My HealtheVet

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My HealtheVet
VIReC Clinical Informatics Cyber Seminar
Kim Nazi, FACHE Veterans Health Administration
April 15, 2008
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Presentation Objectives
topics

• Provide an overview of VAs My HealtheVet
  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 HealtheVet
  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

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Personal Health Records
PHRs
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 ones entire
life experience it is not limited to a single
organization or a single health care provider.
(2003)
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Personal Health Records
AHIC Consumer Empowerment Workgroup
Electronic Personal Health Record (ePHR)
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)
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Why Personal Health Records (PHRs)?
empower

• 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

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Complementary Health Records
Inform Engage Activate
My HealtheVet Personal Health Record
VA Electronic Health Record

• VistA/CPRS is the authoritative VA medical
  record.
• Veteran "owns" his/her My HealtheVet Personal
  Health Record (PHR).
• Veterans will access extracted data sent to My
  HealtheVet from VA Electronic Health Record
  (EHR).
• Veteran controls access to information (via
  delegation).

CPRS ? VistA ? BCMA VistA Imaging
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Pilot Informs National Release
pilot
My HealtheVet Pilot

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

• 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
N 7,500 pilot participants at nine VAMCs
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National My HealtheVet PHR
program
My HealtheVet 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

www.myhealth.va.gov
More than 569,000 Registered Users
Incremental releases of new features (VistA EHR,
Secure Messaging, Delegation)
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Robust Patient Health Education
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
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Recent Research Collaborations
collaboration
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.
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3-Tier Access Model

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

www.myhealth.va.gov
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Personal Information

Personal Information In Case of
Emergency Printable Wallet Card My
Profile Account Management
www.myhealth.va.gov
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Pharmacy

Pharmacy Refill Prescriptions Prescriptions
History Medications, OTC, Herbals,
Supplements Complete Medication List
www.myhealth.va.gov
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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
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Access Care

Get Care Caregivers Providers and
Physicians Treatment Facilities Treatment
Locations My Coverage Health Insurance Health
Calendar
www.myhealth.va.gov
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Track Health

Track Health Vitals Readings Labs
Tests Health History Family Health
History Military History Allergies Immunizations J
ournals Personal Health Summary
www.myhealth.va.gov
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Resources
My HealtheVet National Demo Account http//www.myh
ealth.va.gov username mhvuser password
mhvdemo1 My HealtheVet Pilot Demo
Account http//www.health-evet.va.gov username
demouserb password password_1 My HealtheVet
Product Website http//vaww.va.gov/MyHealtheVet
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Statistics Summary
statistics

• Nearly 24 million veterans and 259,000 VA Staff
  are eligible to use My HealtheVet 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 HealtheVet
  since launched in November 2003 (129,000 visits
  weekly)

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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

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My HealtheVet National Program Statistics
Veteran Population versus Registrant Age
Distributions
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My HealtheVet National Program Statistics
Geographical Distribution of Registrants
Planning Systems Support Group (PSSG)
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My HealtheVet National Program Statistics
usage
1 Online Prescription Refill

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

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My HealtheVet Release Schedule
roadmap

• 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  

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Implementation Strategies

• Health Literacy
• Measuring Empowerment
• Clinical Adoption
• Interoperability

Additional Considerations
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Performance Evaluation
evaluate
Goals

• 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

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Performance Evaluation
An extension of the RE-AIM Framework
www.re-aim.org
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My HealtheVet ACSI Results
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Period of Service
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
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Age
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Frequency of Visits
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
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My HealtheVet ACSI Results
What were you trying to accomplish today?
Trying to Accomplish
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
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My HealtheVet ACSI Preferences
What additional services would you like to see?
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My HealtheVet Satisfaction ACSI
Considering all of your experiences to date, how
satisfied are you with the My HealtheVet program
overall?
Results 8.3 out of 10
How likely are you to recommend this site to
someone else?
Results 8.6 out of 10
How likely are you to return to this site?
Results 9.1 out of 10
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Connecting Operations Research
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

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Research Collaboration
synergy

• 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

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Next Steps

• Policy framework
• Technical infrastructure
• Research Summit
• Community of Practice

For questions/comments/suggestions about this
presentation or research related to My HealtheVet
please contact Kim Nazi via email at
kim.nazi_at_va.gov
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_at_uiowa.edu.