1
|
Nazi KM, Newton T, Armstrong CM. Unleashing the Potential for Patient-Generated Health Data (PGHD). J Gen Intern Med 2024; 39:9-13. [PMID: 38252246 PMCID: PMC10937868 DOI: 10.1007/s11606-023-08461-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/06/2023] [Indexed: 01/23/2024]
Abstract
Patient-generated health data (PGHD) is data created, captured, or recorded by patients in between healthcare appointments, and is an important supplement to data generated during periodic clinical encounters. PGHD has potential to improve diagnosis and management of chronic conditions, improve health outcomes, and facilitate more "connected health" between patients and their care teams. Electronic PGHD is rapidly accelerating due to the proliferation of consumer health technologies, remote patient monitoring systems, and personal health platforms. Despite this tremendous growth in PGHD and anticipated benefits, broadscale use of PGHD has been challenging to implement with significant gaps in current knowledge about how PGHD can best be employed in the service of high-quality, patient-centered care. While the role of PGHD in patient self-management continues to grow organically, we need a deeper understanding of how data collection and sharing translate into actionable information that supports shared decision-making and informs clinical care in real-world settings. This, in turn, will foster both clinical adoption and patient engagement with PGHD. We propose an agenda for PGHD-related research in the Veterans Health Administration that emphasizes this clinical value to enhance our understanding of its potential and limitations in supporting shared decision-making and informing clinical care.
Collapse
Affiliation(s)
- Kim M Nazi
- Trilogy Federal, LLC, Arlington, VA, USA.
- KMN Consulting Services, LTD, Coxsackie, NY, USA.
- Trilogy Federal, LLC, 44 Mountain View Drive, Coxsackie, NY, 12051, USA.
| | - Terry Newton
- Office of Connected Care, US Department of Veterans Affairs, Washington, DC, USA
| | | |
Collapse
|
2
|
Haderlein TP, Guzman-Clark J, Dardashti NS, McMahon N, Duran EL, Haun JN, Robinson SA, Blok AC, Cutrona SL, Lindsay JA, Armstrong CM, Nazi KM, Shimada SL, Wilck NR, Reilly E, Kuhn E, Hogan TP. Improving Veteran Engagement with Virtual Care Technologies: a Veterans Health Administration State of the Art Conference Research Agenda. J Gen Intern Med 2024; 39:21-28. [PMID: 38252243 PMCID: PMC10937853 DOI: 10.1007/s11606-023-08488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/13/2023] [Indexed: 01/23/2024]
Abstract
Although the availability of virtual care technologies in the Veterans Health Administration (VHA) continues to expand, ensuring engagement with these technologies among Veterans remains a challenge. VHA Health Services Research & Development convened a Virtual Care State of The Art (SOTA) conference in May 2022 to create a research agenda for improving virtual care access, engagement, and outcomes. This article reports findings from the Virtual Care SOTA engagement workgroup, which comprised fourteen VHA subject matter experts representing VHA clinical care, research, administration, and operations. Workgroup members reviewed current evidence on factors and strategies that may affect Veteran engagement with virtual care technologies and generated key questions to address evidence gaps. The workgroup agreed that although extensive literature exists on factors that affect Veteran engagement, more work is needed to identify effective strategies to increase and sustain engagement. Workgroup members identified key priorities for research on Veteran engagement with virtual care technologies through a series of breakout discussion groups and ranking exercises. The top three priorities were to (1) understand the Veteran journey from active service to VHA enrollment and beyond, and when and how virtual care technologies can best be introduced along that journey to maximize engagement and promote seamless care; (2) utilize the meaningful relationships in a Veteran's life, including family, friends, peers, and other informal or formal caregivers, to support Veteran adoption and sustained use of virtual care technologies; and (3) test promising strategies in meaningful combinations to promote Veteran adoption and/or sustained use of virtual care technologies. Research in these priority areas has the potential to help VHA refine strategies to improve virtual care user engagement, and by extension, outcomes.
Collapse
Affiliation(s)
- Taona P Haderlein
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, USA.
- Department of Veterans Affairs, Veterans Emergency Management Evaluation Center, Sepulveda, CA, USA.
| | | | - Navid S Dardashti
- NYU Grossman School of Medicine, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY, USA
| | - Nicholas McMahon
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | | | - Jolie N Haun
- Research and Development Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Amanda C Blok
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jan A Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Rice University's Baker Institute for Public Policy, Houston, TX, USA
| | - Christina M Armstrong
- Connected Health Implementation Strategies, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Kim M Nazi
- Trilogy Federal, LLC, Arlington, VA, USA
- KMN Consulting Services, LTD, Coxsackie, NY, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nancy R Wilck
- Connected Health Implementation Strategies, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Erin Reilly
- VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
3
|
Turvey CL, Klein DM, Nazi KM, Haidary ST, Bouhaddou O, Hsing N, Donahue M. Racial differences in patient consent policy preferences for electronic health information exchange. J Am Med Inform Assoc 2021; 27:717-725. [PMID: 32150259 DOI: 10.1093/jamia/ocaa012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/07/2020] [Accepted: 02/25/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE This study aimed to explore the association between demographic variables, such as race and gender, and patient consent policy preferences for health information exchange as well as self-report by VHA enrollees of information continuity between Veterans Health Administration (VHA) and community non-VHA heath care providers. MATERIALS AND METHODS Data were collected between March 25, 2016 and August 22, 2016 in an online survey of 19 567 veterans. Three questions from the 2016 Commonwealth Fund International Health Policy Survey, which addressed care continuity, were included. The survey also included questions about consent policy preference regarding opt-out, opt-in, and "break the glass" consent policies. RESULTS VHA enrollees had comparable proportions of unnecessary laboratory testing and conflicting information from providers when compared with the United States sample in the Commonwealth Survey. However, they endorsed medical record information being unavailable between organizations more highly. Demographic variables were associated with gaps in care continuity as well as consent policy preferences, with 56.8% of Whites preferring an opt-out policy as compared with 40.3% of Blacks, 44.9% of Hispanic Latinos, 48.3% of Asian/Pacific Islanders, and 38.3% of Native Americans (P < .001). DISCUSSION Observed large differences by race and ethnicity in privacy preferences for electronic health information exchange should inform implementation of these programs to ensure cultural sensitivity. Veterans experienced care continuity comparable to a general United States sample, except for less effective exchange of health records between heath care organizations. VHA followed an opt-in consent policy at the time of this survey which may underlie this gap.
