Finally there was one case where an electronic system was not secure there fore,the participant used paper printouts instead,Many VA provider have dual university appointment and prefer to use their corresponding university email account instead of VA email.Transmitting certain information outside of the VA electronic firewall is not permissible .Our interview related an example of an NP specifically printing information from CPRS to show to a physician rather than sending the information through email.in this case,that NP was aware that the physician only used a university email account