# Presentation: 768026

## My HealtheVet

- My Health_***e***_Vet

**April 15, 2008**

**VIReC Clinical Informatics**
**Cyber Seminar**

**Kim Nazi, FACHE**
**Veterans Health Administration**

## Presentation Objectives

**Presentation Objectives**

**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**
**Identify how the RE-AIM Performance Evaluation Framework is used to evaluate the My Health**_***e***_**Vet 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**

** **

**Personal Health Records**

**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)

** **

**Personal Health Records**

**AHIC Consumer **
**Empowerment **
**Workgroup**

- 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)

- Electronic
- Personal Health Record
- (ePHR):

** **

** ****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**

**Why Personal Health Records (PHRs)?**

## Complementary Health Records

**VA Electronic Health Record**

**My Health**_***e***_**Vet**
**Personal Health Record**

**V*****ist*****A/CPRS is the authoritative VA medical record.**
**Veteran "owns" his/her ****My Health**_***e***_**Vet Personal Health Record (PHR).**
**Veterans will access extracted data sent to My Health**_***e***_**Vet from VA Electronic Health Record (EHR).**
**Veteran controls access to information (via delegation).**

**CPRS ******** VistA ****** **BCMA**
**VistA Imaging**

**Inform**
**Engage**
**Activate**

**Complementary Health Records**

## pilot

**pilot**

**N = 7,500 **
**pilot participants **
**at nine VAMCs**

** ****Medical Record Extracts**
** ****Self-entered Metrics**
** ****Patient Health Education Libraries**
** ****Delegation**

**My Health**_***e***_**Vet Pilot **

- 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**

**Pilot Informs National Release **

## program

**program**

**More than 569,000**
**Registered Users**

**My Health**_***e***_**Vet 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...**

**Incremental releases of new features:**
**(VistA EHR, Secure Messaging, Delegation)**

**www.myhealth.va.gov**

**National My Health**_***e***_**Vet PHR**

## 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**

**Robust Patient Health Education **

## collaboration

**Recent Research Collaborations **

**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.

## 3-Tier Access Model

**3 Tier **
**Access **
**Model**
**Visitors**
**Registrants**
**In Person Authentication (IPA)**

**3-Tier Access Model**

_**www.myhealth.va.gov**_** **

## Personal Information

**Personal **
**Information**
**In Case of Emergency**
**Printable **
**Wallet Card**
**My Profile**
**Account**
**Management**

_**www.myhealth.va.gov**_** **

**Personal Information**

## Pharmacy

**Pharmacy**
**Refill**
**Prescriptions**
**Prescriptions History**
**Medications, OTC, Herbals, Supplements**
**Complete Medication List**

_**www.myhealth.va.gov**_** **

**Pharmacy**

## 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**_** **

**Research Health**

## Access Care

**Get Care**
**Caregivers**
**Providers and Physicians**
**Treatment Facilities**
**Treatment Locations**
**My Coverage**
**Health Insurance**
**Health Calendar**

_**www.myhealth.va.gov**_** **

**Access Care**

## 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**_** **

**Track Health**

## Resources

**Resources**

**My Health**_***e***_**Vet National Demo Account**
- _http://www.myhealth.va.gov_
- username: mhvuser
- password:  mhvdemo#1
**My Health**_*e*_**Vet Pilot Demo Account**
- _http://www.health-evet.va.gov_
- username: demouserb
- password:  password_$1
**My HealtheVet Product Website**
- _http://vaww.va.gov/MyHealtheVet_

## Statistics Summary 

**Statistics Summary **

**Nearly 24 million veterans and 259,000 VA Staff are eligible to use My Health**_***e***_**Vet; 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 Health**_***e***_**Vet since launched in November 2003 (~129,000 visits weekly)**

## 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

## My HealtheVet National Program Statistics

**My Health**_***e***_**Vet National Program Statistics**

## My HealtheVet National Program Statistics

**My Health**_***e***_**Vet National Program Statistics**

**Geographical Distribution of Registrants**

- Planning Systems Support Group (PSSG)

**usage**

**Top Self-Entered Metrics:**
- Medication Histories
- Health History
- Weight
- Blood Pressure

**#1: Online Prescription Refill**

**My Health**_***e***_**Vet National Program Statistics**

## My HealtheVet Release Schedule

**My Health**_***e***_**Vet Release Schedule**

**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

## Implementation Strategies 

**Implementation Strategies **

** ****Health Literacy**
** ****Measuring “Empowerment”**
** ****Clinical Adoption**
** ****Interoperability**

**Additional **
**Considerations**

## evaluate

- 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

**Goals****:**

**evaluate**

## Performance Evaluation 

**Performance Evaluation **

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

## 1

**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**

**Period of Service**

**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**

**Frequency of Visits**

**1**

**Age**

**2**

**3**

## My HealtheVet ACSI Results 

- 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

**Trying to Accomplish**

**What were you trying to accomplish today?**

## My HealtheVet ACSI Preferences

**What additional services would you like to see?**

## My HealtheVet Satisfaction: ACSI

**Considering all of your experiences to date, how satisfied are you with the My Health**_***e***_**Vet program overall?**

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

**How likely are you to return to this site?**

**Results:  8.3 out of 10**

**Results:  8.6 out of 10**

**Results:  9.1 out of 10**

## Connecting Operations & Research

**Connecting Operations & 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**

## Research Collaboration

**Research Collaboration**

**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**

## Next Steps

**Next Steps**

-  Policy framework
-  Technical infrastructure
-  Research “Summit”
-  Community of Practice

- 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.

- For questions/comments/suggestions about this presentation or research related to My Health_*e*_Vet please contact Kim Nazi via email at kim.nazi@va.gov