Collapse
Affiliation(s)
- Carolyn L Turvey
- labelVirtual Specialty Care QUERI Program: Implementing and Evaluating Technology Facilitated Clinical Interventions to Improve Access to High Quality Specialty Care for Rural Veterans, Seattle, Washington & Iowa City, Iowa, USA.,VA Office of Rural Health, Rural Health Resource Center, Iowa City, Iowa, USA.,Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center, Iowa City, Iowa, USA.,Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Dawn M Klein
- VA Office of Rural Health, Rural Health Resource Center, Iowa City, Iowa, USA.,Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center, Iowa City, Iowa, USA.,Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,J P Systems, Clifton, Virginia, USA
| | - Kim M Nazi
- Independent Information Technology Consultant, Coxsackie, New York, USA
| | - Susan T Haidary
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Omar Bouhaddou
- US Department of Veterans Affairs, Veterans Health Information Exchange Program, Washington, DC.,innoVet Health, San Diego, California, USA
| | - Nelson Hsing
- US Department of Veterans Affairs, Veterans Health Information Exchange Program, Washington, DC
| | - Margaret Donahue
- US Department of Veterans Affairs, Veterans Health Information Exchange Program, Washington, DC
| |
Collapse
|
4
|
Blok AC, Amante DJ, Hogan TP, Sadasivam RS, Shimada SL, Woods S, Nazi KM, Houston TK. Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study. J Gen Intern Med 2021; 36:592-599. [PMID: 33443693 PMCID: PMC7947092 DOI: 10.1007/s11606-020-06304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In an effort to foster patient engagement, some healthcare systems provide their patients with open notes, enabling them to access their clinical notes online. In January 2013, the Veterans Health Administration (VA) implemented online access to clinical notes ("VA Notes") through the Blue Button feature of its patient portal. OBJECTIVE To measure the association of online patient access to clinical notes with changes in healthcare utilization and clinician documentation behaviors. DESIGN A retrospective cohort study. PATIENTS Patients accessing My HealtheVet (MHV), the VA's online patient portal, between July 2011 and January 2015. MAIN MEASURES Use of healthcare services (primary care clinic visits and online electronic secure messaging), and characteristics of physician clinical documentation (readability of notes). KEY RESULTS Among 882,575 unique portal users, those who accessed clinical notes (16.2%; N = 122,972) were younger, more racially homogenous (white), and less likely to be financially vulnerable. Compared with non-users, Notes users more frequently used the secure messaging feature on the portal (mean of 2.6 messages (SD 7.0) v. 0.87 messages (SD 3.3) in January-July 2013), but their higher use of secure messaging began prior to VA Notes implementation, and thus was not temporally related to the implementation. When comparing clinic visit rates pre- and post-implementation, Notes users had a small but significant increase in rate of 0.36 primary care clinic visits (2012 v. 2013) compared to portal users who did not view their Notes (p = 0.01). At baseline, the mean reading ease of primary care clinical notes was 53.8 (SD 10.1) and did not improve after implementation of VA Notes. CONCLUSIONS VA Notes users were different than patients with portal access who did not view their notes online, and they had higher rates of healthcare service use prior to and after VA Notes implementation. Opportunities exist to improve clinical note access and readability.
Collapse
Affiliation(s)
- Amanda C Blok
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, United States Department of Veterans Affairs, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, USA.
- Systems, Populations and Leadership Department, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Daniel J Amante
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy P Hogan
- Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Medical Center, United States Department of Veterans Affairs, Bedford, MA, USA
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Stephanie L Shimada
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Medical Center, United States Department of Veterans Affairs, Bedford, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Susan Woods
- Maine Behavioral Healthcare, South Portland, ME, USA
| | - Kim M Nazi
- KMN Consulting Services, Coxsackie, NY, USA
| | - Thomas K Houston
- Learning Health Systems, Department of Medicine, Wake Forest University, Winston-Salem, NC, USA
| |
Collapse
|
5
|
Shimada SL, Zocchi MS, Hogan TP, Kertesz SG, Rotondi AJ, Butler JM, Knight SJ, DeLaughter K, Kleinberg F, Nicklas J, Nazi KM, Houston TK. Impact of Patient-Clinical Team Secure Messaging on Communication Patterns and Patient Experience: Randomized Encouragement Design Trial. J Med Internet Res 2020; 22:e22307. [PMID: 33206052 PMCID: PMC7710447 DOI: 10.2196/22307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although secure messaging (SM) between patients and clinical team members is a recommended component of continuous care, uptake by patients remains relatively low. We designed a multicomponent Supported Adoption Program (SAP) to increase SM adoption among patients using the Veterans Health Administration (VHA) for primary care. OBJECTIVE Our goals were to (1) conduct a multisite, randomized, encouragement design trial to test the effectiveness of an SAP designed to increase patient engagement with SM through VHA's online patient portal (My HealtheVet [MHV]) and (2) evaluate the impact of the SAP and patient-level SM adoption on perceived provider autonomy support and communication. Patient-reported barriers to SM adoption were also assessed. METHODS We randomized 1195 patients at 3 VHA facilities who had MHV portal accounts but had never used SM. Half were randomized to receive the SAP, and half served as controls receiving usual care. The SAP consisted of encouragement to adopt SM via mailed educational materials, proactive SM sent to patients, and telephone-based motivational interviews. We examined differences in SM adoption rates between SAP recipients and controls at 9 months and 21 months. Follow-up telephone surveys were conducted to assess perceived provider autonomy support and self-report of telephone communication with clinical teams. RESULTS Patients randomized to the SAP had significantly higher rates of SM adoption than the control group (101/595, 17.0% vs 40/600, 6.7%; P<.001). Most adopters in the SAP sent their first message without a motivational interview (71/101, 70.3%). The 10-percentage point difference in adoption persisted a full year after the encouragement ended (23.7%, 142/600 in the SAP group vs 13.5%, 80/595 in the control group, P<.001). We obtained follow-up survey data from 49.54% (592/1195) of the participants. SAP participants reported higher perceived provider autonomy support (5.7 vs 5.4, P=.007) and less telephone use to communicate with their provider (68.8% vs 76.0%, P=.05), compared to patients in the control group. Patient-reported barriers to SM adoption included self-efficacy (eg, not comfortable using a computer, 24%), no perceived need for SM (22%), and difficulties with portal password or login (17%). CONCLUSIONS The multicomponent SAP was successful in increasing use of SM 10 percentage points above standard care; new SM adopters reported improved perceptions of provider autonomy support and less use of the telephone to communicate with their providers. Still, despite the encouragement and technical assistance provided through the SAP, adoption rates were lower than anticipated, reaching only 24% at 21 months (10% above controls). Common barriers to adoption such as limited perceived need for SM may be more challenging to address and require different interventions than barriers related to patient self-efficacy or technical difficulties. TRIAL REGISTRATION ClinicalTrials.gov NCT02665468; https://clinicaltrials.gov/ct2/show/NCT02665468.
