1. 11 My HealtheVet April 15, 2008 VIReC Clinical Informatics Cyber Seminar Kim Nazi, FACHE Veterans Health Administration

2. 22 topics Presentation 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

3. 33 PHRs Personal 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)

4. 44 Personal 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):

5. 55 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)?

6. 66 VA Electronic Health Record My 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  BCMA VistA Imaging Inform Engage Activate Complementary Health Records

7. 77 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

8. 88 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 PHR

9. 99 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 Robust Patient Health Education

10. 10 collaboration Recent Research Collaborations 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.

11. 11 3 Tier Access Model Visitors Registrants In Person Authentication (IPA) 3-Tier Access Model www.myhealth.va.gov

12. 12 Personal Information In Case of Emergency Printable Wallet Card My Profile Account Management www.myhealth.va.gov Personal Information

13. 13 Pharmacy Refill Prescriptions Prescriptions History Medications, OTC, Herbals, Supplements Complete Medication List www.myhealth.va.gov Pharmacy

14. 14 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

15. 15 Get Care Caregivers Providers and Physicians Treatment Facilities Treatment Locations My Coverage Health Insurance Health Calendar www.myhealth.va.gov Access Care

16. 16 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

17. 17 Resources My HealtheVet National Demo Account http://www.myhealth.va.gov username: mhvuser password: mhvdemo#1 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

18. 18 statistics 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)

19. 19 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

20. 20 Veteran Population versus Registrant Age Distributions My HealtheVet National Program Statistics

21. 21 My HealtheVet National Program Statistics Geographical Distribution of Registrants Planning Systems Support Group (PSSG)

22. 22 usage Top Self-Entered Metrics: 1.Medication Histories 2.Health History 3.Weight 4.Blood Pressure 1.5 Steps to Safer Health Care 2.Vitals Readings Worksheet 3.Food Journal Worksheet 4.Activity Journal Worksheet 5.IPA Form Top 5 Downloaded Files 1. Living with Advanced Congestive Heart Failure 2. Innovative Caregiver Practices 3. 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 Statistics

23. 23 roadmap My 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

24. 24 OutreachAccessStaffClinical Use Implementation Strategies Health Literacy Measuring “Empowerment” Clinical Adoption Interoperability Additional Considerations

25. 25 Performance 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

26. 26 Performance Evaluation *An extension of the RE-AIM Framework www.re-aim.org

27. 27 My HealtheVet ACSI Results 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 Period of Service 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 Frequency of Visits 1% 19 – 30 years 4% 31 – 40 years 10% 41 – 50 years 35% 51 – 60 years 33% 61 – 70 years 17% 71 or older * 68% are between 51-70 years old 1 Age 2 3

28. 28 My HealtheVet ACSI Results 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 Trying to Accomplish What were you trying to accomplish today?

29. 29 My HealtheVet ACSI Preferences What additional services would you like to see?

30. 30 My 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

31. 31 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

32. 32 synergy Research 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

33. 33 5 www.myhealth.va.gov celebrating 5 years of online access to VA health care. Next 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 2 nd at 2pm EST. For more information please contact Carolyn Turvey via email at Carolyn-Turvey@uiowa.edu. For questions/comments/suggestions about this presentation or research related to My HealtheVet please contact Kim Nazi via email at kim.nazi@va.gov