# Presentation: 692504

## My HealtheVet for CAC’s – Where Do We Fit In?224

- Patricia Simon, MHV Management Analyst, National MUR Administrator
- Curtis Anderson, MHV VA System Manager

## Welcome

**Introductions**
- Patricia Simon, MHV Management Analyst and National MUR Administrator
- Curtis Anderson, MHV VA System Manager
**Announcements**
- Questions

**Notes:**
Patricia Simon, MHV Management Analyst and Product Manager for the MHV Administrative Portal.
Curtis Anderson, MHV VA Systems Manager

Bathrooms are located out the door to the 
Today’s lecture is scheduled to last 90 minutes.  We want you to leave today feeling like you can contribute to the promotion of MHV as a resource for veterans so please feel free to ask questions at anytime.  If you do not comfortable asking the question you can write it down on one of the 3x5 cards provided and we will address it at the end of the presentation.

## Learning Objectives

**Participants** will understand how they serve as part of the overall team in supporting MHV.
**Participants** will become aware of strategies and tools for educating and supporting clinical adoption.
**Participants** will be made aware of future MHV functionality.

**Notes:**
The promotion and maintenance of My HealtheVet is very much everyone’s responsibility.  When we first introduced MHV in 2003 each facility was encouraged to establish a My HealtheVet team.  The team was to be multidisciplinary in nature.  Hopefully, at that time the CAC was asked to join the team but if not you really want to become familiar with who is on the team and join if time allows.  The team is responsible for the implementation of MHV at the facility and most recently at the CBOC’s.  Many patients want to become authenticated at their point of access which in a lot of cases is a CBOC.  

The MHV national team has created a tremendous amount of material to help you in educating clinicians and employees in the use and benefits of MHV.  Alex has the monthly POC calls on the second Tuesday and Wednesday of the month to communicate important MHV news and the status of current and future functionality.  You should take advantage of listening to these calls when you can.  The MHV POC community is very generous in sharing their most successful practices with other sites.  Your role in working with Clinicians in the future supporting clinical adoption of MHV can not be stressed enough.  Just as the clinical adoption of CPRS would never have occurred without the CAC’s, the same is true for the use of MHV.

We will also let you know about future functionality that will becoming and the estimated timeframes so you can prepare.

## Why My HealtheVet?

- Who uses MHV and why?
- Veterans want to be partners in the managing their healthcare.
- Veterans are catching on very quickly to the benefits of MHV, we need to keep up.

**Notes:**
There are currently over 450,000 registered users of MHV.  Some are veterans, some are family members or advocates and some are employees.

25,000 of these users have gone through the In-Person Authentication process in anticipation of soon being able to see key portions of their VA medical records on-line.

Over 3 million prescription refills have been processed.

Let’s do the math, almost 90% of the registered users are veterans which means potentially another 405,000 veterans will be seeking authentication so that they to can see their VA records on-line over the next few years. 

Veterans can access MHV from the comfort of their homes.  They are able to see their medication names once they complete IPA when ordering their prescriptions and they have a place to write down how they are feeling.

They need to feel like they have some control over their healthcare and are in control and are making a difference.  Statistics show that veterans who are more involved in their healthcare and making decisions about their appointments are more likely to follow their regimen.

Visits are so short in some cases and there is so much to cove.  MHV allows them the opportunity to print information off and bring it in.  This way they also do not forget what they wanted to talk to the physician about.

It gives them a wealth of medical information at their fingertips so they can research a new diagnosis or symptom and know what questions to ask.

Ultimately they will have bragging rights because they can see their medical records on-line.

They can also print out an identification card with pertinent information on it to carry in their wallets.

## The CAC as part of the MHV team

- MHV POC’s
- Pharmacist/Pharmacy staff
- HIM Staff/ROI clerk

**Notes:**
MHV POC’s - Have played a critical role in introducing the concept of MHV to the hospital.  They have worked diligently over the past several years to work on setting up a space for IPA to take place, handing out materials and doing staff education.  They have set up teams, set goals, and tracked and worked with leadership to track the performance of their individual sites and VISN’s.  They also often serve as liaisons between patients and the MHV national team in gathering requirements and suggestions for improvement of the portal.

