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My Health e Vet. VIReC Clinical Informatics Cyber Seminar. Kim Nazi, FACHE Veterans Health Administration. April 15, 2008. Presentation Objectives. topics. Provide an overview of VA’s My Health e Vet Personal Health Record as a robust set of tools to improve health and health care delivery

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My health e vet l.jpg

My HealtheVet

VIReC Clinical Informatics

Cyber Seminar

Kim Nazi, FACHE

Veterans Health Administration

April 15, 2008


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Presentation Objectives

topics

  • Provide an overview of VA’s My HealtheVet Personal Health Record as a robust set of tools to improve health and health care delivery

  • Identify how the RE-AIM Performance Evaluation Framework is used to evaluate the My HealtheVet Program

  • Share implementation strategies and lessons learned for this health information technology best practice

  • Identify recent collaborations with VA Researchers and current strategies underway to further research collaboration efforts


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Personal Health Records

PHRs

American Health Information Management Association (AHIMA):

The PHR as an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR that is collected from healthcare providers or entered by the individual. The PHR is maintained in a secure and private environment with the individual determining rights of access, it is separate from and does not replace the legal record of any provider. (2003)

Markle Foundation Connecting for Health Initiative:

The Personal Health Record is an Internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts available to those who need it. PHRs offer an integrated and comprehensive view of health information, including information people generate themselves. The PHR is a single, person-centered system designed to track and support health activities across one’s entire life experience; it is not limited to a single organization or a single health care provider. (2003)


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RWJF Project Health Design: Rethinking the Power and Potential of Personal Health Records

Personal Health Records

AHIC Consumer

Empowerment

Workgroup

Electronic

Personal Health Record

(ePHR):

An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created, gathered, and managed by the individual. The integrity of the data in the ePHR and control of access to that data is the responsibility of the individual. (Draft, 2008)


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Why Personal Health Records (PHRs)?

empower

  • more comprehensive records

  • access to trusted patient education

  • access to electronic services

  • patient engagement and activation

  • patient safety

  • medication reconciliation

  • wellness reminders

  • decision support

  • communication

  • patient and provider partnerships


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Complementary Health Records

Inform

Engage

Activate

My HealtheVet

Personal Health Record

VA Electronic Health Record

  • VistA/CPRS is the authoritative VA medical record.

  • Veteran "owns" his/her My HealtheVet Personal Health Record (PHR).

  • Veterans will access extracted data sent to My HealtheVet from VA Electronic Health Record (EHR).

  • Veteran controls access to information (via delegation).

CPRS  VistA BCMA

VistA Imaging


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Pilot Informs National Release

pilot

My HealtheVet Pilot

  • Medical Record Extracts

  • Self-entered Metrics

  • Patient Health Education Libraries

  • Delegation

  • Demographics, Admissions, Appointments, Prescriptions

  • Vitals & Allergies

  • Progress Notes, Discharge Summaries

  • Basic Problem List information

  • Lab Reports: Chemistry, Microbiology, Microscopy, Cytology, Pathology

  • ECG & Radiology reports

  • Wellness Reminders

  • Co-payment Balances

www.health-evet.va.gov

N = 7,500

pilot participants

at nine VAMCs


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National My HealtheVet PHR

program

My HealtheVet National Program

  • Online Prescription Refills

  • Health Education Information

  • Condition Centers

  • Self-assessment Tools

  • Health Journals & e-Logs

  • Veteran Specific Conditions

  • Seasonal Health Reminders

  • Wellness Calendar

  • Complete Medications View

  • and more…

www.myhealth.va.gov

More than 569,000

Registered Users

Incremental releases of new features:

(VistA EHR, Secure Messaging, Delegation)


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Robust Patient Health Education

education

Common Conditions:

Age-Related Macular Degeneration

Bipolar Disorder

Cataracts

Colds

Colorectal Cancer

Depression

Diabetes

Diabetic Retinopathy

Glaucoma

Coronary Heart Disease

Heart Failure

High Blood Cholesterol

Hypertension

Influenza

Post Traumatic Stress Disorder

Schizophrenia

Stroke

Healthy Living Centers:

Healthy Eating

Physical Activity Center

Smoking & Tobacco Use Cessation

Mental Health Screening Tools:

Alcohol Use Screening (AUDIT-C)

Depression Screening (PHQ-9)

PTSD Screening (PCL)

Substance Abuse Screening (ASSIST)

Medical Libraries:

MedlinePlus®

HealthWise®

Service Related Conditions:

Spinal Cord Injury

Post Traumatic Stress Disorder

Traumatic Brain Injury

Hearing Impairment


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Recent Research Collaborations

collaboration

Spinal Cord Injury (SCI) QUERI

Creating a Spinal Cord Injuries/Disorders Condition Center to provide condition-specific education regarding common problems in SCI/D using evidence-based consumer guides, videos and other materials for veterans with SCI/D, their caregivers and their providers.

Chronic Heart Failure (CHF) QUERI

Enhancing the current Heart Failure Center by adding 2 interactive tools for users (the Kansas City Cardiomyopathy Questionnnaire and the Minnesota Living with Heart Failure Questionnaire). Patients will be able to take these online surveys, get the scoring, and then print hard copies to take to their provider.


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3-Tier Access Model

  • 3 Tier

  • Access

  • Model

  • Visitors

  • Registrants

  • In Person Authentication (IPA)

www.myhealth.va.gov


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Personal Information

Personal

Information

In Case of Emergency

Printable

Wallet Card

My Profile

Account

Management

www.myhealth.va.gov


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Pharmacy

Pharmacy

Refill

Prescriptions

Prescriptions History

Medications, OTC, Herbals, Supplements

Complete Medication List

www.myhealth.va.gov


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Research Health

Research Health

Healthy Living Centers

Diseases and Condition Centers

Service Related Conditions

Common Conditions

Mental Health

Medical Library

MedlinePlus®

HealthWise®

www.myhealth.va.gov


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Access Care

Get Care

Caregivers

Providers and Physicians

Treatment Facilities

Treatment Locations

My Coverage

Health Insurance

Health Calendar

www.myhealth.va.gov


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Track Health

Track Health

Vitals & Readings

Labs & Tests

Health History

Family Health History

Military History

Allergies

Immunizations

Journals

Personal Health Summary

www.myhealth.va.gov


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Resources

  • My HealtheVet National Demo Account

  • http://www.myhealth.va.gov

  • username: mhvuser

  • password: mhvdemo#1

  • My HealtheVet Pilot Demo Account

  • http://www.health-evet.va.gov

  • username: demouserb

  • password: password_$1

  • My HealtheVet Product Website

  • http://vaww.va.gov/MyHealtheVet


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Statistics Summary

statistics

  • Nearly 24 million veterans and 259,000 VA Staff are eligible to use My HealtheVet; almost 8 million veterans enrolled in VA

  • More than 569,000 registered users (71% are VA patients)

  • More than 60,000 Veterans have been In Person Authenticated (IPA) and are now able to receive VA prescription medication names as the initial extract from the electronic health record, improving medication reconciliation

  • More than 5.5 Million prescription refills have been processed since August 31, 2005

  • More than 17 million visits to My HealtheVet since launched in November 2003 (~129,000 visits weekly)


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My HealtheVet National Program Statistics

Age Distribution of Registrants (December 2007)

  • Median age is 59

  • Largest segment is 60-64

  • But, younger age segments growing most for past 2 quarters


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My HealtheVet National Program Statistics

Veteran Population versus Registrant Age Distributions


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My HealtheVet National Program Statistics

Geographical Distribution of Registrants

Planning Systems Support Group (PSSG)


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Top 5 Downloaded Files

  • 5 Steps to Safer Health Care

  • Vitals Readings Worksheet

  • Food Journal Worksheet

  • Activity Journal Worksheet

  • IPA Form

Top 5 VA Health Library Downloads

1. Living with Advanced Congestive Heart Failure

2. Innovative Caregiver Practices

3. Supporting Veterans Caregivers (FAQs)

4. Post Traumatic Stress Disorder (PTSD)

5. Glaucoma

My HealtheVet National Program Statistics

usage

#1: Online Prescription Refill

  • Top Self-Entered Metrics:

