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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


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    1. My HealtheVet VIReC Clinical Informatics Cyber Seminar Kim Nazi, FACHE Veterans Health Administration April 15, 2008

    2. 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

    3. 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)

    4. 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)

    5. 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

    6. 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

    7. 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

    8. 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)

    9. 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

    10. 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.

    11. 3-Tier Access Model • 3 Tier • Access • Model • Visitors • Registrants • In Person Authentication (IPA) www.myhealth.va.gov

    12. Personal Information Personal Information In Case of Emergency Printable Wallet Card My Profile Account Management www.myhealth.va.gov

    13. Pharmacy Pharmacy Refill Prescriptions Prescriptions History Medications, OTC, Herbals, Supplements Complete Medication List www.myhealth.va.gov

    14. 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

    15. Access Care Get Care Caregivers Providers and Physicians Treatment Facilities Treatment Locations My Coverage Health Insurance Health Calendar www.myhealth.va.gov

    16. 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

    17. 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

    18. 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)

    19. 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

    20. My HealtheVet National Program Statistics Veteran Population versus Registrant Age Distributions

    21. My HealtheVet National Program Statistics Geographical Distribution of Registrants Planning Systems Support Group (PSSG)

    22. 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

    23. 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  

    24. Outreach Access Staff Clinical Use Implementation Strategies • Health Literacy • Measuring “Empowerment” • Clinical Adoption • Interoperability Additional Considerations

    25. 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

    26. Performance Evaluation *An extension of the RE-AIM Framework www.re-aim.org

    27. 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

    28. 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

    29. My HealtheVet ACSI Preferences What additional services would you like to see?

    30. 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

    31. 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

    32. 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

    33. 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 kim.nazi@va.gov 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 Carolyn-Turvey@uiowa.edu.