Pharmacist – Pharmacists have helped tremendously in getting on-line prescription refill up and running with MHV.  The have educated patients on the process and worked hard to make sure that they understand exactly what needs to be done to ensure that patients get the medications they need when they need them.  They continue to work on issues related to the blended medication view and getting patients to enter their non-VA medications in support of the medication reconciliation goals.

HIM Staff – The business practices that go along with In-Person Authentication are owned by the HIM staff.  They have successfully set up processes for allowing IPA to occur both at their sites and now at the CBOC’s to facilitate getting veterans enhanced access to functionality available in MHV.  They continue to play a critical role in protecting the privacy of all patient related information.

## MHV Team cont.

- Clinician/Nurses
- Patient Education
**CAC**

**Notes:**
Clinician/Nurses – Have begun to embrace the concepts of MHV and realizing how they can benefit from the functionality that MHV has to offer.  Nurses are promoting many of the journals and SEI’s in having patients track and report ongoing healthcare concerns.  They are also taking advantage of the wealth of medical information available to the patient through Medline Plus and Health wise in encouraging patients to become more educated about their disease processes.

Patient Education Staff – As each new SEI or healthy living condition center is introduced patient educators have and will continue to incorporate its use into the teachings of their diabetic clinics, obesity clinics, nutrition clinics, etc.   The have taken advantage of all the health information tools have to offer.

CAC’s – As with CPRS, the CAC will be critical in driving clinical adoption of the use of MHV with all clinicians by promoting the use of MHV before, during, and after the clinic visit.  By understanding the relationship between VistA and MHV the CAC can promote the quality and standardization of documentation to clinicians.  They can incorporate the use of MHV during clinician orientation as another tool that is available to them.

## Strategies for Clinical Adoption

- Be aggressive, join the team and ask the tough questions.

**Notes:**
 - If you are not currently part of the MHV team then please become a member.  If they are not very active get them going.  Ask the necessary questions that will help you to be comfortable with promoting the product with the clinicians.

## Strategies Cont.

- Register as a MHV user yourself.
- Keep track of personal health information.
- Track SEI’s such as weight, blood pressure, etc.
- Research educational tools as part of the trusted health information libraries.

**Notes:**
MHV has many things to offer non-VA patients as well.  You can use it to enter personal health information, use the SEI’s to track vitals, use the journals if you are dieting, etc.  Just check the VA employee box when registering.

Play with the tools and become comfortable with using them so when it comes time to show the clinician can demonstrate the use.  Experience how easy it is to navigate through MHV for the patient.

By using the MHV product for your personal use you will begin to see what the benefits are for both the clinician and the patient.  You will then be able to demonstrate the use of the SEI’s to the provider, show them how the graphing works and even show them the doctors sheet.

We all have an obligation to stay informed on what is out there and available to our patients.  This includes all employees particularly those that work in the front lines such as clinic clerks and telephone operators.

## Creating a doctor sheet

**Notes:**
 - To create a doctor sheet go to the track health tab and click on health history.  On the left you will see all of the areas that you can self-enter information into.

Health History – What has happened to the patient in the past and what is happening now in terms of symptoms that caused them to seek 
Allergies – Food and Drug allergies that the patient may have.
Immunizations – What immunizations has the patient had and when?
Medical Events – What illnesses have they had in the past, have they been hospitalized?
Personal Health Summary – This is where you can pull it all together.
Family History –  What disease processes exist within the family history.
Military Health History – What was the patient exposed to while in the military, do they have any injuries related to their time in the service?

## Doctor Sheet cont.

**Notes:**
 - Once you are done entering all of the information then click on the personal health summary tab on the left navigation bar.

 - All of this information can then be printed out on a doctors sheet that can be brought to the provider for the visit.  You can choose to add as much of the information as you want or as little on the doctor sheet.  

