[Federal Register Volume 74, Number 88 (Friday, May 8, 2009)]
[Notices]
[Pages 21742-21746]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-10711]


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DEPARTMENT OF VETERANS AFFAIRS


Privacy Act of 1974; System of Records

AGENCY: Department of Veterans Affairs (VA).

ACTION: Notice of Amendment to System of Records.

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SUMMARY: As required by the Privacy Act of 1974, 5 U.S.C. 552a(e), 
notice is hereby given that the Department of Veterans Affairs (VA) is 
amending the system of records currently entitled ``Telephone Service 
for Clinical Care Records-VA'' (113VA112) as set forth in the Federal 
Register 67 FR 63497. VA is amending the system of records by revising 
the System Name, Routine Uses of Records Maintained in the System 
Including Categories of Users and the Purpose of Such Uses, Storage, 
Safeguards, and System Manager and Address. VA is republishing the 
system notice in its entirety.

DATES: Comments on the amendment of this system of records must be 
received no later than June 8, 2009 If no public comment is received, 
the amended system will become effective June 8, 2009.

ADDRESSES: Written comments may be submitted through 
www.Regulations.gov; by mail or hand-delivery to Director, Regulations 
Management (02REG), Department of Veterans Affairs, 810 Vermont Avenue, 
NW., Room 1068, Washington, DC 20420; or by fax to (202) 273-9026. 
Comments received will be available for public inspection in the Office 
of Regulation Policy and Management, Room 1063B, between the hours of 8 
a.m. and 4:30 p.m., Monday through Friday (except holidays).
    Please call (202) 461-4902 (this is not a toll-free number) for an 
appointment. In addition, during the comment period, comments may be 
viewed online through the Federal Docket Management System (FDMS) at 
www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Veterans Health Administration (VHA) 
Privacy Officer, Department of Veterans Affairs, 810 Vermont Avenue, 
NW., Washington, DC 20420; telephone (704) 245-2492.

SUPPLEMENTARY INFORMATION: 

I. Description of Proposed System of Records

    The primary purpose of telephone care and service function is to 
provide veterans with clinical advice and education related to symptoms 
or problems an enrolled veteran caller may be experiencing. Calls may 
be made by family members but records of the calls will be maintained 
in the enrolled veteran's record. Except in the case of emergencies, 
clinical advice and education may only be provided to enrolled 
veterans. In order to better track and retrieve information about 
previous calls, all records of calls will be maintained under the name 
of the enrolled veteran. Records will not be retrievable by the name of 
the caller. Telephone care and service provides another mode of access 
for veterans that is available 24 hours a day, seven days a week from 
any place in the country. The telephone care function acts as a part of 
the primary and ambulatory care delivery system and augments that 
system by providing advice to callers over the telephone. When patients 
or family members call with a concern or request, a record of the call 
is developed, whether it is a clinical or administrative issue.
    Clinical symptom calls are managed through the use of pre-approved 
clinical algorithms that ask a series of questions and based on the 
answers to each question moves to the next question, which eventually 
leads to the advice that is to be provided to the caller. The record of 
the call captures the questions asked, answers given, particularly 
those answers that reflect something abnormal, and the advice provided. 
Documentation of this type of information is consistent with standard 
requirements for medical record documentation, which captures symptoms 
and findings as they relate to how specific questions are answered and 
a plan of action established. This information is also recorded in the 
patient's medical record. At a minimum, documentation includes the 
complaint(s) and symptoms of the enrolled veteran, the algorithm and/or 
protocol used and the advice given. Information is recorded either 
electronically in the progress notes of the medical record and in the 
Call Center database. Acting as a part of the primary and ambulatory 
care delivery system, the telephone care function may provide private 
sector providers or facilities with relevant clinical information about 
enrolled veterans in urgent or emergent situations. Information such as 
allergies, results of recent lab tests, medications, recent health 
history or procedures may be provided. Telephone care and service for 
clinical symptom calls are provided in a number of ways, including 
contracts with private sector vendors, contracts with VA facilities or 
Networks that have developed clinical Call Centers, or through medical 
center-based Call Centers in primary care and other types of clinics. A 
number of VA facilities and Networks are providing access to telephone 
care and service through clinics or medical center-based Call Centers 
during the day and through Network or contracted Call Centers during 
non-administrative hours. Protocols or algorithms are used at any of 
these sites when advice is given by a registered nurse without first 
consulting with a clinician and all of these calls must be documented 
in the medical record and Call Center database. Keeping records of all 
calls to a clinical Call Center in a separate database is the standard 
of practice for clinical Call Centers and is a required accreditation 
standard of the Utilization Review Accreditation Commission (URAC) for 
clinical Call Centers. Accreditation by URAC or another clinical Call 
Center accrediting body, if one should become available, is required 
for Regional or VISN call centers by the VHA Directive 2007-033 
Telephone Service for Clinical Care. This system allows a record of all 
previous calls made by or for a veteran to be accessed whenever 
patients or family members call, which improves both the quality and 
the timeliness of addressing callers' concerns. Records are generally 
collected and stored electronically for ease of retrieval by the 
veteran's name or other personal identifier. The primary purpose of the 
data in this system of records is for rapid retrieval and ease of 
access to a record of all calls made by or for veterans, including the 
complaints of the patient, the findings according to the algorithms and 
the advice provided. This information is also used for follow-up calls 
to some patients. Information is also used for aggregation of data for 
the purposes of monitoring and improving quality. Though information is 
retrievable by individual patient identifier, when reporting aggregate 
information for purposes, such as quality, patient identifiers are not

[[Page 21743]]

provided. Access to such records provide Call Center staff with 
information about previous contacts and the clinical symptoms reported 
by veterans in those contacts. The protocol used, education provided, 
advice given and actions taken by the caller in previous calls are 
readily available to Call Center staff each time a veteran or family 
member calls, which improves the quality of the services. 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. VA and contracted Call Centers are held to 
the Department of Veterans Affairs Computer Security Policy and all 
free standing and contracted Call Centers are required to develop and 
implement a Computer Security Policy that is consistent with the 
National Policy. Call Centers located within a medical center are 
required to meet the requirements of that medical center's computer 
security policy. 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. 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 databases 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.

