MAY 21 2013 

The My HealtheVet Personal Health Record Portal in 

2013: New Features, Study Findings, and Opportunities

VIReC Cyberseminar

Kim Nazi, PhD, FACHE

Management Analyst, V/CHIO, Office of Informatics and Analytics

Fran Weaver, PhD

Director, Health Services Research, Hines VA Hospital
VETERANS HEALTH ADMINISTRATION

Poll

2 

What best describes your work at VA?

• Research 

• Clinical

• Administrative

• Other 

• Non-VA
VETERANS HEALTH ADMINISTRATION

Objectives

3

• New/enhanced features including VA Blue Button 

expansion

• Study findings on PHR/Secure Messaging

• Strategies/opportunities for research collaboration 
VETERANS HEALTH ADMINISTRATION

My HealtheVet

4 

• Provide Veterans with an easy to use 

Personal Health Record (PHR), trusted 

health education resources, and tools

• Give VA patients easier access to their 

personal health information

• Provide them with tools to understand 

and manage their information

• Support their need to communicate 

easily with their health care team(s)
VETERANS HEALTH ADMINISTRATION 5 

Overview of My HealtheVet Features

• Self-entered information:

 Personal information (contacts, providers, insurance, etc.)

 Personal, family and military health history

 HealtheLogs (blood sugar, blood pressure, weight, etc.)

 Medications (over-the-counter drugs, herbals, etc.)

 Allergies, immunizations and medical events

 Food and activity journals

• VA prescription refills, medication history and blended view

• Health education resources, courses and self-assessment tools 

• Mental health resources (including online courses)

• VA Wellness Reminders 

• VA Appointments (list, health calendar and email reminders)

• VA Allergies, Immunizations, Lab test results, Problem List, etc.

• VA Notes, Radiology and Pathology Reports, Discharge Summaries

• Department of Defense (DoD) Military Service Information

• Secure Messaging with the VA health care team

• VA Blue Button: Download My Data

• VA Continuity of Care Document (VA CCD)
VETERANS HEALTH ADMINISTRATION 6 

My HealtheVet Statistics 

(as of April 2013)

Types of Accounts:

• Basic

• Advanced

• Premium

www.myhealth.va.gov

• More than 90 million visits

• Over 2.2 million registered users

• More than 1.1 million users have a 

Premium (authenticated) account

• Over 40 million VA prescription 

refills since August 2005 (1M in JAN)

• More than 770,000 unique VA 

Blue Button users since August 2010

• More than 3.6 million VA Blue 

Button file downloads

• More than 640,000 VA patients 

opted in to use Secure Messaging 

The My HealtheVet 

Member Login Box 

now contains an 

icon: B, A, or P
• Food Journal and Activity Journals from the My HealtheVet PHR now 

available in the VA Blue Button (all registered users)

• VA Blue Button now offers a significant expansion of the types of 

information from their VA EHR (including VA Notes) for Veterans with a 

Premium account

• VA Continuity of Care Document (VA CCD): a summary of clinical 

information from the VA EHR in an XML format that can be exchanged 

between providers; XML Style Sheet and PDF format (requires a Premium 

My HealtheVet account)

• My Goals: helps Veterans to set individualized, personally relevant 

recovery goals and to track progress toward achieving these goals

• New account indicator icon (B=Basic, A=Advanced, P=Premium)

Recent My HealtheVet Releases in 2013

7 L

VET earnER moANrS e aHEAL t thT

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Product website: vaww.va.gov/myhealthevet 
VETERANS HEALTH ADMINISTRATION

VA Blue Button

• For VA patients with a Premium account, 

this data includes information self-entered 

into their My HealtheVet Personal Health 

Record and data from the VA Electronic 

Health Record (EHR) 

• Veterans can easily customize their VA Blue 

Button output by selecting the date range 

and/or types of information they wish to 

include

8 

The VA Blue Button enables Veterans to view, print and download 

an electronic file (.txt, .PDF, or .bluebutton) that contains their 

available personal health information from My HealtheVet
VETERANS HEALTH ADMINISTRATION

VA Blue Button: Self Reported Data

• Demographic and Emergency Contact Information

• Health Care Providers

• Health Insurance

• Treatment Facilities

• Medical Events and Personal Medical History

• Medications, Herbals, and Supplements

• Allergies and Adverse Reactions

• Lab and Test Results

• Immunizations

• Vitals and Readings

• Family Health History (Self and Relatives)

• Military Health History

• Health Journal Data (blood sugar, blood pressure, weight, etc.)