## Doctor Sheet cont.

**Notes:**
 - Because I only checked personal information and contact information that is all that printed on the doctor sheet.  So the self-entered personal information then displays on a one-page document that can be printed and taken in to the provider at the time of the visit.

 - By having this information printed out and brought to the provider it can shorten the number of questions they have to ask the patient and then they can focus just on what is bothering the patient on this particular visit.

## Strategies cont.

- You know who your clinical champions are.

**Notes:**
Through working with the implementation of CPRS you have been able to determine who your clinical champions are.  Who are the ones that lead by example and can convince other providers that the tools offered in CPRS are time saving and beneficial.  These are the individuals that will ultimately help to drive the adoption of MHV.

Exposing components of the PHR will require significant behavioral change in the clinical community.  As the PHR roll-out continues clinicians will  begin interacting with a veteran that is more educated and aware of their health information.  

## Strategies cont.

- Work with the Nursing Staff.

**Notes:**
 - Everyone knows that the Nursing Staff can help tremendously helpful in introducing new functionality to the providers.  There are several classes being offered this week for the nurses on how to use MHV to have patients track and monitor their progress between visits.

 - Nurses will field many of the questions that patients have regarding MHV so they should be trained early on.

## Strategies cont.

- Do you know how many of your providers are veterans?

**Notes:**
 - Convince your providers that are also veterans to register on MHV and explore what it has to offer.  Have them look at all of the medical information that is available and the healthy living centers to see the wealth of information regarding particular diagnoses.

## Strategies Cont.

- How many of your providers attended VEHU in the last three years and were introduced to MHV?

**Notes:**
If they have attended VEHU in the past few years chances are they know about MHV and might just need to be reminded.  If they are attending this year there are MHV classes that are geared towards providers so they may be looking to you for additional guidance when they return to your facility.  Get to them while they are still very enthusiastic about what they saw here this week.

We take advantage of the provider track to introduce them to how they can incorporate MHV into their practice, they will be looking to you for help with this.  Maybe they will become your clinical champions.

## MHV Pilot

- 18 Subject areas of a veteran’s individual health record are available including labs and progress notes.
- Ability to grant permission for another to view or manage an MHV account.
- Historical account  activity reporting.

**Notes:**
 - The pilot has many things that are not currently available on the national site but will be in the future.  We need to start thinking about how we can help the clinicians become comfortable with the thought of having all this health information available to the patient.

 - In VISN 2 we included the physicians right up front and let them recommend which of their patients they thought we be good candidates for the pilot program.  This gave them a sense of control and made them feel like they were part of the process.  We made sure that they knew that their feedback about MHV would help to shape the national product.  The CAC’s were educated about MHV early on and assisted with the implementation of MHV across the VISN.

## Clinician Orientation of MHV

- Introduce the relationship between CPRS and MHV right from the beginning.
- Use of the “Perfect Visit” video during new employee orientation.
- Help clinicians register for their own account within MHV so they will become familiar with what it has to offer.

**Notes:**
 - It is important for clinicians to know right up front that patients have always had access to their medical records and now they will have access over the computer.  They need to know that CPRS is still the authoritative source and that information is being copied into a patients Personal Health Record.  In cases of sensitive information they need to feel comfortable that they will still be consulted before information is released.

They need to understand that nothing in MHV substitutes for the need to continue to utilize clinical practice guidelines in communicating abnormal test results.  If anything, MHV gives them even more time to communicate with the automatic 7 day hold on certain types of reports.

Help them to understand that if they make a change in CPRS the next time a patient’s record is updated it will be available in MHV.  Also, that patients cannot make changes in MHV and expect the provider to know about them.

Introduce them to the concept of the CPRS flag so that they can recognize those patients that have been authenticated and have access to their medical records on-line.  The CPRS flag is scheduled to be released with 8.1 in the Dec 2007 timeframe.

Highlight areas within MHV that can serve as sources of patient education regarding diagnoses, treatments or medications.

Show them the SEI’s and how the graphing works so they can see the benefits for their patients.  Talk about how patients can print this information and bring it in to their visit to help the clinician.

Introduce them to the concept of the healthy living centers and the vast amount of information available there.