II. Compatibility of the Proposed Routine Uses

    The Report of Intent to Amend a System of Records Notice and an 
advance copy of the system notice have been sent to the appropriate 
Congressional committees and to the Director of the Office of 
Management and Budget (OMB) as required by 5 U.S.C. 552a(r) (Privacy 
Act) and guidelines issued by OMB (65 FR 77677), December 12, 2000.
    Routine use 14 was added to disclose information to the National 
Archives and Record Administration (NARA) and the General Services 
Administration (GSA) in records management inspections conducted under 
authority of Title 44, Chapter 29, of the United States Code (U.S.C.).
    NARA and GSA are responsible for management of old records no 
longer actively used, but which may be appropriate for preservation, 
and for the physical maintenance of the Federal Government's records. 
VA must be able to provide the records to NARA and GSA in order to 
determine the proper disposition of such records.
    Routine use 15 was added to disclose information to other Federal 
agencies that may be made to assist such agencies in preventing and 
detecting possible fraud or abuse by individuals in their operations 
and programs.
    This routine use permits disclosures by the Department to report a 
suspected incident of identity theft and provide information and/or 
documentation related to or in support of the reported incident.
    Routine use 16 was added so that the VA may, on its own initiative, 
disclose any information or records to appropriate agencies, entities, 
and persons when (1) VA suspects or has confirmed that the integrity or 
confidentiality of information in the system of records has been 
compromised; (2) the Department has determined that as a result of the 
suspected or confirmed compromise, there is a risk of embarrassment or 
harm to the reputations of the record subjects, harm to economic or 
property interests, identity theft or fraud, or harm to the security, 
confidentiality, or integrity of this system or other systems or 
programs (whether maintained by the Department or another agency or 
entity) that rely upon the potentially compromised information; and (3) 
the disclosure is to agencies, entities, or persons whom VA determines 
are reasonably necessary to assist or carry out the Department's 
efforts to respond to the suspected or confirmed compromise and 
prevent, minimize, or remedy such harm. This routine use permits 
disclosures by the Department to respond to a suspected or confirmed 
data breach, including the conduct of any risk analysis or provision of 
credit protection services as provided in 38 U.S.C. 5724, as the terms 
are defined in 38 U.S.C. 5727.

    Approved: April 21, 2009.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
113VA112

SYSTEM NAME:
    Telephone Service for Clinical Care 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:
    1. 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.

[[Page 21744]]

    2. 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.
    3. 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:
    To the extent that records contained in the system include 
information protected by 45 CFR Parts 160 and 164, i.e., individually 
identifiable health information, and 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 information cannot be disclosed under a routine use unless 
there is also specific statutory authority in 38 U.S.C. 7332 and 
regulatory authority in 45 CFR Parts 160 and 164 permitting disclosure.
    1. 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.
    2. 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.
    3. 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 non-government 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 non-government 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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

[[Page 21745]]

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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. 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.
    14. Disclosure may be made to the National Archives and Records 
Administration (NARA) and the General Services Administration (GSA) in 
records management inspections conducted under authority of Title 44, 
Chapter 29, of the United States Code (U.S.C).
    15. Disclosure to other Federal agencies may be made to assist such 
agencies in preventing and detecting possible fraud or abuse by 
individuals in their operations and programs.
    16. VA may, on its own initiative, disclose any information or 
records to appropriate agencies, entities, and persons when (1) VA 
suspects or has confirmed that the integrity or confidentiality of 
information in the system of records has been compromised; (2) the 
Department has determined that as a result of the suspected or 
confirmed compromise, there is a risk of embarrassment or harm to the 
reputations of the record subjects, harm to economic or property 
interests, identity theft or fraud, or harm to the security, 
confidentiality, or integrity of this system or other systems or 
programs (whether maintained by the Department or another agency or 
entity) that rely upon the potentially compromised information; and (3) 
the disclosure is to agencies, entities, or persons whom VA determines 
are reasonably necessary to assist or carry out the Department's 
efforts to respond to the suspected or confirmed compromise and 
prevent, minimize, or remedy such harm. This routine use permits 
disclosures by the Department to respond to a suspected or confirmed 
data breach, including the conduct of any risk analysis or provision of 
credit protection services as provided in 38 U.S.C. 5724, as the terms 
are defined in 38 U.S.C. 5727.

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, 
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
    Records are maintained in the electronic medical record and on an 
automated storage media, such as magnetic tape, disc or laser optical 
media.

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:
    1. 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 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.
    2. 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. 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 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.
    3. 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 Care (11PC) 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

[[Page 21746]]

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 at http://www2.va.gov/directory/guide/home.asp?isFlash=1. Inquiries should include the person's full name, 
social security number, dates of employment, date(s) of contact, and 
return address.

RECORD ACCESS PROCEDURE:
    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.

[FR Doc. E9-10711 Filed 5-7-09; 8:45 am]
BILLING CODE 8320-01-P