113VA112
Telephone Care and Service Records-VA
System location:
Records are located at each Call Center, which are operated at VA
health care facilities or at contractor locations. Address locations
for VA facilities are listed in VA Appendix 1 of the biennial
publication of VA Privacy Act Issuances. In addition, information
from clinical symptom calls is maintained in the patient's medical
record at VA health care facilities and at the Department of Veterans
Affairs (VA), 810 Vermont Avenue, NW., Washington, DC; Veterans
Integrated Service Network Offices (VISNs); and Employee Education
Systems.
Categories of individuals covered by the system:
The records include information concerning individual enrolled
patients.
Categories of records in the system:
The records may include information related to:
- Clinical care such as clinical symptoms, questions asked about
symptoms, answers received, clinical protocol used and advice
provided. It might include doctors' orders for patient care including
nursing care, current medications, including their scheduling and
delivery, consultations, radiology, laboratory and other diagnostic
and therapeutic examinations and results; clinical protocol and other
reference materials; education provided, including title of education
material and reports of contact with individuals or groups. It
includes information related to the patient's or family member's
understanding of the advice given and their plan of action and,
sometimes, the effectiveness of those actions.
- Record of all calls made to the Call Center, including caller
questions about medications, their uses and side effects; requests
for renewals of prescriptions, appointment changes, benefits
information and the actions taken related to each call, including the
notification of providers and other staffs about the call.
- Contact information from private sector medical facilities or
clinicians contacting the VA about issues such as enrolled veterans'
visits to an emergency department or admissions to a community
medical center.
Authority for maintenance of the system:
Title 38, United States Code, section 501.
Purpose(s):
The purpose of these records is to provide clinical and
administrative support to patient care and provide medical and
administrative documentation of the care and/or services provided in
Call Centers. The records may be used for such purposes as improving
Call Center staff's ability to provide telephone care services to
veterans and the quality of the service by having immediate access to
records of calls made previously by the veteran. Records may be used
for purposes of notifying VA providers of the patient's condition and
status, the criteria used to judge the status of the patient and/or
the information given to the external provider on follow-up steps
that they must take to receive authorization for the care.
Records may be used to assess and improve the quality of the
services provided through telephone care services and to produce
various management and patient follow-up reports. Records may be used
to respond to patient, family and other inquiries, including at times
non-VA clinicians and Joint Commission for Accreditation of
Healthcare Organizations (JCAHO) or the Utilization Review
Accreditation Commission (URAC) for the accreditation of a Call
Center or facility. Records may also be used to conduct health care
related studies, statistical analysis, and resource allocation
planning using data that has been stripped of individual patient
identifiers. The clinical information is integrated into the
patient's overall medical record, into quality improvement plans, and
activities of the facility, such as utilization review and risk
management. They are also used to improve Call Center services, such
as patient education, the improved integration of clinical care, the
provision of telephone care services, and communication.
Routine uses of records maintained in the system, including
categories of users and the purposes of such uses:
Information contained in the record system may include
information protected by 38 U.S.C. 7332, i.e., medical treatment
information related to drug abuse, alcoholism or alcohol abuse,
sickle cell anemia or infection with the human immunodeficiency
virus, that cannot be disclosed under a routine use unless there is
also specific statutory authority permitting disclosure.
- Disclosure may be made to a member of Congress or staff person
acting for the member when the member or staff person requests the
records on behalf of and at the request of that individual.
- Disclosure may be made to the Department of Justice and United
States Attorneys in defense or prosecution of litigation involving
the United States, and to Federal agencies upon their request in
connection with review of administrative tort claims filed under the
Federal Tort Claims Act, 28 U.S.C. 2672.
- Disclosure may be made to a Federal agency or to a State or
local government licensing board and/or to the Federation of State
Medical Boards or a similar nongovernment entity which maintains
records concerning individual's employment histories or concerning
the issuance, retention or revocation of licenses, certifications, or
registration necessary to practice an occupation, profession or
specialty, in order for the Department to obtain information relevant
to a Department decision concerning the hiring, retention or
termination of an employee or to inform a Federal agency or licensing
boards or the appropriate nongovernment entities about the health
care practices of a terminated, resigned or retired health care
employee whose professional health care activity so significantly
failed to conform to generally accepted standards of professional
medical practice as to raise reasonable concern for the health and
safety of patients receiving medical care in the private sector or
from another Federal agency. These records may also be disclosed as
part of an ongoing computer matching program to accomplish these
purposes.
- Disclosure may be made for program review purposes and the
seeking of accreditation and/or certification, disclosure may be made
to survey teams of the Joint Commission on Accreditation of
Healthcare Organizations, College of American Pathologists, American
Association of Blood Banks, and similar national accreditation
agencies or boards with whom VA has a contract or agreement to
conduct such reviews, but only to the extent that the information is
necessary and relevant to the review.
- Disclosure may be made to a State or local government entity
or national certifying body which has the authority to make decisions
concerning the issuance, retention or revocation of licenses,
certifications or registrations required to practice a health care
profession, when requested in writing by an investigator or
supervisory official of the licensing entity or national certifying
body for the purpose of making a decision concerning the issuance,
retention or revocation of the license, certification or registration
of a named health care professional.
- Disclosure may be made to the National Practitioner Data Bank
at the time of hiring and/or clinical privileging/reprivileging of
health care practitioners, and other times as deemed necessary by VA.