## Clinical Education 

- Computer orientation classes for all employees.
- Offer in-services.
- Attend staff meetings.

**Notes:**
When showing employees how to navigate through CPRS take the opportunity to show them MHV and help them to register for an account if time permits, if not, encourage them to on their own time.  

Offer in-services to target audiences and show them how the use of MHV can benefit their patient population.

Staff meetings are always a good place to discuss how all employees play a role in promoting and supporting MHV.

## Clinical Education Cont.

- Highlight content that is pertinent to that group of individuals.
- MOVE
- Primary Care/Nurse Practitioners
- Nutrition
- Mental Health

## MOVE Program

**Notes:**
MOVE – Walk through the activity and food journals.  Show them how to enter weights and then graph them.

## MOVE Program

## Primary Care/Nurse Practitioners

**Notes:**
Primary Care/Nurse Practitioners – Talk about the benefits of seeing prescription names when doing prescription refills, about patients being able to enter non-VA medicines so we can keep track of everything they are taking.  Display the use of the SEI’s in allowing patients to track their health and be compliant with watching their blood sugar, blood pressure, etc.  How about tracking their level of pain?

Talk about what MHV has to offer in terms of prevention and wellness.

## Primary Care/Nurse Practitioners cont.

-  MHV will allow them to monitor the health status of their patients more quickly.
-  It will allow them to see a fuller picture of the patients total care.
-  It will outside providers to understand the patients total care.
-  Some day they will be able to utilize progress notes as patient education tools

## Nutrition

**Notes:**
Nutrition – Again use of the food journal, the activity journal in being compliant with their diet.  Show them how the SEI for weight can be graphed.

## Mental Health

**Notes:**
Mental Health – Patients have a place where they can tell their story of what happened to them while in the service.  This can be very therapeutic.  Condition centers are very informative in helping them to understand their symptoms.

## Tools and Training Materials

- Videos from the Product website
- Handouts, FAQ’s, posters, business cards, table tents.
- Hands-on classes, help them to register, lunch and learns for MHV.
- The Perfect Visit video.
- Web-based training.

**Notes:**
 - There are a tremendous amount of training materials already available that you can take advantage of.  You can also take advantage of all of the classes that are offered this week once they are posted to the website.  You are not in this alone.

 - Find out what other CAC’s in your VISN are doing and work with them.

 - Tammy Salewsky and I will be soliciting information from both Kaiser and Vanderbilt in terms of their education plan for lab results in anticipation of the release of the chemistry/hematology later this year and we will share that information with you.

## GPO Lockdown Solution

- As a recap, a MHV Kiosk Lockdown Solution has been approved by VA IT Field Operations that will allow any PC using Windows XP SP2 as an operating system to access MHV via the VA Network.
- John Hays, OI&T Chief Technology Officer – Central Region, has the lead for coordinating implementation, maintenance, and support plans for the national rollout of this solution.

**Notes:**
The MHV Lockdown Solution uses a Microsoft Active Directory Group Policy Object (GPO) to create locked down kiosks from PCs running Windows XP SP2. This solution allows VA facilities to place MHV Kiosks on the VA WAN throughout the VA enterprise to provide patients with point-of-service access to My HealtheVet (MHV). Office of Enterprise Development and Field Operations offers this solution as the single approved and supported method for patient access to MHV over the VA WAN. 

## GPO Lockdown Solution continued

- Revisions have been made to the instruction materials that were originally distributed to the IT community.
- Questions concerning the MHV Kiosk Lockdown Solution should be referred directly to John Hays at _[john.hays2@va.gov](mailto:john.hays2@va.gov)_.

**Notes:**
 - Soon, a memo will be sent to OI&T Field Operations management instructing them to identify Kiosk Lockdown Solution support staff at all levels. After support staff is identified and trained, the MHV Kiosk Installation Instructions and MHV Kiosk Readiness Checklist will be posted on the MHV Product Website. MHV POCs will receive notification once these materials become available on the Product Website.