• Food Journal and Activity Journal 9 

recent 

additions

shown in 

bold green 

font
VETERANS HEALTH ADMINISTRATION

VA Blue Button: VA Electronic Health 

Record (EHR) Data

• VA Medication History

• VA Appointments*

• VA Laboratory Results: Chemistry/Hematology/Microbiology* 

• VA Allergies*

• VA Wellness Reminders*

• VA Immunizations*

• VA Demographics*

• VA Problem List* (all active problems)

• VA Admissions and Discharges* (including Discharge Summaries) 

• VA Notes* (Progress Notes)

• VA Vitals and Readings*

• VA Pathology Reports: Surgical Pathology, Cytology, Electron Microscopy*

• VA Radiology Reports*

• VA Electrocardiogram or EKG* (list of studies) 10

*requires authentication recent 

additions

shown in 

bold green 

font
VETERANS HEALTH ADMINISTRATION

VA Blue Button: DoD Data

 DoD Military Service Information*

11

*requires authentication
VETERANS HEALTH ADMINISTRATION

VA Continuity of Care Document*

12

VA Blue Button: VA Continuity of Care 

Document (VA CCD)

*requires authentication

• Contains essential health and medical care 

information in an XML file format that uses 

recognized standards for interoperability

• Can support the exchange of information 

between health care providers for the effective 

continued care of the patient 

• Can be viewed by health care systems and 

providers who have the capability to read or 

process an XML file, or imported into other 

applications 

• Visual view (PDF) and style sheet

• Future enhancement: send securely via DIRECT

recent additions

shown in bold 

green font 
VETERANS HEALTH ADMINISTRATION

VA OpenNotes

13

• VA patients have a legal right to access all of the information in 

their VA health record. 

• VA patients often exercise this right by requesting a copy of their 

information via their local Release of Information Office.

• The My HealtheVet Pilot Program (2000-2010) demonstrated the 

value of providing patients with easier access to information 

contained in their VA health record.

• A multidisciplinary workgroup was convened in November 2012 

to identify and address communication and education needs, 

develop and execute strategy, and support successful 

implementation. 
VETERANS HEALTH ADMINISTRATION

VA OpenNotes: What is Included?

14

• VA Notes include all signed Progress Notes including primary care, 

specialty care, mental health, social work, nursing notes, Secure 

Messaging Progress Notes, etc. VA Notes also include note 

addendums. 

• VA Notes written on or after January 1, 2013 are currently available.

• VA Notes are subject to a 7 day hold, which means that they are not 

available to the patient until 7 calendar days after the note has been 

completed. Consideration being given to reduce holds in alignment 

with Meaningful Use)

• CPRS business rules are respected; for example if a co-signer is 

required, the note will not be completed until it is signed by all 

required co-signers.
VA OpenNotes: What is Included?

15

VA My HealtheVet Pilot Experience (2000-2010)

Reference: Nazi KM, Hogan TP, McInnes DK, Woods SS, and Graham G. Evaluating patient access to electronic 

health records: results from a survey of Veterans, Medical Care, 2013 Mar:51 Suppl:S52-S56. VETERANS HEALTH ADMINISTRATION doi: 10.1097/MLR.0b013e31827808db
VETERANS HEALTH ADMINISTRATION

Poll

16

Which statement most closely describes your opinion 

about patients having online access to VA Notes? 

• I think risks outweigh benefits

• I am neutral or not sure 

• I think benefits outweigh risks
VETERANS HEALTH ADMINISTRATION

Objectives 

17

• New/enhanced features including VA Blue Button 

expansion

• Study findings on PHR/Secure Messaging

• Strategies/opportunities for research collaboration 
Study Findings on PHR/Secure Messaging

The Personal Health Record Paradox: Health Care 

Professionals’ Perspectives and the Information 

Ecology of Personal Health Record Systems in 

Organizational and Clinical Settings

Reference: Nazi KM. The Personal Health Record Paradox: Health Care Professionals’ Perspectives and the 

Information Ecology of Personal Health Record Systems in Organizational and Clinical Settings. J Med Internet Res VETERANS HEALTH ADMINISTRATION 18 2013;15(4):e70. doi: 10.2196/jmir.2443
VETERANS HEALTH ADMINISTRATION 19

Why PHRs?

