Veterans Health Administration | Office of Health Information
Topics

• Consumer Pre• M y H lth ea

eV t 

V

et 

Health Record Overview

• Evaluation Pro• C d ti g R 

Con

ducti

ng Re

with My Health

• Q&A• Cross-QUERI In

d S

an urvey

Veterans Health Administration | Office of Health Information
POLL QUESTION #1 

-Before today, had you ever heard of My HealtheVet?

- Yes 

- No

Veterans Health Administration | Office of Health Information
POLL QUESTION #2 

-H i ave you ever visit

e

d the 

My H lth ea

eV t e

website at www.myhealth.va.gov

?

- Yes- No

Veterans Health Administration | Office of Health Information
Consumer Preferences

• Although few patients have 

access to online services for communicating with their 

doctors most o ld like to

• About 7% of respo

used a PHR

doctors, most w

o

uld like to

• About 8% of respo

• 77% would like reminders via 

email from their doctors when 

• About 8% of respo

sent/received emadoctor

they are due for a visit or some type of medical care

• 74% would like to communicate

• Of those who do no

PHR, 40% express 

74

% would like to communicate usin

g one for self; 4

directly with their physician via email

• 67% would like to receive test

g ;

interested in using the person they ca

• 67

% would like to receive test

results via email Source: Consumers and 

Information Technology: A Survey. California HealthFoundation April 2010 Source: Wall Street Journal Foundation, April 2010 Online/Harris Interactive Health

Care Poll, September 22, 2006 2006 

Veterans Health Administration | Office of Health Information
My HealtheVet Personal Health Record (P

www.myhealth

July 2010:

• Over 42 Million visit• Over 1 Million regist

(75% are VA patients

• Over 214,000 users 

users 

account

• Over 16.4 Million VA 

refills since August 

3 Types of Access:Visitors, Registrants, Authenticated Users 

My HealtheVet PHR:• as an intervention• as a platform to del

interventions

• as a portal with too

Veterans Health Administration | Office of Health Information
My HealtheVet Features Today

• Personal information (contacts, provide• Personal, family, and military health his• Personal health summary Personal health summary• HealtheLogs (blood pressure, weight et• Medications (over the counter drugs, he• Allergies and immunizations Allergies and immunizations• Medical events• Food and activity journals• Online VA prescription refills, VA prescr• My Complete Medications (printable su• Wallet health information card• Health calendar • Trusted health education information

• Self-assessment tools• VA Wellness Reminders

• Mental health resources (including onlin

Mental health resources (including onlin

• Secure Messaging (currently at selecte

Veterans Health Administration | Office of Health Information
My Health

eVet: Research Health

Healthy Living Centers:• Healthy Eating• Physical Activity Center • Smoking & Tobacco Use Cessat

Condition Centers:• Age-Related Macular Degeneration Smoking

& Tobacco Use Cessat

• Separation From Active Duty• Caregiver Assistance• Healthy Sleep• Emergency Preparedness

M di ti Pl it S fSmoking

& Tobacco Use Cessat

• Separation From Active Duty• Caregiver Assistance• Healthy Sleep• Emergency Preparedness

M di ti Pl it S f

• Bipolar Disorder • Breast Cancer• Cataracts • Colds • Colorectal Cancer • M

edications: Play it

S

afe

• Spirituality• Spinal Cord Injury

• M

edications: Play it

S

afe

• Spirituality• Spinal Cord Injury

Colorectal Cancer

• Depression • Diabetes • Diabetic Retinopathy • Glaucoma 

C H t Di Mental Health Screening Too

• Coronary 

Heart Disease 

• Heart Failure • High Blood Cholesterol • Hypertension • Influenza 

Mental Health Screening Too• Alcohol Use Screening (AUDIT-C• Depression Screening (PHQ-9) • PTSD Screening (PCL)• Substance Abuse Screening (AS