  • Medication Histories

  • Health History

  • Weight

  • Blood Pressure


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My HealtheVet Release Schedule

roadmap

  • January 2008: Release 8.1 (Collection of rolling releases)

  • International Normalized Ratio (INR) - Self-Entered Information

  • Enhanced Cholesterol - Self Entered Information (Lipid Profile test results)

  • Automated E-Mail Notifications for MHV password changes or User ID requests

  • FOIA Reporting

  • Additional 8.1 PHR features are under review and planned for Spring 2008

  • Future Releases

  • Wellness Reminders

  • • View Appointments

  • • Chemistry/Lab Extracts

  • • Patient/Clinician Secure Messaging

  • • Delegation

  • • Check-In (Virtual check-in for clinic visit upon arrival)

  • • Drug Interaction Checking

  • • Treatment (Action) Plans

  • • Personalization: Information Therapy  


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Outreach

Access

Staff

Clinical Use

Implementation Strategies

  • Health Literacy

  • Measuring “Empowerment”

  • Clinical Adoption

  • Interoperability

Additional

Considerations


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Performance Evaluation

evaluate

Goals:

  • Optimize program to improve veterans health care

  • Evidence-based knowledge to support clinical adoption

  • New collaborative relationships with VA Research

  • Agency requirements (i.e., OMB 300 Program)

  • Inform external partnerships (i.e., AHIC)

  • Contribute to field of health care informatics


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Performance Evaluation

*An extension of the

RE-AIM Framework

www.re-aim.org


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1% 19 – 30 years

4% 31 – 40 years

10% 41 – 50 years

35% 51 – 60 years

33% 61 – 70 years

17% 71 or older

* 68% are between

51-70 years old

My HealtheVet ACSI Results

1

Period of Service

60% Vietnam War

19% Peacetime Service

12% Desert Shield/ Desert Storm

11% Korean War

5% World War II

5% Global War on Terror OEF/OIF

5% Other

2% Not Applicable

2

Age

3

Frequency of Visits

51% About once a month

25% About once a week

11% First time

5% About every 6 months

4% Daily

3% Less than every 6 months

1% More than once a day


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My HealtheVet ACSI Results

What were you trying to accomplish today?

Trying to Accomplish

77% Request a VA prescription refill

22% Access VA Rx history

17% Look up medication info

13% Enter personal information

12% Enter personal health care data

8% Other

6% Find VA benefits information

6% Research a health condition

2% Find a VA Facility


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My HealtheVet ACSI Preferences

What additional services would you like to see?


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My HealtheVet Satisfaction: ACSI

Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall?

Results: 8.3 out of 10

How likely are you to recommend this site to someone else?

Results: 8.6 out of 10

How likely are you to return to this site?

Results: 9.1 out of 10


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Connecting Operations & Research

research

Effective collaboration to produce evidence-based knowledge to inform program optimization

  • Focus on research agenda priorities

  • Create effective processes for collaboration

  • Align with existing methods for solicitation, approval, monitoring, compliance, and support

  • Ensure operational support for studies

  • Identify and address relevant policy needs

  • Define and implement technical infrastructure to support appropriate data access strategies


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Research Collaboration

synergy

Effective communication to produce synergy

  • Connect operations with research community

  • Track status of active projects and studies

  • Synthesize results into a centralized knowledge base

  • Utilize knowledge sharing tools and techniques to maximize information sharing

  • Build a community of practice

  • Create synergistic opportunities which advance program goals

  • Publicize results to contribute to the field of healthcare informatics


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Next Steps

5

www.myhealth.va.gov

celebrating 5 years of online access to VA health care.

  • Policy framework

  • Technical infrastructure

  • Research “Summit”

  • Community of Practice

For questions/comments/suggestions about this presentation or research related to My HealtheVet please contact Kim Nazi via email at [email protected]

Interested in further discussion about growing a Community of Practice?

We welcome your suggestions and invite you to join us for a conference call on May 2nd at 2pm EST. For more information please contact Carolyn Turvey via email at [email protected]


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