Jennifer S. Norris

My HealtheVet was created to help address some of the communication issues veterans had with medical providers at the Department of Veterans Affairs and is a wonderful program. We love it. When it was first created, we were finally able to easily have conversations with our medical providers and get medical clearance forms signed by our doctors enabling us to get involved in other programming including programming at other VAs. Then one day, my doctor told me that she could no longer take the medical clearance forms directly from me and it had to go through the Release of Information office. So basically, one of the communications issues we finally resolved took a step back in time. ROI informed us they could not receive anything electronically and we would have to drop the forms off, send it in the snail mail, or fax it to them on an unsecure fax. ROI reminded us that they have 20 days to fulfill a release of information request. But, they don’t have a process in place to ensure a form gets to another VA in another state by a certain suspense date.

Both my husband and I worked in communications while we served in the military and we know for a fact that the Release of Information office could easily be added to My HealtheVet secure messaging but the word we got from one of the IT folks at the VA Maine Healthcare System is that the ROI staff are resistant to change. So basically instead of them learning how to use a simple secure messaging system in My HealtheVet, they created a duplicate tracking system that doesn’t really track anything at all and puts the burden on the veterans to keep track of the paper trail. As rural veterans, we depend on the ability to use electronic communications so that we can continue to communicate with our medical providers and take good care of ourselves. Asking a home bound veteran (especially one with severe depression and anxiety) to drive to find an unsecure fax or a post office instead of using electronic communications is preposterous. The goal is to make things easier for the veteran, not the VA employees. We are the ones with the disabilities after all.

Complaint to VA Patient Advocate:

“We need help with ROI. We sent them a medical clearance form to be signed by our doctors on or around 10/5. They were not sent to our doctors until 10/17 according to ROI. All we need is a signature to clear us for the VA winter sports clinic. Every six months, we deal with this stress right up until the last minute. The suspense date is 11/1 for these forms or else we can’t attend. The ROI office despite having a ‘tracking system’ tells us every time they don’t know where the forms are (even though we have confirmed with the doctor that they signed and sent it to them) and then they pass us off to a voicemail. We are about ready to give up on all this because we can’t deal with this groundhog day scenario every six months. All we need is a simple signature and for the forms to be sent to the VA Boston Healthcare system. We shouldn’t have to stay on top of and have to make phone calls for a month to make sure this gets done. Why can’t they deal with signature only requests differently then they do regular ROI requests? Why is it that the veteran has to stay on top of this to ensure suspense dates are met. Why can’t they tell me where the forms are when they claim they have a tracking system? We need these forms to go to the VA Boston Healthcare system. It’s going from one VA to the next. We would like to speak with the Director of Togus to get this addressed once and for all. We dread this process every six months because it’s such a cluster. ROI is in fact impacting our health negatively by forcing us to make multiple phone calls to address this, not giving us straight answers, passing us off to voicemails, and making us ineligible for the winter sports clinic if the forms do not get to the appropriate people. Please help us find a way to address this once and for all so we don’t have to continue going through this red tape nightmare.” -Rural Maine Veterans

Release of Information (ROI) Process at Togus VA Maine Healthcare System:

1. Drop off form to VA in person while you are at the VA because it is a two hour drive one way (you better get a time stamped copy from them confirming they received it to cover your ass)
2. Fax it to them on an unsecure fax but there is no guarantee they got it so one has to call them to make sure they got it (they don’t care if you are rural and have to drive 50 miles to find a fax). If you use an unsecure fax, your information is stored on that public fax.
3. Snail mail the form to them but make sure and send it certified mail to once again cover your ass because you don’t want them to say they never got it. Now you have proof. (Again they don’t care if you have to pay to send them something or if you have to drive 50 miles to your closest post office)
4. Give them some time and then contact your doctor to find out if they got the form.
5. Contact your doctor again and make sure they signed the form and sent it back to ROI.
6. Give them some more time then call ROI to make sure they got the form so it can be sent to another VA in another state by the suspense date.
7. ROI tells you that they don’t have the form and when we express frustration that they can’t track the form despite their “state of the art” tracking system, we get transferred to someone else, it usually goes to voicemail. (And the voicemail cuts you off after saying your name.)
8. Call the VA to speak to someone in person so ensure we find the form so it can get to the other VA by the suspense date. Usually get passed around to at least five people who all are powerless to do anything & they usually place blame on you.
9. Ask for the VA Director, get transferred to a patient advocate, get voicemail again.
10. Patient advocate may or may not call you and tells you all the things you did wrong even though thus far you did everything right to ensure they couldn’t blame you for not getting it in on time to meet their 20 day requirement. Excuses made include: the doctor has it, we don’t know where it is, we didn’t get it, we have 20 days to process this, we need the process to work like this because it needs to go through a tracking system for HIPAA purposes (but can’t tell me where the form is despite having a tracking system and now even more people have my personal information)
11. Get upset because you did everything you were supposed to do yet somehow the whole thing gets turned around on the veteran despite driving to find a fax or to send something certified mail so they couldn’t blame you for not giving them 20 days to process it.
12. Always make a copy of the form so if they say they lost it, you can at least quickly scramble and get the second copy to ROI so you can again go through the process and meet the suspense deadline. Now you have one week to accomplish this process and need to really push the issue to meet the suspense date.
13. Mind begins to spin when told they don’t have the forms, begin to stress wondering how we can fix this so their mistakes don’t impact our ability to attend a disabled sports program recommended by doctors for mental health.
14. Have to change up schedule, block off one day to give this process all the attention you have to make sure things get done so you can in fact attend the program you need the medical clearance form for.
15. After contacting ROI and finding out they don’t know where your paperwork is, start making a plan of how you are going to make this happen before the suspense date is busted. May need to drive 2 hours one way to VA to hand carry paperwork because the fax or snail mail is useless at this point.
16. Wait for all the people you called at ROI and in administration to find your paperwork (keep paperwork back up plan in mind because there is no guarantee they will find it)
17. Complain to ROI supervisor about process and how it puts all the burden on the veteran despite the mistake being on their part. We sent the form giving them the 20 days necessary to process the paperwork but they have no obligation to make sure it gets to the other VA by the suspense date nor do they appear to care.
18. Tell ROI that they could easily fix this issue for all veterans but especially rural veterans if they would simply add the ROI office to My HealtheVet. The veteran could send the forms via secure messaging (not unsecure fax or snail mail) and we would know that they got the form.
19. Suggest they use secure messaging and after the vet forwards the release of information request to them, they could then forward it to the doctor and track that they received it.
20. Suggest Doctor send it back to ROI via secure messenger and then doctor would know that ROI received it.
21. If using secure messaging, veteran could contact ROI regarding the paperwork and ROI could then tell the veteran definitively that the doctor got it, signed it and sent it back because it’s all tracked in My HealtheVet.
22. Suggest that they use secure messenger as a way to keep the veteran informed of the status of paperwork and create a policy for ROI that forces them to keep the veteran updated when the paperwork is sent and received. This would prevent adding additional stress to the veteran for no reason AND hold people accountable.
23. Suggest they process signature only paperwork separately from other requests so that it doesn’t hinder our ability to get involved in other programs that require medical clearance from our doctors.
24. Explain that this process is counterproductive to our mental health, puts the burden on the veterans despite the VA’s mistakes, and hinders the veterans ability to get involved in other programming necessary for healing and growing.
25. Finally, after calling 10 people because you are now stressing about the fact that they can’t find the form and the suspense date is in one week, pray that they find it because if they don’t, you will be spending at least one more day trying to fix their mistake.

In summary, it’s 2017. Do we still have faxes around? If this release of information process at the VA Maine Healthcare System in Augusta, Maine isn’t the definition of red tape and bureaucracy, we don’t know what is. We have to take 25 steps to get one signature for a suspense date that means nothing to them. Now this process includes our driver’s licenses because we have been diagnosed with PTSD and we risk losing that privilege if they don’t do their part. Losing your driver’s license privilege means stuck at home, the very thing our medical providers don’t want us to do. Now we are up to four months of aggravation and chaos out of every year because we have two disabled veterans in this household. And if homebound or in the early phase of PTSD development, these are 25 very difficult steps to take because we purposefully isolate in our homes to avoid any confrontation. But guess what, we do have the internet.

We don’t take a stand until things have got so ridiculous, we just can’t take it anymore. We’d rather be a wallflower then push through intense anxiety and severe depression to address a systemic problem every time we simply need a signature. The ROI office tells us this process is in place because of HIPAA. Isn’t HIPAA supposed to safeguard your information? If so, how is this process safeguarding my personal information when you don’t know where the documents are and now even more people can lay eyes on them? If secure messaging on My HealtheVet is good enough for me to have private, sensitive conversations with my medical providers, then why isn’t it good enough for release of information documents? This process is hindering our ability to get care from providers outside the VA Maine Healthcare System and we understand why some veterans may simply give up.