• Post Traumatic Stress Disorder (PTSD)• Schizophrenia • Stroke 

Med• Med• Hea

Service Related:• Spinal Cord Injury• Traumatic Brain Injury• Hearing Impairment

Hearing Impairment

• PTSD Lea

Veterans Health Administration | Office of Health Information
My HealtheVet: Get Care

Get Care:• Care provide• Treatment fac• My coverage• Health insura• H lth l d Health calend• To do list• Customize ca

Veterans Health Administration | Office of Health Information
My HealtheVet: Track Health

Track Health:• Vitals & readin• Labs & tests Labs & tests• Health history• Family health • Military health 

Military health 

• Allergies• Immunizations• Medical event• Food & activit• Personal heal

• Health • Health • Medica• Weight

Top 5

Self

Entered

Metrics

Weight

• Blood p

Veterans Health Administration | Office of Health Information
My HealtheVet: Pharmacy

Number One Request for Online Services from Veterans

Pharmacy:• VA Prescription • VA Prescription 

VA Prescription 

• Self-entered m

herbals, Over-t(OTCs), and su

• My VA medicat• My complete m

list (VA and sel

Over 16.4 Million Vrefill requests sincAugust 2005

July 2010: highest with 492,883 prescrequests

Veterans Health Administration | Office of Health Information
My HealtheVet: VA Wellness Reminders

1. Hypertension2. Influenza vacc3. P 

neumococca

4. Colorectal can5. Lipid measure

6. LDL co t o n r l7. Body mass ind8. Diabetes foot 9. Diabetes hemo10. Diabetes retin

Diabetes retin

11. Mammography 12. Cervical cance

• Empower patient• Improve access t• Promote patient 

team collaboratioteam collaboratio

• Improve health o

Veterans Health Administration | Office of Health Information
My HealtheVet Secure Messaging (SM)

• Health care team triag• Only for non-urgent co• Integration with clinica

Integration with clinica

critical to enable effect

• Available at a limited n

sites currently planninsites, currently plannin

expansion

• Veterans can request 

reqp p uest prescription re

health or administrativetc.

• Health care team resp

Secure Messaging is a new 

eHealth clinical service that 

i l d li t l f three business days

• Veterans can receive 

new Secure Messages 

V t t l 

includes an online tool for secure 

electronic communication 

between VA patients and their 

health care teams • Veterans must comple

participate

health care teams.

Veterans Health Administration | Office of Health Information
Coming Soon: the Blue Button 

Veterans Health Administration | Office of Health Information
My HealtheVet Evaluation and Research

*An extension of the RE-AIM Framework

www.re-aim.org

Veterans Health Administration | Office of Health Information
Performance Evaluation Strategies

• Web analytic tools to monitor usage patterns• Measuring satisfaction (American Customer Satisfa

Index (ACSI) Survey, Survey of Healthcare Experie

Patients (SHEP), My Health Patients (SHEP), My Health

eVet Pilot Surveys) Vet Pilot Surveys)

• Customized indicators for RE-AIM model dimensio• Performance Evaluation Roadmap Tool• Veteran Focus Groups Veteran Focus Groups• CITL Value Study and Benefit Cost Analysis• Research collaboration• Dissemination of results

Veterans Health Administration | Office of Health Information
My HealtheVet ACSI Annual Review

• Model Questions• Satisfaction Index• Trends• Priority Mapping• Benchmarks• Custom Questions Custom Questions• Segmentations• Identify Actionable Improvem• Monitor Impact

Nazi, K. (2010). Veterans’ voices: UsCustomer Satisfaction Index (ACSI) Customer Satisfaction Index (ACSI) 

My HealtheVet Personal Health Reco

characteristics, needs, and preferenc17(2):203-211.

http://www.ehealth.va.gov/EHEALTH/MHV2.asp

Veterans Health Administration | Office of Health Information
My HealtheVet Research Collaboration

• HSR&D and QUERI Research Studies• QUERI Cross-cutting Workgroup (Cyber Seminar 

My HealtheVet Research Agenda

QUERI Cross cutting Workgroup (Cyber Seminar 

Nazi, K., Hogan, T., Wagner, T., McInnes, D., Smith, B., HChumbler, N., Gifford, A., Charters, K., Saleem, J., WeingFischetti, L., & Weaver, F. (2010). Embracing a health serperspective on personal health records: Lessons learned fHealtheVet system. J Gen Intern Med, 25 Suppl 1:62-67.