Collapse
Affiliation(s)
- Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Department of Veterans Affairs, Bedford, MA, United States
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mark S Zocchi
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Department of Veterans Affairs, Bedford, MA, United States
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Department of Veterans Affairs, Bedford, MA, United States
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States
| | - Stefan G Kertesz
- Birmingham VA Medical Center, Department of Veterans Affairs, Birmingham, AL, United States
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Armando J Rotondi
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Department of Veterans Affairs, Pittsburgh, PA, United States
- Center for Behavioral Health, Media and Technology, University of Pittsburgh, Pittsburgh, PA, United States
- Mental Illness Research Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Department of Veterans Affairs, Pittsburgh, PA, United States
| | - Jorie M Butler
- Innovation, Decision Enhancement & Analytic Sciences (IDEAS) Center, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake, UT, United States
| | - Sara J Knight
- Innovation, Decision Enhancement & Analytic Sciences (IDEAS) Center, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake, UT, United States
| | - Kathryn DeLaughter
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Department of Veterans Affairs, Bedford, MA, United States
| | - Felicia Kleinberg
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Department of Veterans Affairs, Bedford, MA, United States
| | - Jeff Nicklas
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Department of Veterans Affairs, Bedford, MA, United States
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, United States
| | - Kim M Nazi
- KMN Consulting Services, LTD, Coxsackie, NY, United States
| | - Thomas K Houston
- Section on General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| |
Collapse
|
6
|
Stewart MT, Hogan TP, Nicklas J, Robinson SA, Purington CM, Miller CJ, Vimalananda VG, Connolly SL, Wolfe HL, Nazi KM, Netherton D, Shimada SL. The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement. J Med Internet Res 2020; 22:e17744. [PMID: 32706679 PMCID: PMC7395248 DOI: 10.2196/17744] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/26/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023] Open
Abstract
Background Patients play a critical role in managing their health, especially in the context of chronic conditions like diabetes. Electronic patient portals have been identified as a potential means to improve patient engagement; that is, patients’ involvement in their care. However, little is known about the pathways through which portals may help patients engage in their care. Objective Our objective is to understand how an electronic patient portal facilitates patient engagement among individuals with diabetes. Methods This qualitative study employed semistructured telephone interviews of 40 patients living with diabetes since at least 2011, who had experienced uncontrolled diabetes, and had used secure messaging through a portal at least 4 times over 18 months. The interviews were recorded, transcribed, coded, and analyzed using primarily an inductive approach to identify how patients living with diabetes use an online health portal to support diabetes self-management. Results Overall, patients who used the portal reported feeling engaged in their health care. We identified four pathways by which the portal facilitates patient engagement and some challenges. The portal provides a platform that patients use to (1) better understand their health by asking questions about new symptoms, notes, or labs, (2) prepare for medical appointments by reviewing labs and notes, (3) coordinate care between VA (Veterans Affairs) and non-VA health care teams, and (4) reach out to providers to request help between visits. Several patients reported that the portal helped improve the patient-provider relationship; however, aspects of the portal design may hinder engagement for others. Patients reported challenges with both secure messaging and access to medical records that had negative impacts on their engagement. Benefits for patient engagement were described by many types of portal users with varying degrees of diabetes control. Conclusions Patient portals support engagement by facilitating patient access to their health information and by facilitating patient-provider communication. Portals can help a wide range of users engage with their care.