- Disclosure may be made to the National Practitioner Data Bank
and/or State Licensing Board in the State(s) in which a practitioner
is licensed, in which the VA facility is located, and/or in which an
act or omission occurred upon which a medical malpractice claim was
based when VA reports information concerning: (1) Any payment for the
benefit of a physician, dentist, or other licensed health care
practitioner which was made as the result of a settlement or judgment
of a claim of medical malpractice if an appropriate determination is
made in accordance with agency policy that payment was related to
substandard care, professional incompetence or professional
misconduct on the part of the individual; (2) a final decision which
relates to possible incompetence or improper professional conduct
that adversely affects the clinical privileges of a physician or
dentist for a period longer than 30 days; or, (3) the acceptance of
the surrender of clinical privileges or any restriction of such
privileges by a physician or dentist either while under investigation
by the health care entity relating to possible incompetence or
improper professional conduct, or in return for not conducting such
an investigation or proceeding. These records may also be disclosed
as part of a computer matching program to accomplish these purposes.
- Disclosure of information related to the performance of a
health care student or provider may be made to a medical or nursing
school or other health care related training institution or other
facility with which there is an affiliation, sharing agreement,
contract or similar arrangement when the student or provider is
enrolled at or employed by the school or training institution or
other facility and the information is needed for personnel
management, rating and/or evaluation purposes.
- Disclosure of relevant information may be made to individuals,
organizations, private or public agencies, etc., with whom VA has a
contract or agreement to perform such services as VA may deem
practicable for the purposes of laws administered by VA, in order for
the contractor or subcontractor to perform the services of the
contract or agreement.
- Disclosure may be made to a Federal agency, in response to
its request, in connection with the hiring or retention of an
employee, the issuance of a security clearance, reporting of an
investigation of an employee, the letting of a contract, or the
issuance or continuance of a license, grant or other benefit given by
that agency to the extent that the information is relevant and
necessary to the requesting agency's decision on the matter.
- Disclosure of information may be made to the next-of-kin and/
or the person(s) with whom the patient has a meaningful relationship
to the extent necessary and on a need-to-know basis consistent with
good medical-ethical practices.
- On its own initiative, VA may disclose information, except
for the names and home addresses of veterans and their dependents, to
a Federal, State, local, tribal or foreign agency charged with the
responsibility of investigating or prosecuting civil, criminal or
regulatory violations of law, or charged with enforcing or
implementing the statute, regulation, rule or order issued pursuant
thereto. On its own initiative, VA may also disclose the names and
addresses of veterans and their dependents to a Federal agency
charged with the responsibility of investigating or prosecuting
civil, criminal or regulatory violations of law, or charged with
enforcing or implementing the statute, regulation, rule or order
issued pursuant thereto.
- Disclosure of relevant information may be made to a non-VA
physician or medical facility staff caring for a veteran for the
purpose of providing relevant clinical information in an urgent or
emergent situation.
Policies and practices for storing, retrieving, accessing,
retaining, and disposing of records in the system:
Storage:
Records are maintained on paper and automated storage media, such
as magnetic tape, disc or laser optical medial.
Retrievability:
Records are retrieved by name, social security number or other
assigned identifier of the enrolled veteran who is calling or about
whom the call is being made.
Safeguards:
- Access to patient-specific information located in Call Center
databases and storage areas is restricted to VA employees and
contract personnel on a ``need-to-know'' basis; strict control
measures are enforced to ensure that disclosure to these individuals
is also based on this same principle. Generally, VA Call Center file
areas are locked after normal duty hours or when the Call Center is
closed, and the facilities are protected from outside access by the
Federal Protective Service or other security personnel.
- Access to VA and contracted Call Centers and computer rooms is
generally limited by appropriate locking devices and restricted to
authorized VA employees and vendor personnel. ADP peripheral devices
are placed in secure areas (areas that are locked or have limited
access) or are otherwise protected. Information in the Veterans
Health Information Systems and Technology Architecture (VistA) may be
accessed by authorized VA employees or authorized contract employees.
Access to file information is controlled at two levels; the systems
recognize authorized employees or contract employees by a series of
individually unique passwords/codes as a part of each data message,
and personnel are limited to only that information in the file which
is needed in the performance of their official duties. Information
that is downloaded from VistA and maintained on VA or contract
personal computers is afforded similar storage and access protections
as the data that is maintained in the original files. Access to
information stored on automated storage media at other VA and
contract locations is controlled by individually unique passwords/
codes.
- Remote access to VHA information in VistA is provided to those
Call Center employees, either VA or contract staff, that require
access to information stored in the medical record. Access to this
information is protected through hardened user access and is
controlled by individual unique passwords. Additionally, contracted
Call Centers, either VA or private sector, are required to have a
separate computer security plan that meets national information
security requirements.
Retention and disposal:
Records are to be disposed of in accordance with the Veterans
Health Administration Records Control Schedule; 10-1. Paper records
and information stored on electronic storage media are maintained and
disposed of in accordance with the records disposition authority
approved by the Archivist of the United States.
System manager(s) and address:
Official responsible for policies and procedures: Chief
Consultant for Primary and Ambulatory Care (112), Department of
Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420.
Officials maintaining the system: Network and/or facility director at
the Network and/or facility where the individuals are associated.
Notification procedure:
Individuals who wish to determine whether a record is being
maintained in this system under his or her name or other personal
identifier, or wants to determine the contents of such record, should
submit a written request or apply in person to the last VA health
care facility where care was rendered. Addresses of VA health care
facilities may be found in VA Appendix 1 at the end of this document.
Inquiries should include the person's full name, social security
number, dates of employment, date(s) of contact, and return address.
Record access procedures:
Individuals seeking information regarding access to and
contesting of records in this system may write or visit the VA
facility location where they normally receive their care.
Contesting record procedures:
(See Record Access Procedures above.)
Record source categories:
Record sources include: Enrolled patients, patients' families and
friends, private medical facilities and their clinical and
administrative staffs, health care professionals, Patient Medical
Records-VA (24VA136), VistA (79VA19), VA health care providers, and
Call Center nurses and administrative staff.
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