Development of an eHealth QUERI July 2010: Targeted solicitation of concept papefull proposal for new QUERI Center in eHealthSeptember 2010: eHealth Collaborative Think TDevelopment of an eHealth QUERI September 2010: eHealth Collaborative Think T

Veterans Health Administration | Office of Health Information
Advisory Board Structure

Veterans Health Administration | Office of Health Information
 POLL QUESTION 

 How many of you are registered as:

• An individual• A group

Veterans Health Administration | Office of Health Information
Conducting Research with My Health

eV

 Increasing interest in use of 

eHealth techno

for improving health care access managemfor improving health care access, managemoutcomes.

 VA s transformation initiatives include Patie

’s transformation initiatives include Patie

Centered Medical Home and virtual medicithrough information technology.

 Researchers see opportunities to work with 

Health

eVet to test interventions and to imp

evidence into practice.

 My Health

eVet is many things – a source of 

h lth d li t i thealth care d

elivery sys

tem, a communicat

Veterans Health Administration | Office of Health Information
Types of Research Requests Received

•Letter of support (CDA, grant submissio•Recruit research participants Recruit research participants•Field a survey•Add co e ( o a o / oo s) cont

ent 

(inf

orm

ati

o

n

/tools)

•Identify a study cohort•Access patient self-entered information•Test an intervention• Conduct secondary analysis of ACSI 

survey data survey data

•Communicate with Veterans

Veterans Health Administration | Office of Health Information
Research Infrastructure Subgroup

 Mission: develop Mission: develop

 Membership in

standardized policies and procedures for 

Membership in

reps from: MHprogram office

submitting and reviewing research 

t

Privacy Office, Security, Policy

reques s P f er

formance 

Evaluation sub

OHI VINCI HOHI, VINCI, H

QUERI, VIReCV/CHIO

Veterans Health Administration | Office of Health Information
Other planned activities of RIG

• Determine triage criteria for approval/ disapprov

re

quests

• Develop tracking mechanism for monitor status 

approved projects

• Create necessary supporting tools (e g survey 

Create necessary supporting tools (e.g., survey 

data dictionary)

• Develop guidelines for study recruitment through 

• Id tif th h ld f id Identify thres

h

old o

f evidence necessary 

f 

or sys

implementation of findings

• Development of knowledge management system

• Clarify how links to other studies or recruitment 

Veterans should occur

Veterans Health Administration | Office of Health Information
MHV data types/sources

Data Details Acc

Administrative Data Collected as part of 

registration or IPA process (demos, SSN, 

i d)

Request to office, IRB a(change in S

zip co

d

e

) R d (SO

Recor

ds (SO

process)

Patient self-entered Track health & health Not part of t

Data journal (vitals, diet), 

health history, lab tests, medications

Patient writtconsent OR delegation o

(in process) (in process)

Veterans Health Administration | Office of Health Information
MHV data cont.

Data Details Acc

Web Analytics Web traffic (hits to a 

page, sequence of pages visited)

Request to program offapproval

ACSI Survey (American Consumer 

Demos, satisfaction with portal, reasons 

Data Use A

( (in process)Satisfaction Index)

p ,

for use of MHV, custom questions (e.g., distance to 

(p )

nearest facility, power of attorney/advance directives

Veterans Health Administration | Office of Health Information
More MHV data options

Data Details Acc

National data (VHA National data (VHA IPA Flag Austin acce

Medical SAS data sets)

Local data

IPA FlagCPRS

– IPA flag

Austin acce

Local data CPRS IPA flag, CPRS acce

medication refilled through MHV

CPRS acce

In the pipeline the pipeline: TBDMy Recovery PlanPatient Education 

My GoalsRe

ports on who took 

TBD

Management System patient education 

classes

Blue Button Project Which Veterans 

download their data 

Veterans Health Administration | Office of Health Information
Example review process: Recruiting Resear

Participants Scope of recruitment – national? Affili ti VA? If t VA ? Affili

ation: VA? If no

t, VA sponsor

?