Collapse
Affiliation(s)
- Maureen T Stewart
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jeff Nicklas
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Carolyn M Purington
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Hill L Wolfe
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Kim M Nazi
- Independent Consultant, Coxsackie, NY, United States
| | - Dane Netherton
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| |
Collapse
|
7
|
Cotner BA, Chavez M, Hathaway W, Melilo C, Nazi KM, Messina W, Zilka B, Patel-Teague S, Mercedes T, Haun J. Rapid Analysis of Strategies to Implement Virtual Medical Modalities (VMM). Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
8
|
Nazi KM, Turvey CL, Klein DM, Hogan TP. A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design. J Med Internet Res 2018; 20:e10413. [PMID: 29991468 PMCID: PMC6058093 DOI: 10.2196/10413] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/14/2018] [Accepted: 06/16/2018] [Indexed: 12/24/2022] Open
Abstract
Background Health care systems have entered a new era focused on patient engagement. Patient portals linked to electronic health records are recognized as a promising multifaceted tool to help achieve patient engagement goals. Achieving significant growth in adoption and use requires agile evaluation methods to complement periodic formal research efforts. Objective This paper describes one of the implementation strategies that the Department of Veterans Affairs (VA) has used to foster the adoption and sustained use of its patient portal, My HealtheVet, over the last decade: an ongoing focus on user-centered design (UCD). This strategy entails understanding the users and their tasks and goals and optimizing portal design and functionality accordingly. Using a case study approach, we present a comparison of early user demographics and preferences with more recent data and several examples to illustrate how a UCD can serve as an effective implementation strategy for a patient portal within a large integrated health care system. Methods VA has employed a customer experience analytics (CXA) survey on its patient portal since 2007 to enable ongoing direct user feedback. In a continuous cycle, a random sample of site visitors is invited to participate in the Web-based survey. CXA model questions are used to track and trend satisfaction, while custom questions collect data about users’ characteristics, needs, and preferences. In this case study, we performed analyses of descriptive statistics comparing user characteristics and preferences from FY2008 (wherein “FY” means “fiscal year”) to FY2017 and user trends regarding satisfaction with and utilization of specific portal functions over the last decade, as well as qualitative content analysis of user’s open-ended survey comments. Results User feedback has guided the development of enhancements to core components of the My HealtheVet portal including available features, content, interface design, prospective functional design, and related policies. Ten-year data regarding user characteristics and portal utilization demonstrate trends toward greater patient engagement and satisfaction. Administration of a continuous voluntary Web-based survey is an efficient and effective way to capture veterans’ voices about who they are, how they use the patient portal, needed system improvements, and desired additional services. Conclusions Leveraging “voice-of-the-customer” techniques as part of patient portal implementation can ensure that such systems meet users’ needs in ways that are agile and most effective. Through this strategy, VA has fostered significant adoption and use of My HealtheVet to engage patients in managing their health.
Collapse
Affiliation(s)
- Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Coxsackie, NY, United States
| | - Carolyn L Turvey
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center, Iowa City, IA, United States.,Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Dawn M Klein
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center, Iowa City, IA, United States.,Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| |
Collapse
|
9
|
Hill JN, Smith BM, Weaver FM, Nazi KM, Thomas FP, Goldstein B, Hogan TP. Potential of personal health record portals in the care of individuals with spinal cord injuries and disorders: Provider perspectives. J Spinal Cord Med 2018; 41:298-308. [PMID: 28325112 PMCID: PMC6055947 DOI: 10.1080/10790268.2017.1293760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
CONTEXT/OBJECTIVE Although personal health record (PHR) portals are designed for patients, healthcare providers are a key influence in how patients use their features and realize benefits from them. A few studies have examined provider attitudes toward PHR portals, but none have focused on those who care for individuals with spinal cord injuries and disorders (SCI/D). We characterize SCI/D provider perspectives of PHR portals, including perceived advantages and disadvantages of PHR portal use in SCI/D care. DESIGN Cross-sectional; semi-structured interviews. SETTING Spinal Cord Injury (SCI) Centers in the Veterans Health Administration. PARTICIPANTS Twenty-six SCI/D healthcare providers. INTERVENTIONS None. OUTCOME MEASURES Perceived advantages and disadvantages of PHR portals. RESULTS The complex situations of individuals with SCI/D shaped provider perspectives of PHR portals and their potential role in practice. Perceived advantages of PHR portal use in SCI/D care included the ability to coordinate information and care, monitor and respond to outpatient requests, support patient self-management activities, and provide reliable health information to patients. Perceived disadvantages of PHR portal use in SCI/D care included concerns about the quality of patient-generated health data, other potential liabilities for providers and workload burden, and the ability of individuals with SCI/D to understand clinical information accessed through a portal. CONCLUSION Our study highlights advantages and disadvantages that should be considered when promoting engagement of SCI/D healthcare providers in use of PHR portals, and portal features that may have the most utility in SCI/D care.
Collapse
Affiliation(s)
- Jennifer N. Hill
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VA Hospital, Veterans Health Administration, Hines, Illinois, USA,Correspondence to: Jennifer N. Hill, MA, Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VA Hospital, Veterans Health Administration, 5000 S. 5th Ave (151H), Hines, IL 60141, USA.
| | - Bridget M. Smith
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VA Hospital, Veterans Health Administration, Hines, Illinois, USA,Department of Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - Frances M. Weaver
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VA Hospital, Veterans Health Administration, Hines, Illinois, USA,Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Kim M. Nazi
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Florian P. Thomas
- Neuroscience Institute, Hackensack University Medical Center, and Seton Hall-Hackensack-Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Barry Goldstein
- Patient Care Services, Spinal Cord Injury and Disorder Services, Veterans Health Administration, Seattle, Washington, USA
| | - Timothy P. Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, Massachusetts, USA,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
10
|
Hogan TP, Luger TM, Volkman JE, Rocheleau M, Mueller N, Barker AM, Nazi KM, Houston TK, Bokhour BG. Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging. J Med Internet Res 2018; 20:e82. [PMID: 29519774 PMCID: PMC5864998 DOI: 10.2196/jmir.8801] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. OBJECTIVE Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. METHODS We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. RESULTS Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. CONCLUSIONS This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members.