• More comprehensive records

• Access to trusted health education

• Convenient electronic services 

• Patient engagement and activation

• Patient safety 

• Self management/self care

• Medication reconciliation

• Wellness reminders

• Decision support

• Enhanced communication

• Patient and provider partnerships
VETERANS HEALTH ADMINISTRATION

The PHR Paradox

• Consumer interest in PHR 

features is high, while 

adoption of PHRs is relatively 

low (but growing)

• Growth and demise of various 

PHR models 

• Evolution in organizational 

patient portal systems

• Meaningful Use is crucial

Consumers value:

• Transactional services 

to accomplish tasks

• Tools that provide 

convenience 

• Easy access to their 

personal health 

information 

• Trusted relationships 

with health care 

providers and 

organizations

20
VETERANS HEALTH ADMINISTRATION 21

• Consumer empowerment is 

part of the equation

• Health care professional 

endorsement and 

engagement with patient 

PHR use is crucial and may 

be transformational

• Health care professionals and 

systems must integrate PHR 

use into the fabric of care in 

meaningful ways

A New Paradigm

Health care professionals 

value: 

• Tools that engage and 

activate patients

• Patient generated data 

(must be accessible and 

manageable)

• Solutions that integrate 

with clinical workflow 

(i.e., ‘fit’) and provide 

efficiency (i.e., relative 

advantage)
VETERANS HEALTH ADMINISTRATION 22

• Need to explore social and organizational context of health care 

delivery, relationships and interactions, information flow, and 

impact on work practices

• Little is currently known about the experiences and perspectives 

of health care professionals, the consequences of PHR use, and 

the social and organizational implications

• To understand the paradox, PHR use must be examined as a 

component of health care work, influenced by and influencing 

organizational actors and their work practices

Central Research Problem
VETERANS HEALTH ADMINISTRATION 23

Conceptual Framework

• Technologies-in-practice framework as a lens to examine not 

only technical properties and features of a technology but also 

elements of human agency and resulting practices that 

emerge from use (Orlikowski, 1999)

• Diffusion of Innovations theory (Rogers, 2003) and broader 

extensions (Greenhalgh et al., 2004)

• Information Ecology model (Nardi and O’Day, 1999) 

emphasizing the dynamic between technologies, people, 

practices and values in an ecosystem
VETERANS HEALTH ADMINISTRATION 24

Methodology

• Qualitative method: in-depth interviews conducted with 30 VA 

health care professionals (10 providers, 10 nurses, and 10 

pharmacists)

• Purposeful and theoretical sampling

• Initial background questionnaire to validate criteria for 

participation and focus interview guide questions

• Iterative data analysis; coding and analysis of transcripts using an 

inductive approach (field notes and memos)

• Analysis of organizational documents to trace history of Secure 

Messaging and Patient Aligned Care Team (PACT) implementation
VETERANS HEALTH ADMINISTRATION 25

Secure Messaging and PACT
VETERANS HEALTH ADMINISTRATION 26

Key Themes

• General awareness of My HealtheVet but little familiarity with its 

features (prior to Secure Messaging)

• Secure Messaging:

- lowers the threshold at which patients initiate communication

- improves documentation by capturing the patients voice

- is convenient and efficient (avoids phone tag), and can often 

eliminate the need for a physical visit

• Patient self report of medications via Secure Messaging is different 

(more timely, actionable, bidirectional)

• The importance of matching the method of communication with the 

need (this patient at this time) 
VETERANS HEALTH ADMINISTRATION 27

Three My HealtheVet features have been generally 

underutilized (with some notable exceptions), 

while Secure Messaging has been successfully 

implemented and used by health care professionals.

Key Finding #1

Underutilized 

• Patient health education resources

• Tools to support medication reconciliation 

• Tools to enable patient tracking and self-reporting 

of data

Utilized 

• Secure Messaging
Key Finding #2

Several factors have facilitated or inhibited the adoption, 

use, and endorsement of patient use by health care 

professionals.