 IRB approval? QI project? Recruitment plan – who is being rec Len

g p th of recruitment 

period?

 Direct link to survey on MHV? Relevance to VA mission? Relevance to VA mission? Needs to be reviewed by program o

prior to approval prior to approval

Veterans Health Administration | Office of Health Information
Other activities

 To submit a clinical content request:

http://vaww1.va.gov/MYHEALTHEVET/clinical_content.as

 Some Examples of Content for which Res

was involved:

• SCI H lth Li i C t SCI Healthy Living Center• Heart Failure Condition Center 

Veterans Health Administration | Office of Health Information
MHV Cross-Cutting Quality Enhancement Re

Initiative Workgroup

• Originated from a working group offered by representative

four QUERI centers and MHV Program Office representat

D b 2008 QUERI N ti l M ti December 2008 QUERI National Meeting

– Resulting publication:

Nazi KM, Hogan TP, Wagner T, et al. A Research Vision for Personal Health RecoExperiences with the VA My HealtheVet System. J Gen Intern Med. 2010;25(1): 62

• To continue the dialogue, the formation of a collaborative 

cross-cutting QUERI workgroup was proposed and funde

HSR&D in summer 2009 (RRP 09 HSR&D in summer 2009 (RRP 09-225)

• Workgroup goals

– To understand, p , pp p promote, and support the pursuit of PH

research within the context of QUERI through resourcdialogue, strengthened relationships, and exploration cutting projects across the QUERI Centers, HSR&D, tProgram Office, and other offices

Veterans Health Administration | Office of Health Information
Activities of the MHV Cross

-Cutting QUERI 

Workgroup

• Over the last year, workgroup members have engaged in 

activities in an effort to address the aforementioned goals

– Bi-monthly Conference Calls. Dedicated to the exploration o

or issues related to PHR/MHV research

– Dissemination Efforts Dissemination Efforts. Meeting minutes slide presentations 

Meeting minutes, slide presentations, 

posted on a Share Point website

– Cross-QUERI MHV Survey. Creation of a short online surve

interest levels in MHV-related research across the VHA resecommunity, perceptions of the MHV system and its features/ functionality, and needs that must be met to pursue MHV-relresearch

– Abstract(s) and Manuscript(s). Plans include a manuscript th

survey data and further explores the intersection of implemesci PHR h d h MHV ience, PHR researc

h, an

d t

he MHV system, and b 

 an a

bstra

HSR&D Annual Meeting *E

Veterans Health Administration | Office of Health Information
Survey of Cyber seminar Participants

 Purpose: to learn more about your res

interests related to My Health

eVet and 

eHealth technologies

 F ll o ow-up i t i ith l t i

n

terviews

with select survey

respondents

 Feedback will be provided to seminar 

participants and manuscript of survey 

results is planned

Veterans Health Administration | Office of Health Information
Survey Link

 In a few minutes you will receive an ema

link to a survey. We would greatly apprec

responses. Thank you for joining us toda

 Additional questions?

• Kim Nazi kim.nazi@va.gov• Fran Weaver frances.weaver@va.gov• Tim Hogan timothy.hogan@va.gov

 Please note that the survey link that you receive via email will be available until S

2010. We encourage you to complete the survey within this timeframe. Thank yo

your participation.

Veterans Health Administration | Office of Health Information
“ I feel more in control and aware of my cho

“This is a great thing for us. 

I love being able to refill prescriptions ”

I feel more in control and aware of my cho

“I like the approach because if I have a decision 

I h th i f ti ”

I love being able to refill prescriptions.

I have the information.”

Veterans Health Administration | Office of Health Information