Collapse
Affiliation(s)
- Timothy P Hogan
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Tana M Luger
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Psychology Field Group, Pitzer College, Claremont, CA, United States
| | - Julie E Volkman
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Communication, Bryant University, Smithfield, RI, United States
| | - Mary Rocheleau
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Nora Mueller
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Anna M Barker
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, United States
| | - Thomas K Houston
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Barbara G Bokhour
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Department of Health, Law, Policy & Management, School of Public Health, Boston University, Boston, MA, United States
| |
Collapse
|
11
|
Haun JN, Hathaway W, Chavez M, Antinori N, Vetter B, Miller BK, Martin TL, Kendziora L, Nazi KM, Melillo C. Clinical Practice Informs Secure Messaging Benefits and Best Practices. Appl Clin Inform 2017; 8:1003-1011. [PMID: 29241240 DOI: 10.4338/aci-2017-05-ra-0088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Clinical care team members in Department of Veterans' Affairs (VA) facilities nationwide are working to integrate the use of Secure Messaging (SM) into care delivery and identify innovative uses. Identifying best practices for proactive use of SM is a key factor in its successful implementation and sustained use by VA clinical care team members and veterans.
Objectives A collaborative project solicited input from VA clinical care teams about their local practices using SM to provide access to proactive patient-centered care for veterans and enhance workflow.
Methods This project implemented a single-item cross-sectional qualitative electronic survey via internal e-mail to local coordinators in all 23 Veterans Integrated Service Networks (VISNs). Content analysis was used to manage descriptive data responses. Descriptive statistics described sample characteristics.
Results VA clinical care team members across 15 of 23 VISNs responded to the questionnaire. Content analysis of 171 responses produced two global domains: (1) benefits of SM and (2) SM best practices. Benefits of SM use emphasize enhanced and efficient communication and increased access to care. Care team members incorporate SM into their daily clinical practices, using it to provide services before, during, and after clinical encounters as a best practice. SM users suggest improvements in veteran care, clinical team workflow, and efficient use of health resources. Clinical team members invested in the successful implementation of SM integrate SM into their daily practices to provide meaningful and useful veteran-centered care and improve workflow.
Conclusion VA clinical care team members can use SM proactively to create an integrated SM culture. With adequate knowledge and motivation to proactively use this technology, all clinical team members within the VA system can replicate best practices shared by other clinical care teams to generate meaningful and useful interactions with SM to enrich veterans' health care experience.
Collapse
Affiliation(s)
- Jolie N Haun
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States.,Department of Community and Family Health, University of South Florida College of Public Health, Tampa, Florida, United States
| | - Wendy Hathaway
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States
| | - Margeaux Chavez
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States
| | - Nicole Antinori
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States
| | - Brian Vetter
- Department of Veterans Affairs, St. Cloud VA Medical Center, St. Cloud, Minnesota, United States
| | - Brian K Miller
- Northwest Innovation Center, VA Portland Health Care System, Portland, Oregon, United States
| | - Tracey L Martin
- Department of Veterans Affairs, VA New England Health Care System, Bedford, Massachusetts, United States
| | - Lisa Kendziora
- Department of Veterans Affairs, Erie VA Medical Center, Erie, Pennsylvania, United States
| | - Kim M Nazi
- Veterans and Consumers Health Informatics Office, Veterans Health Administration, Department of Veterans Affairs, Washington, District of Columbia, United States
| | - Christine Melillo
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, Florida, United States
| |
Collapse
|
12
|
Woods SS, Forsberg CW, Schwartz EC, Nazi KM, Hibbard JH, Houston TK, Gerrity M. The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users. J Med Internet Res 2017; 19:e345. [PMID: 29042345 PMCID: PMC5663951 DOI: 10.2196/jmir.7895] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND As electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time. OBJECTIVE The study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions. METHODS We prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment. RESULTS A total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0%) reported going online, typically at home (248/268, 92.5%). At 6 months, 84.1% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively. CONCLUSIONS Short-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services.
Collapse
Affiliation(s)
- Susan S Woods
- VA Maine Healthcare System, Augusta, ME, United States.,VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States.,Connected Care Office, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, United States
| | - Christopher W Forsberg
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
| | - Erin C Schwartz
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
| | - Kim M Nazi
- Connected Care Office, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, United States
| | - Judith H Hibbard
- Health Policy Research Group, University of Oregon, Eugene, OR, United States
| | - Thomas K Houston
- Bedford VA Medical Center, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
| | - Martha Gerrity
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
| |
Collapse
|
13
|
Wakefield BJ, Turvey CL, Nazi KM, Holman JE, Hogan TP, Shimada SL, Kennedy DR. Psychometric Properties of Patient-Facing eHealth Evaluation Measures: Systematic Review and Analysis. J Med Internet Res 2017; 19:e346. [PMID: 29021128 PMCID: PMC5656774 DOI: 10.2196/jmir.7638] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/14/2017] [Accepted: 08/25/2017] [Indexed: 11/13/2022] Open
Abstract
Background Significant resources are being invested into eHealth technology to improve health care. Few resources have focused on evaluating the impact of use on patient outcomes A standardized set of metrics used across health systems and research will enable aggregation of data to inform improved implementation, clinical practice, and ultimately health outcomes associated with use of patient-facing eHealth technologies. Objective The objective of this project was to conduct a systematic review to (1) identify existing instruments for eHealth research and implementation evaluation from the patient’s point of view, (2) characterize measurement components, and (3) assess psychometrics. Methods Concepts from existing models and published studies of technology use and adoption were identified and used to inform a search strategy. Search terms were broadly categorized as platforms (eg, email), measurement (eg, survey), function/information use (eg, self-management), health care occupations (eg, nurse), and eHealth/telemedicine (eg, mHealth). A computerized database search was conducted through June 2014. Included articles (1) described development of an instrument, or (2) used an instrument that could be traced back to its original publication, or (3) modified an instrument, and (4) with full text in English language, and (5) focused on the patient perspective on technology, including patient preferences and satisfaction, engagement with technology, usability, competency and fluency with technology, computer literacy, and trust in and acceptance of technology. The review was limited to instruments that reported at least one psychometric property. Excluded were investigator-developed measures, disease-specific assessments delivered via technology or telephone (eg, a cancer-coping measure delivered via computer survey), and measures focused primarily on clinician use (eg, the electronic health record). Results The search strategy yielded 47,320 articles. Following elimination of duplicates and non-English language publications (n=14,550) and books (n=27), another 31,647 articles were excluded through review of titles. Following a review of the abstracts of the remaining 1096 articles, 68 were retained for full-text review. Of these, 16 described an instrument and six used an instrument; one instrument was drawn from the GEM database, resulting in 23 articles for inclusion. None included a complete psychometric evaluation. The most frequently assessed property was internal consistency (21/23, 91%). Testing for aspects of validity ranged from 48% (11/23) to 78% (18/23). Approximately half (13/23, 57%) reported how to score the instrument. Only six (26%) assessed the readability of the instrument for end users, although all the measures rely on self-report. Conclusions Although most measures identified in this review were published after the year 2000, rapidly changing technology makes instrument development challenging. Platform-agnostic measures need to be developed that focus on concepts important for use of any type of eHealth innovation. At present, there are important gaps in the availability of psychometrically sound measures to evaluate eHealth technologies.
