a more specialized subject, I think that instead we should meet with Ms. Magali Picard, or extend our meeting, despite our already tight schedule.

That is my suggestion. I feel it's important to meet with union officials.

[The Chair, Conservative, David Sweet]

Mr. Stoffer.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

I tend to agree with that.

You're also having a lunch at 12:05. It wouldn't hurt to invite the president of the veterans association, who is at Ste. Anne's, to join you. He could give you first-hand knowledge from their perspective on how the treatment is going there and how these proposed changes to the contract workers will affect them.

He wrote a letter outlining their concerns. I believe Mr. Kerr and Mr. Thompson have received it, because we received a copy. He was quite concerned about what may happen. As a courtesy—he is the president of the veterans association there—it would be a nice gesture on the committee's part to invite him so you can have a friendly chat to discuss that and other issues within Ste. Anne's Hospital.

[The Chair, Conservative, David Sweet]

Just to clarify, he's the president of the Ste. Anne's veterans association.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Yes. His name is Raymond something. I don't have his last name.

[The Chair, Conservative, David Sweet]

I think we'll be able to source that.