Use of the My HealtheVet for Health Information Sharing

Study Overview
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Brief Summary
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This study aims to conduct a pilot of an intervention to improve care coordination between VA and non-VA providers using the Department of Veteran's Affairs' (VA) personal health record, My HealtheVet (MHV). Participants will be randomized to receive either training on 1) how to use My HealtheVet to share VA health information or 2) training on how to how to search the Internet for health information and decide which Internet sites have good quality information. The investigators predict that Veterans who receive the My HealtheVet training will have fewer medication errors and duplication of services between the VA and outside providers.

Detailed Description
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This study aims to conduct a pilot of an intervention to improve care coordination between VA and non-VA providers using the Department of Veteran's Affairs' (VA) personal health record, My HealtheVet (MHV). Background: The Blue Button feature of My HealtheVet allows Veterans to print out a comprehensive summary of their health that can be shared with non-VA providers. Dual use is common and has been associated with negative health outcomes including higher mortality. Preliminary data collected by the principal investigator in collaboration with the My HealtheVet Performance Evaluation workgroup shows that few Veterans enrolled in My HealtheVet use it to inform either VA or non-VA providers of their care. To remedy this, the principal investigator has developed an online video and companion paper-based training. This training will teach Veterans how to use the Blue Button feature and why it is important to share the print out with their non-VA provider. Methods: To participate, Veterans must have an upcoming non-VA provider appointment, be prescribed 5 or more medications, and be registered on My HealtheVet with a premium account. Participants will be randomized to receive either training on how to use the Blue Button or training on how to search for health information on the Internet and if that information is good quality. Veterans in both arms will receive training materials and phone support. After the non-VA provider visit, both the Veteran and the provider will be asked to indicate what occurred during the visit, including whether or not the Veteran gave the provider the Blue Button print out. Both Veterans and providers will also be asked to complete a 15-minute qualitative interview about their experience during the visit. Medical records of the non-VA provider visit will be obtained. Outcomes: The main outcome for the study is whether the patient provided the non-VA provider a copy of his or her health information printed from My HealtheVet. In addition, comparison between the VA and non-VA provider records will be conducted to test whether Veterans who completed the training had 1) better medication reconciliation between the VA and the non-VA provider and 2) fewer instances of therapeutic or laboratory duplication. The results of this pilot will be used to inform a larger randomized controlled trial of the training intervention.

Official Title
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Pilot of My HealtheVet Training to Improve Co-Managed Care for Veterans

Conditions
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Chronic Illness

Intervention / Treatment
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* Behavioral: My HealtheVet Training
* Other: Internet Skills Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Upcoming Non-VA provider appointment Take 5 or more prescribed medications Have or obtain a My HealtheVet premium account Access to computer, printer, & Internet to complete study protocol Exclusion Criteria: No non-VA provider or upcoming appointment Less than 5 medications No premium MHV account

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: My HealtheVet Training<br>Participants will be asked to watch an on-line training video, review written materials, and print a document containing health information from their My HealtheVet account. | Behavioral: My HealtheVet Training<br>* Participants will be asked to watch an on-line training video, review written materials, and print a document containing health information from their My HealtheVet account.<br>|
| Active Comparator: Internet Skills Training<br>Participants will review written training materials to learn how to search the Internet for health information and how to decide which Internet sites have good quality information. | Other: Internet Skills Training<br>* Participants will review written training materials to learn how to search the Internet for health information and how to decide which Internet sites have good quality information.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Participants Who Brought Their VA Information From My HealtheVet to Their Visit With Their Non-VA Provider | The primary outcome is whether or not the veteran brings their VA information from My HealtheVet to their visit with their non-VA provider. Providers will be asked to complete a form during the appointment where assessment of sharing this information is embedded in a checklist of possible visit activities. Participants will also if they provided this information to the provider in the event the provider opts to not return the form. | Within 1-2 week of non-VA provider visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of Total Number of Unique Medications Discrepant Between VA and Non-VA Medication Lists | A medication discrepancy metric was be calculated by comparing the current VA medication list with the non-VA provider medication list to determine the total number of distinct medications. The number of discrepant medications between these lists is the numerator and is divided by the total number of distinct medications on both lists combined. This will yield a range of scores between score between 0 and 1, with 1 indicating perfect agreement between the two lists. | Typically within 1 month of non-VA provider visit | 
| Proportion of Participants Who Received One or More Duplicate Laboratory Tests in the Non-VA Provider Visit. | Therapeutic duplication will be defined as concurrent use of more than one medication from the same therapeutic class. For laboratory duplication, we will review non-VA and VA medical records 6 months prior to the non-VA provider visit. Each patient will be assigned a dichotomous indicator for whether they received therapeutic duplication and/or laboratory duplication during their non-VA provider visit | Typically within 1 month of non-VA provider visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Records, Personal, Delivery of healthcare, Consumer Participation, Internet