Absence/Presence of Key Factors:

• Education and training opportunities geared toward the intended user

• Integration with the existing technology used to accomplish work tasks

• Alignment with workflow within the particular setting of use

• Incentives that affect intended users (e.g., organizational performance 

measures, remuneration for work efforts)

• Access to information entered by patients

• Asynchronous bidirectional communication for collaborative work tasks

VETERANS HEALTH ADMINISTRATION 28
VETERANS HEALTH ADMINISTRATION 29

Secure Messaging was the missing element of a complex 

information ecology and its implementation acted as a 

catalyst for change.

Key Finding #3

• Multidimensional dynamic between the trajectory of Secure Messaging 

implementation and PACT with impact on organizational actors and their 

endorsement and use of My HealtheVet (e.g., institutionalism of Secure 

Messaging)

• Secure Messaging perceived by health care professionals as a tool that has 

significant value for both themselves and patients (e.g., a way to accomplish 

patient-centered care)

• Shaping effects on workflow, work practices, and the flow of information 

between patients and their health care team (e.g., pre-appointment planning)
Key Finding #4

Secure Messaging has had dramatic consequences for 

communication, patterns of communication, and 

patient/provider relationships.

Consequences/Effects of Asynchronous Electronic Communication:

• Improves access (better connectivity) and patient perceptions of access

• Communication is more direct and focused

• Avoidance of telephone tag

• Patients and health care professionals can send/respond when they have time 

(convenience, efficiency)

• More frequent communication in between periodic in-person visits

• Lowering the threshold at which patients will initiate communication

• Improved patient engagement, satisfaction, and trust; enhanced VETERANS HEALTH ADMINISTRATION 30

patient/provider relationships
VETERANS HEALTH ADMINISTRATION 31

“It gives you a conversation that you 

might not have otherwise had, except that 

you see them once every seven to eight 

months or a year. You now have this 

interjected conversation piece that’s going 

on that allows you to find out what their 

value system is, what their reasons are, 

what the barriers are, how is it that 

they’re able to be successful ...”
VETERANS HEALTH ADMINISTRATION 32

“So it’s a different kind of information 

gathering journey...In the most simple 

sentence that I could provide I would say 

that it strengthens the relationship.”
VETERANS HEALTH ADMINISTRATION 33

“Face-to-face visits seem to have a better 

flow. I have the patient set an agenda 

when I first walk into the room rather 

than ‘What are you here for?’ I say 

‘What would YOU like to accomplish in 

this visit?’ ...and we launch from there in 

the direction that the patient really 

wants to travel.”
VETERANS HEALTH ADMINISTRATION 34

Considerations for Asynchronous 

Electronic Communication

• Secure Messaging requires an existing relationship

• Health care professionals can easily move between methods of 

communication based on a particular need

• Unanticipated consequences (both positive and negative)

• Changes in workflow and workload (i.e., as use increases)

• Further integrate within the clinical information system

• Opportunities for clinical process redesign
Examine the physical, social, and organizational structures 

and processes needed to facilitate adoption and sustained 

use of technology.

• Physical placement of patient-accessible computers (e.g., flow of the patient visit, 

proximity to enable the “teachable moment”)

• The importance of user training and education

• The importance of fit with existing systems

• Performance targets and measures as incentives

• Alignment with structures facilitates use; misalignment produces inefficiencies in a timeconstrained system

• Decentralization of processes to enable staff to assist patients at “touch points” to 

register and authenticate

• Closer examination of the activities and processes that PHR features are intended to 

support (e.g., medication reconciliation)

• VET CollERabANoraS tHivEAL e wToHr ADk reMqINuI

i

STresRAtiT

meIONly information sharing and interactive communication 35

Additional Considerations
36

Areas for Future Research

Adoption Further identify facilitators and inhibitors to adoption and use at 

multiple levels (system, organizational, individual) taking into account 

the various roles of health care professionals.

Implementation Develop approaches grounded in implementation science to measure 

the efficacy of implementation strategies.

Education Design and test interventions that will improve health care 

professional’s knowledge and familiarity with the system and its 

features.

Information Flow Model information flow and map to health care processes and 

activities across the patient trajectory to identify optimal ways to 

apply technology.

Communication Apply communication theory to further examine the nuances of 

VETERANS HEALTH ADasMynINcI

h

STroRnAoTuIOs eN lectronic communication.

