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My HealtheVetMy HealtheVet
April 15, 2008
VIReC Clinical InformaticsCyber Seminar
Kim Nazi, FACHE
Veterans Health Administration
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topicsPresentation ObjectivesPresentation Objectives
• Provide an overview of VA’s 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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PHRs Personal Health RecordsPersonal Health Records
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 one’s entire life experience; it is not limited to a single organization or a single health care provider. (2003)
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Personal Health RecordsPersonal Health Records
RWJF Project Health Design: Rethinking the Power and Potential of Personal Health Records
AHIC Consumer Empowerment
Workgroup
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)
Electronic Personal Health Record(ePHR):
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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
Why Personal Health Records (PHRs)?Why Personal Health Records (PHRs)?
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VA Electronic Health RecordMy HealtheVet
Personal 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 BCMAVistA Imaging
InformEngageActivate
Complementary Health RecordsComplementary Health Records
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pilot
N = 7,500 pilot participants
at nine VAMCs
• Medical Record Extracts• Self-entered Metrics• Patient Health Education Libraries• Delegation
My HealtheVet Pilot
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
Pilot Informs National Release Pilot Informs National Release
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program
More than 569,000 Registered Users
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…Incremental releases of new features:(VistA EHR, Secure Messaging, Delegation)
www.myhealth.va.gov
National My HealtheVet PHRNational My HealtheVet PHR
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educationCommon Conditions:Age-Related Macular DegenerationBipolar 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 EatingPhysical 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 InjuryPost Traumatic Stress DisorderTraumatic Brain InjuryHearing Impairment
Robust Patient Health Education Robust Patient Health Education
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collaborationRecent Research Collaborations Recent Research Collaborations
Spinal Cord Injury (SCI) QUERICreating 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) QUERIEnhancing 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
• Visitors
• Registrants
• In Person Authentication (IPA)
3-Tier Access Model
www.myhealth.va.gov
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Personal Information
In Case of Emergency
Printable Wallet Card
My Profile
AccountManagement
www.myhealth.va.gov
Personal Information
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Pharmacy
RefillPrescriptions
Prescriptions History
Medications, OTC, Herbals, Supplements
Complete Medication List
www.myhealth.va.gov
Pharmacy
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Research Health
Healthy Living Centers
Diseases and Condition Centers
Service Related Conditions
Common Conditions
Mental Health
Medical Library
MedlinePlus®
HealthWise®
www.myhealth.va.gov
Research Health
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Get Care
Caregivers
Providers and Physicians
Treatment Facilities
Treatment Locations
My Coverage
Health Insurance
Health Calendar
www.myhealth.va.gov
Access Care
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Track Health
Vitals & Readings
Labs & Tests
Health History
Family Health History
Military History
Allergies
Immunizations
Journals
Personal Health Summary
www.myhealth.va.gov
Track Health
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Resources
My HealtheVet National Demo Accounthttp://www.myhealth.va.govusername: mhvuserpassword: mhvdemo#1
My HealtheVet Pilot Demo Accounthttp://www.health-evet.va.govusername: demouserbpassword: password_$1
My HealtheVet Product Websitehttp://vaww.va.gov/MyHealtheVet
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statisticsStatistics Summary Statistics Summary
• 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 StatisticsMy HealtheVet National Program Statistics
Age Distribution of Registrants (December 2007)My Healthe Vet Registrant Distribution by Age - December 2007
521,634 Total Registrants
Median Age = 59
896
4,968
24,758
30,518
38,409
80,579
38,906
32,044
23,560
11,699
2,588
18,43018,243
52,637
95,036
48,363
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
< 20 20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+age
40-69345,542
66%
< 4067,295
13%
70+108,797
21%
• Median age is 59• Largest segment is 60-64• But, younger age
segments growing most for past 2 quarters
2020
Veteran Population versus Registrant Age Distributions
97,813
262,387
147,147
14,2870
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
<45 45-64 65-84 85+
0
50,000
100,000
150,000
200,000
250,000
300,000
VetPop Projection 9/30/2007 MHV Registrants
My HealtheVet National Program StatisticsMy HealtheVet National Program Statistics
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My HealtheVet National Program StatisticsMy HealtheVet National Program Statistics
Geographical Distribution of Registrants
Planning Systems Support Group (PSSG)
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usageTop Self-Entered Metrics:1. Medication Histories2. Health History3. Weight4. Blood Pressure
1. 5 Steps to Safer Health Care2. Vitals Readings Worksheet3. Food Journal Worksheet4. Activity Journal Worksheet5. IPA Form
Top 5 Downloaded Files
1. Living with Advanced Congestive Heart Failure2. Innovative Caregiver Practices3. Supporting Veterans Caregivers (FAQs)4. Post Traumatic Stress Disorder (PTSD)5. Glaucoma
Top 5 VA Health Library Downloads
#1: Online Prescription Refill
My HealtheVet National Program StatisticsMy HealtheVet National Program Statistics
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roadmapMy HealtheVet Release ScheduleMy HealtheVet Release Schedule
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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Outreach Access Staff Clinical Use
Implementation Strategies Implementation Strategies
• Health Literacy• Measuring “Empowerment”• Clinical Adoption• Interoperability
Additional Considerations
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Performance EvaluationPerformance Evaluation
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
Goals: evaluate
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Performance Evaluation Performance Evaluation
*An extension of the RE-AIM Framework www.re-aim.org
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My HealtheVet ACSI Results My HealtheVet ACSI Results
60% Vietnam War19% Peacetime Service12% Desert Shield/ Desert Storm11% Korean War 5% World War II 5% Global War on Terror OEF/OIF 5% Other 2% Not Applicable
Period of Service
51% About once a month25% About once a week11% First time 5% About every 6 months 4% Daily 3% Less than every 6 months 1% More than once a day
Frequency of Visits
1% 19 – 30 years 4% 31 – 40 years10% 41 – 50 years35% 51 – 60 years33% 61 – 70 years17% 71 or older
* 68% are between 51-70 years old
1Age2
3
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My HealtheVet ACSI Results My HealtheVet ACSI Results
77% Request a VA prescription refill22% 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
Trying to Accomplish
What were you trying to accomplish today?
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My HealtheVet ACSI PreferencesMy HealtheVet ACSI Preferences
What additional services would you like to see?
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My HealtheVet Satisfaction: ACSIMy HealtheVet Satisfaction: ACSI
Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall?
How likely are you to recommend this site to someone else?
How likely are you to return to this site?
Results: 8.3 out of 10
Results: 8.6 out of 10
Results: 9.1 out of 10
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research
Connecting Operations & 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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synergyResearch Collaboration
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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5www.myhealth.va.gov
celebrating 5 years of online access to
VA health care.
Next StepsNext Steps
• Policy framework • Technical infrastructure• Research “Summit” • Community of Practice
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 [email protected].
For questions/comments/suggestions about this presentation or research related to My HealtheVet please contact Kim Nazi via email at [email protected]