Collapse
Affiliation(s)
- Bonnie J Wakefield
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, IA, United States
| | - Carolyn L Turvey
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, IA, United States
| | - Kim M Nazi
- Veterans and Consumers Health Informatics Office, Veterans Health Administration, Washington, DC, United States
| | - John E Holman
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, IA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Boston, MA, United States
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Boston, MA, United States
| | - Diana R Kennedy
- Department of Health Management and Informatics, University of Missouri, Columbia, MO, United States
| |
Collapse
|
14
|
McInnes DK, Shimada SL, Midboe AM, Nazi KM, Zhao S, Wu J, Garvey CM, Houston TK. Patient Use of Electronic Prescription Refill and Secure Messaging and Its Association With Undetectable HIV Viral Load: A Retrospective Cohort Study. J Med Internet Res 2017; 19:e34. [PMID: 28202428 PMCID: PMC5332835 DOI: 10.2196/jmir.6932] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Electronic personal health records (PHRs) can support patient self-management of chronic conditions. Managing human immunodeficiency virus (HIV) viral load, through taking antiretroviral therapy (ART) is crucial to long term survival of persons with HIV. Many persons with HIV have difficulty adhering to their ART over long periods of time. PHRs contribute to chronic disease self-care and may help persons with HIV remain adherent to ART. Proportionally veterans with HIV are among the most active users of the US Department of Veterans Affairs (VA) PHR, called My HealtheVet. Little is known about whether the use of the PHR is associated with improved HIV outcomes in this population. Objective The objective of this study was to investigate whether there are associations between the use of PHR tools (electronic prescription refill and secure messaging [SM] with providers) and HIV viral load in US veterans. Methods We conducted a retrospective cohort study using data from the VA’s electronic health record (EHR) and the PHR. We identified veterans in VA care from 2009-2012 who had HIV and who used the PHR. We examined which ones had achieved the positive outcome of suppressed HIV viral load, and whether achievement of this outcome was associated with electronic prescription refill or SM. From 18,913 veterans with HIV, there were 3374 who both had a detectable viral load in 2009 and who had had a follow-up viral load test in 2012. To assess relationships between electronic prescription refill and viral control, and SM and viral control, we fit a series of multivariable generalized estimating equation models, accounting for clustering in VA facilities. We adjusted for patient demographic and clinical characteristics associated with portal use. In the initial models, the predictor variables were included in dichotomous format. Subsequently, to evaluate a potential dose-effect, the predictor variables were included as ordinal variables. Results Among our sample of 3374 veterans with HIV who received VA care from 2009-2012, those who had transitioned from detectable HIV viral load in 2009 to undetectable viral load in 2012 tended to be older (P=.004), more likely to be white (P<.001), and less likely to have a substance use disorder, problem alcohol use, or psychosis (P=.006, P=.03, P=.004, respectively). There was a statistically significant positive association between use of electronic prescription refill and change in HIV viral load status from 2009-2012, from detectable to undetectable (OR 1.36, CI 1.11-1.66). There was a similar association between SM use and viral load status, but without achieving statistical significance (OR 1.28, CI 0.89-1.85). Analyses did not demonstrate a dose-response of prescription refill or SM use for change in viral load. Conclusions PHR use, specifically use of electronic prescription refill, was associated with greater control of HIV. Additional studies are needed to understand the mechanisms by which this may be occurring.
Collapse
Affiliation(s)
- D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Amanda M Midboe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, Washington, DC, United States
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Casey M Garvey
- School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Thomas K Houston
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| |
Collapse
|
15
|
Fix GM, Hogan TP, Amante DJ, McInnes DK, Nazi KM, Simon SR. Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives. J Med Internet Res 2016; 18:e308. [PMID: 27876686 PMCID: PMC5141333 DOI: 10.2196/jmir.6488] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/23/2016] [Accepted: 10/29/2016] [Indexed: 11/30/2022] Open
Abstract
Background Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low. Objective We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal. Methods Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system. Results We gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal. Conclusions Patients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption.