Needs:

• sociotechnical and multilevel approach to research

• research in the context of health care processes
VETERANS HEALTH ADMINISTRATION 37

Implications 

• The PHR Paradox: Looking beyond commonly 

reported barriers

• The important influence of health care 

professional endorsement and engagement in 

patient use of PHR tools

• Ongoing education and training opportunities 

for health care professionals

• Health care processes, information flow and 

bidirectional communication (e.g., medication 

reconciliation) 

• Further research should focus on health care 

processes

• Implications for workload
VETERANS HEALTH ADMINISTRATION 38

Activities in the Patient Trajectory
VETERANS HEALTH ADMINISTRATION

Objectives 

39

• New/enhanced features including VA Blue Button 

expansion

• Study findings on PHR/Secure Messaging

• Strategies/opportunities for research collaboration 
VETERANS HEALTH ADMINISTRATION

Poll

40

Are you currently conducting or planning to conduct a 

research study that involves My HealtheVet?

• Yes

• No

• Not sure yet
VETERANS HEALTH ADMINISTRATION

Research Opportunities

41

• MHV as an intervention

• MHV as a source of data

• eHealth QUERI Center

- Adoption

- Meaningful Use
VETERANS HEALTH ADMINISTRATION 42

•eHealth QUERI letter of support

- For projects that align with their strategic plan

•Letters for grant submissions, CDA applications

- Letter request checklist*

• Does the project require any resources from MHV?

• Does it require access to MHV data?

- MHV administrative data

- Patient self-entered data

- Other (ASCI, activity)

- Copy of proposal 

- Where grant is being submitted

- Timeline (2-3 weeks advance notice)

Requesting Letters of Support from MHV

*email: frances.weaver@va.gov
American Consumer Satisfaction 

Index (ACSI):

• Demographics

• Use, Reason for visit

• Satisfaction

• Custom questions

• Requires DUA

Other Data/Sources:

• IPA (Premium) Flag (national or 

local CPRS)

• SHEP

• MHV Coordinators

• PACT Compass measures 

(VSSC)

43

My HealtheVet Data and Sources

Administrative Data:

• Patient demographics 

• Level of MHV access

• Date and type of transaction

• Web analytics

• Blue Button downloads

Patient self-entered:

• Track health (BP, weight)

• Health journals (food, 

exercise)

• Health history

• Medications & supplements

VET

• My Goals ERANS HEALTH ADMINISTRATION
VETERANS HEALTH ADMINISTRATION

Frequently Asked Questions (FAQs) about 

Research with My HealtheVet

• Can MHV administrative data be used for 

research?

– Updates to the System of Records (2010) and MHV Terms 

& Conditions (2012) specify research as a purpose for use 

of administrative data for authorized and IRB approved 

studies. 

– MHV is working with VSSC to populate a MHV Data Mart 

within the CDW (not yet available).

– Requests would be managed through DART system similar 

to other program data.

44
VETERANS HEALTH ADMINISTRATION

FAQs continued

• Can MHV administrative data, including emails be used 

for research-related communication?

– No, Terms & Conditions do NOT specify that account 

emails can be used for research-related communication.

• Can MHV Secure Messaging content be used for 

research? 

– SM content is not stored in the CDW. Activity related to 

SM use is stored (supporting PACT Compass) and is 

available through VSSC.

– Accessing content would require IRB approval and patient 

informed consent.

45
VETERANS HEALTH ADMINISTRATION

• Can MHV Secure Messaging be used for research 

communication? 

– Workgroup identified three scenarios:

1. Use SM for research-related communication.

Not currently - Recommend pilot to explore this use and identify 

any issues to be addressed.

2. Use SM to deliver interventions.

Support this use within IRB framework.

3. Use SM for study recruitment (e.g., distribute flyers).

Not recommended – Could be perceived as burdensome or 

inappropriate by patients; and dilute patient-provider channel of 

communication.

46

FAQs continued
VETERANS HEALTH ADMINISTRATION

Summary of Projects requesting MHV 

support 

• 54 Requests for Letters of Support in past 3-4 years

• 5 CDAs, 26 RRPs, 3 SDPs, 4 RR&Ds, 10 IIRs, 6 other

• Variety of Topics

– Caregiver support

– Medication adherence

– Open Notes

– Health literacy

– Care transitions

– Promoting MHV adoption/use in special populations

– MHV use in PACT

– eHealth measures

– Proactive SM

– Pain Management

47
VETERANS HEALTH ADMINISTRATION

Questions? 

48

Contact Information:

kim.nazi@va.gov

frances.weaver@va.gov