Overcoming Obstacles in Implementing My HealtheVet

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Overcoming Obstacles in Implementing My
HealtheVet
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Problem

• Boston was having difficulty cultivating interest
  in MHV
• Clinicians often felt they had too much to do
  already
• Veterans never heard of My HealtheVet (MHV) and
  had little to no understanding of how it could
  benefit them

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Our Goals

• To become a leader in enrolling veterans and
  completing the In Person Authentication (IPA) as
  1 of 6 test sites nationally.
• To get both staff and veterans to see My
  HealtheVet as an instrument that could have a
  positive impact on the patient/clinician
  relationship
• To demonstrate the potential for positive impact
  on patient outcomes

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Objectives

• To educate clinicians about the tools within MHV
• To help clinicians view MHV as something that
  could make their job easier, not just another
  thing they had to do
• Assist staff in finding opportunities to
  incorporate MHV in what they were already doing

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Objectives (cont)

• Increase enrollment of Veterans in MHV and
  complete IPA process on all enrolled vets
  receiving their care thru the VA
• To help veterans see how using MHV can benefit
  them and assist them in navigating within MHV,
  becoming familiar with the various options within
  the site.
• Provide supportive resources for veterans to
  facilitate their use of MHV and decrease their
  frustration when an obstacle presents itself.

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Create a Multidisciplinary MHV Teamwith members
from

• Voluntary Services
• ROI staff/HIMS
• Library Services
• Medical Media
• IRM
• QM Coordinator
• Employee Education
• Public Affairs

• Primary care
• Cardiac clinic
• Nursing Case Mgmt
• Nutrition
• Pharmacy
• Rehab Services
• Mental Health
• Surgical Services

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Meetings

• Sent out agenda prior to meeting
• Kept meetings short (lt1 hour)
• Met by conference call every week initially
• Brainstormed to gather information, then sifted
  thru and developed game plan
• Developed small achievable goals to build momentum

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Meetings (cont)

• Gave members assignments that coincided with
  their position minimized time commitment but
  maximized participation
• Attended POC calls w/ Alex Hersh the 2nd
  Tuesday/Wednesday of every month and VISN POC
  meetings to capture other facilitys ideas (dont
  re-invent the wheel)
• Visited MHV product site and training site

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To bring clinicians on-board we

• Offered short convenient classes either during
  staff meetings or at lunch time
• Sought to include MHV as part of the Annual
  Mandatory education
• Made hands-on sessions available where we showed
  the tour of MHV and The Perfect Visit and then
  had viewers create their own account.

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To bring clinicians on-board we (cont)

• Identified likely areas whose patients could
  benefit from currently available features in MHV
• Targeted those clinical areas to saturate, giving
  providers support and tools to promote MHV

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Move Program

• Assisted veterans enrolled in the Move Program
  to create accounts.
• Participants were asked to keep food and activity
  journals which could be reviewed and suggestions
  made to modify the program for optimal results.
• Weights were entered and used to track progress.
• Research Health options were introduced.

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Primary Care Team

• Patients were encouraged to create their own MHV
  account. Providers encouraged to use E-script to
  direct their patients to
• -Complete their medical history under Track
  Health and to enter weights, blood pressures
  and glucose levels between visits

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Primary Care (cont)

• -Complete the list of medications including
  herbal preps and over the counter medications and
  print out for next doctors visit (assists
  w/Medication Reconciliation process)
• - Utilize Food and Activity Journals as
  appropriate
• -Develop treatment goals
• -Research health topics

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Nurses

• Examined the materials in Research Health,
  particularly under the Medical Library which
  includes interactive tutorials for patients to
  use.

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Pharmacy

• Check to see when medications can be refilled by
  mail-order option
• Reorder medications
• Enter list of medications obtained from other
  resources including over the counter meds,
  vitamins and herbal preps and medications from
  non-VA health care providers
• Use Contact Us to report any problems

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To facilitate the use of MHV by Veterans, we

• Developed a MHV Center in the lobby of each of
  our 3 campuses which is easily accessible, highly
  visible and could provide for privacy and
  confidentiality of patients information
• Improved signage and banners to provide direction
• Sent out flyers with appointment reminders

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To facilitate the use of MHV by Veterans, we
(cont)

• Used volunteers to Man our MHV desk who can
  walk the veteran through the process of creating
  an account or assist them with features of the
  program.
• -Forged relationships with the local high
  school to bring in students needing to complete
  mandatory community service requirements
• -Worked with local colleges to develop a job
  description for their work study program

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We made ourselves visible at every event
possible!

• MHV Open Houses
• Veterans/Memorial
• Day
• Nursing Orientation
• Nursing Equipment Day
• Holiday Parties

• Veteran Employees Luncheon
• Local Council on Aging
• Women's Health VISN Seminar
• Red Sox Opening Day Party

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We made ourselves visible (Cont)

• Joined Hospital Committees which would help
  promote MHV
• -The Latest Generation committee which focuses
  on the needs of our newest veterans unique needs
  to access care
• -Patient Family Health Education
• Put announcements on our electric moving message
  boards
• Sent flyers in appointment letters
• Placed flyers in all waiting rooms in Lucite wall
  holders
• All flyers and signage bears the MHV logo

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To support our Veterans and Improve
Communications

• We added a phone number for veterans to call with
  questions specific to MHV that appears on all
  flyers
• Created an email account
• Sent out monthly e-letters
• Suggested features for them to explore
• Provided veterans with another way to trouble
  shoot issues that arise in using MHV

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Our climb to success.
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My Favorite Success Story

• Mr X sat in his wheelchair, hooked up to his
  oxygen tank, waiting to be picked up after his
  doctors appointment. After watching me assist
  several veterans in creating MHV accounts, he
  asked me what I was doing. I explained and then
  offered to assist him in creating an account.

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• Mr X shared that he was 90 yo Navy veteran and
  had served his country aboard a ship in the
  Pacific as a communications officer. He currently
  had a computer for his grandsons use but had not
  used it himself.
• Because of Parkinson's Disease, he had trouble
  using the mouse, so I made him a list of keyboard
  commands to minimize his dependence on the mouse.
  Keyboarding was somewhat familiar to him from his
  work in the Navy.
• At Christmas, I received a card from him
  thanking me for helping him with learning to use
  My HealtheVet.

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• He has celebrated his 91st birthday and now
  orders his groceries on line, enjoyed doing his
  own Christmas shopping on line, no longer
  depending on his daughter, and thanks to his
  grandson, has learned about chat rooms where he
  made a connection with a ship mate he said he had
  not heard from in 50 years!
• Using the computer has given him a sense of
  independency that he had lost as his aging body
  betrayed him. And to think it all started with
  MHV!

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In review, did we meet our goals?

• Goal 1
• To become a leader in enrolling veterans and
  completing the In Person Authentication as 1 of 6
  test sites nationally.
• In the past 9 months, we rose from 51st place
  to 2nd place with enrollment into MHV and number
  of veterans completing the IPA process.

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• Goal 2
• To get both staff and veterans to see My
  HealtheVet as an instrument that could have a
  positive impact on the patient/clinician
  relationship
• Our team has built a working collaboration
  between clinicians and our veteran population.
  Patient Satisfaction remains high.

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• Goal 3
• To demonstrate the potential for positive impact
  on patient outcomes
• It is too soon to draw any conclusions with
  this as many of the features that may impact this
  have not yet been released.