Collapse
Affiliation(s)
- Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Daniel J Amante
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Kim M Nazi
- Veterans Health Administration, Veterans and Consumers Health Informatics Office, Office of Connected Care, US Department of Veterans Affairs, Washington, DC, United States
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.,Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, United States
| |
Collapse
|
16
|
Klein DM, Pham K, Samy L, Bluth A, Nazi KM, Witry M, Klutts JS, Grant KM, Gundlapalli AV, Kochersberger G, Pfeiffer L, Romero S, Vetter B, Turvey CL. The Veteran-Initiated Electronic Care Coordination: A Multisite Initiative to Promote and Evaluate Consumer-Mediated Health Information Exchange. Telemed J E Health 2016; 23:264-272. [PMID: 27726644 DOI: 10.1089/tmj.2016.0078] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Information continuity is critical to person-centered care when patients receive care from multiple healthcare systems. Patients can access their electronic health record data through patient portals to facilitate information exchange. This pilot was developed to improve care continuity for rural Veterans by (1) promoting the use of the Department of Veterans Affairs (VA) patient portal to share health information with non-VA providers, and (2) evaluating the impact of health information sharing at a community appointment. MATERIALS AND METHODS Veterans from nine VA healthcare systems were trained to access and share their VA Continuity of Care Document (CCD) with their non-VA providers. Patients and non-VA providers completed surveys on their experiences. RESULTS Participants (n = 620) were primarily older, white, and Vietnam era Veterans. After training, 78% reported the CCD would help them be more involved in their healthcare and 86% planned to share it regularly with non-VA providers. Veterans (n = 256) then attended 277 community appointments. Provider responses from these appointments (n = 133) indicated they were confident in the accuracy of the information (97%) and wanted to continue to receive the CCD (96%). Ninety percent of providers reported the CCD improved their ability to have an accurate medication list and helped them make medication treatment decisions. Fifty percent reported they did not order a laboratory test or another procedure because of information available in the CCD. CONCLUSIONS This pilot demonstrates feasibility and value of patient access to a CCD to facilitate information sharing between VA and non-VA providers. Outreach and targeted education are needed to promote consumer-mediated health information exchange.
Collapse
Affiliation(s)
- Dawn M Klein
- 1 Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center , Iowa City, Iowa.,2 Department of Psychiatry, The University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Kassi Pham
- 1 Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center , Iowa City, Iowa
| | - Leila Samy
- 3 Department of Health and Human Services, Office of the National Coordinator , Washington, District of Columbia
| | - Adam Bluth
- 4 Department of Veterans Affairs, Office of Rural Health , Washington, District of Columbia
| | - Kim M Nazi
- 5 Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration , Washington, District of Columbia
| | - Matthew Witry
- 6 Department of Pharmacy Practice and Science, The University of Iowa College of Pharmacy , Iowa City, Iowa
| | - J Stacey Klutts
- 7 Iowa City VA Health Care System, Pathology and Laboratory Medicine , Iowa City, Iowa.,8 Department of Pathology, The University of Iowa Carver College of Medicine , Iowa City, Iowa
| | - Kathleen M Grant
- 9 VA Nebraska Western Iowa Health Care System, Substance Use Disorders Treatment Program , Omaha, Nebraska.,10 Department of Internal Medicine, University of Nebraska Medical Center , Omaha, Nebraska
| | - Adi V Gundlapalli
- 11 VA Salt Lake City Health Care System , Salt Lake City, Utah.,12 University of Utah School of Medicine , Salt Lake City, Utah
| | - Gary Kochersberger
- 13 Canandaigua VA Medical Center , Geriatrics and Extended Care, Canandaigua, New York
| | | | - Sergio Romero
- 15 North Florida/South Georgia Veterans Health System, Center of Innovation on Disability and Rehabilitation Research , Gainesville, Florida.,16 Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida , Gainesville, Florida
| | - Brian Vetter
- 17 St. Cloud VA Health Care System , St. Cloud, Minnesota
| | - Carolyn L Turvey
- 1 Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center , Iowa City, Iowa.,2 Department of Psychiatry, The University of Iowa Carver College of Medicine , Iowa City, Iowa
| |
Collapse
|
17
|
Haun JN, Chavez M, Nazi KM, Antinori N. Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach. J Med Internet Res 2016; 18:e266. [PMID: 27713112 PMCID: PMC5073205 DOI: 10.2196/jmir.6499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/15/2016] [Accepted: 09/17/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer's vision for the future. OBJECTIVE The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers' vision for the future of an integrated VA HIT system. METHODS This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. RESULTS The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA's existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA websites) are organized by row. Columns are titled with thematic and functional domains (eg, access, function, benefits, barriers, authentication, delegation, user tasks). Cells for each sheet include descriptions and details that reflect factors relevant to domains and the topic of each worksheet. CONCLUSIONS This study provides documentation of the current VA HIT system and efforts for consumers' vision of an integrated system redesign. The HIT Systems Matrix provides a consumer preference blueprint to inform the current VA HIT system and the vision for future development to integrate electronic resources within VA and beyond with non-VA resources. The data presented in the HIT Systems Matrix are relevant for VA administrators and developers as well as other large health care organizations seeking to document and organize their consumer-facing HIT resources.
Collapse
Affiliation(s)
- Jolie N Haun
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, US Department of Veterans Affairs, Tampa, FL, United States.
| | | | | | | |
Collapse
|
18
|
Turvey CL, Klein DM, Witry M, Klutts JS, Hill EL, Alexander B, Nazi KM. Patient Education for Consumer-Mediated HIE. A Pilot Randomized Controlled Trial of the Department of Veterans Affairs Blue Button. Appl Clin Inform 2016; 7:765-76. [PMID: 27484821 DOI: 10.4338/aci-2016-01-ra-0014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/04/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Consumer-mediated health information exchange (HIE) is one of the three types of HIE designated by the Office of the National Coordinator. HIE is intended to improve the quality of care while reducing cost, yet empirical support for this claim is mixed. Future research should identify the contexts whereby HIE is most effective. METHODS This study was conducted as a pilot two-arm randomized controlled trial. In the intervention arm, 27 veterans were taught how to generate a Continuity of Care Document (CCD) within the Blue Button feature of their VA patient portal and were then asked to share it with their community non-VA provider. In the attention control condition, 25 Veterans were taught how to look up health information on the Internet. The impact of this training on the next non-VA medical visit was examined. RESULTS Nineteen (90%) veterans in the intervention arm shared their CCD with their non-VA provider as compared with 2 (17%) in the attention control arm (p<0.001). Both veterans and non-VA providers indicated high satisfaction with the CCD. Comparison of medical records between the VA and non-VA providers did not indicate improved medication reconciliation (p=0.72). If veterans shared their CCD prior to their non-VA providers ordering laboratory tests, the number of duplicate laboratories was significantly reduced (p=0.02). CONCLUSIONS In this pilot randomized controlled trial, training 52 veterans to share their CCD was feasible and accepted by both patients and providers. Sharing this document appeared to reduce duplicate laboratory draws, but did not have an impact on documented medication list concordance.