## Inquiring minds want to know

- Will patients be able to view scheduled appointments online?
- What about health reminders?
- What VISTA data files is the Blended Medication view pulling from?
- Can the Blended medication view be downloaded back into CPRS?

**Notes:**
 - Yes.  Eventually patients will be able to import their appointments into the Calendaring feature along with other personal appointments that they have made so that they can have just one place to see all of their appointments.  The feature that will allow them to actually make appointments will not be available until some time after the Scheduling Package is redone.

 - Yes, health reminders are due to be released later this year.

 - Blended medication is pulling from the Vista pharmacy package and will list all VA prescribed medications that are listed there in any status.

 - Not at this time.  Patients can, however, choose to print of the blended medication view and let their provider view it so they be aware of both VA prescribed and non-VA meds.  This can provide additional information to clinicians and may potentially alert them to possible life-threatening drug interactions.

## Inquiring minds cont.

- When will secure messaging be available?
- Will an audit trail be conducted?
- What is going on with Hold For Review?

**Notes:**
 - We will be discussing secure messaging as part of future functionality.

 - My HealtheVet will have an Account Activity Logging feature that will remain active at all times.

 - At this time we are revisiting the whole business process of Hold For Review.  Of great concern is the workload for both the HIMS clerk and the clinician.  The HIMS clerk for having to go back and review all patients who have already gone through IPA, to date that is about 30,000 veterans.  And the clinician who would have to go back and review records for many of these patients prior to release.  We are working on some automated solutions to be able to provide this functionality and above all protect the privacy of the patient.

## Future Functionality

- Secure Messaging
- Why should we use it?
- Clinician-Patient bi-directional messaging
- Clinician-Clinician
- Clinician Interface/Patient Interface
- Business Process for Triaging Messages
- Capturing messages in CPRS
- When?

**Notes:**
 - One study in particular that Kaiser did showed a 13.7% reduction in phone calls and office visits for patients that utilized secure messaging.  Implementation of SMS may even serve to lengthen the time between visits and reduce hospitalizations.

 - Clinician and patients will be able to communicate back and forth

 - Clinicians will also be able to e-mail other clinicians with questions

 - Clinicians will be able to access the web-browser through a tab in CPRS without having to log out.

 - Patients will be able to access the web-browser once they have logged onto MHV.

 - Clinicians will have the option to capture the contents of a message into CPRS.

 - Beta testing will be performed in the Dec/Jan timeframe with release scheduled for 2008.

- Delegation
- VA and Outside providers
- Family Members
- Home care givers
- E-Learning Management
- Previously known as SCORM or LMS
- Provides the infrastructure to deliver educational/training materials to the veteran and provide ongoing tracking of the materials viewed.
- Your Life/Your Choices – Advanced care planning that allows you to designate your wishes for future healthcare decisions.

**Notes:**
 - The objective of the Delegation feature of My HealtheVet (MHV) is to allow MHV registered users to designate delegates, and assign them privileges to view and/or update some or all of the data in their account, while maintaining privacy of their personal health records. Delegation currently exists in the pilot.  This is particularly helpful in settings where someone is helping a veteran order medications and keep track of their SEI’s.  VA providers and outside providers can be given access to a patients account through delegation.

- PHR Extracts – When ?

**Notes:**
MHV Releases 
•July 2007: Release 8.0 Calendaring v1.5, User Forgotten Password Updates, Healthwise® updates, Account Activity Log, Blended Medications View , New Healthy Living Center (Spirituality) and Condition Centers (Hepatitis C and HIV/AIDS), Terms and Conditions Reacceptance.
•Dec 2007: Release 8.1Hold for Review, PHR: Chemistry/Lab, Appointments v1, and Rx Refill update.
•Beyond the 8.1 release you can expect more
Future Releases 
•Secure Messaging
•Delegation
•E-Learning Management
•User views for clinical alerts
•Check-In; this allows an MHV user to virtually check into a clinical visit upon arrival to the facility
•Drug Interaction Checking
•Treatment (Action) Plans; plan developed by a clinician in collaboration with patient to map out treatment course
•Personalization: Information Therapy 

## Questions