Collapse
Affiliation(s)
- Carolyn L Turvey
- Carolyn L. Turvey, Ph.D., Iowa City VA Health Care System (152), 601 Highway West, Iowa City, IA 52246, Phone: 319-338-0581, extension 7714;, Fax: 319-887-4932;,
| | | | | | | | | | | | | |
Collapse
|
19
|
Hogan TP, Hill JN, Locatelli SM, Weaver FM, Thomas FP, Nazi KM, Goldstein B, Smith BM. Health Information Seeking and Technology Use Among Veterans With Spinal Cord Injuries and Disorders. PM R 2016; 8:123-30. [DOI: 10.1016/j.pmrj.2015.06.443] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 06/22/2015] [Accepted: 06/28/2015] [Indexed: 11/16/2022]
|
20
|
Klein DM, Fix GM, Hogan TP, Simon SR, Nazi KM, Turvey CL. Use of the Blue Button Online Tool for Sharing Health Information: Qualitative Interviews With Patients and Providers. J Med Internet Res 2015; 17:e199. [PMID: 26286139 PMCID: PMC4736289 DOI: 10.2196/jmir.4595] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/01/2015] [Accepted: 07/16/2015] [Indexed: 12/05/2022] Open
Abstract
Background Information sharing between providers is critical for care coordination, especially in health systems such as the United States Department of Veterans Affairs (VA), where many patients also receive care from other health care organizations. Patients can facilitate this sharing by using the Blue Button, an online tool that promotes patients’ ability to view, print, and download their health records. Objective The aim of this study was to characterize (1) patients’ use of Blue Button, an online information-sharing tool in VA’s patient portal, My HealtheVet, (2) information-sharing practices between VA and non-VA providers, and (3) how providers and patients use a printed Blue Button report during a clinical visit. Methods Semistructured qualitative interviews were conducted with 34 VA patients, 10 VA providers, and 9 non-VA providers. Interviews focused on patients’ use of Blue Button, information-sharing practices between VA and non-VA providers, and how patients and providers use a printed Blue Button report during a clinical visit. Qualitative themes were identified through iterative rounds of coding starting with an a priori schema based on technology adoption theory. Results Information sharing between VA and non-VA providers relied primarily on the patient. Patients most commonly used Blue Button to access and share VA laboratory results. Providers recognized the need for improved information sharing, valued the Blue Button printout, and expressed interest in a way to share information electronically across settings. Conclusions Consumer-oriented technologies such as Blue Button can facilitate patients sharing health information with providers in other health care systems; however, more education is needed to inform patients of this use to facilitate care coordination. Additional research is needed to explore how personal health record documents, such as Blue Button reports, can be easily shared and incorporated into the clinical workflow of providers.
Collapse
Affiliation(s)
- Dawn M Klein
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, IA, United States.
| | | | | | | | | | | |
Collapse
|
21
|
Haun JN, Nazi KM, Chavez M, Lind JD, Antinori N, Gosline RM, Martin TL. A participatory approach to designing and enhancing integrated health information technology systems for veterans: protocol. JMIR Res Protoc 2015; 4:e28. [PMID: 25803324 PMCID: PMC4376141 DOI: 10.2196/resprot.3815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 11/17/2022] Open
Abstract
Background The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information. Objective The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans’ preferences for using VA HIT to manage their health conditions and exchange health information. Methods The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks. Results This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on direct veteran feedback that depict patient preferences for enhancing the synchronization, integration, and standardization of VA patient-facing platforms. Focus group topics include current uses, preferences, facilitators, and barriers to using electronic health resources; recommendations for synchronizing, integrating, and standardizing VA HIT; and preferences on data sharing and delegation within the VA system. Conclusions This work highlights the practical, technological, and personal factors that facilitate and inhibit use of current VA HIT, and informs an integrated system redesign. The Digital Health Matrix Model and visual modeling simulations use knowledge of veteran preferences and experiences to directly inform enhancements to VA HIT and provide a more holistic and integrated user experience. These efforts are designed to support the adoption and sustained use of VA HIT to support patient self-management and clinical care coordination in ways that are directly aligned with veteran preferences.
Collapse
Affiliation(s)
- Jolie N Haun
- HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, United States.
| | | | | | | | | | | | | |
Collapse
|
22
|
Nazi KM, Turvey CL, Klein DM, Hogan TP, Woods SS. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes. J Am Med Inform Assoc 2014. [PMID: 25352570 DOI: 10.1136/amiajnl-2014-003144.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. METHODS A web-based survey of VA patient portal users from June 22 to September 15, 2013. RESULTS 33.5% of respondents knew that clinical notes could be viewed, and nearly one in four (23.5%) said that they had viewed their notes at least once. The majority of VA Notes users agreed that accessing their notes will help them to do a better job of taking medications as prescribed (80.1%) and be better prepared for clinic visits (88.6%). Nine out of 10 users agreed that use of visit notes will help them understand their conditions better (91.8%), and better remember the plan for their care (91.9%). In contrast, 87% disagreed that VA Notes will make them worry more, and 88.4% disagreed that access to VA Notes will be more confusing than helpful. Users who had either contacted their provider or healthcare team (11.9%) or planned to (13.5%) primarily wanted to learn more about a health issue, medication, or test results (53.7%). CONCLUSIONS Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication.
Collapse
Affiliation(s)
- Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Informatics &Analytics, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA
| | - Carolyn L Turvey
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Dawn M Klein
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), A VA HSR&D Center of Innovation, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, eHealth Quality Enhancement Research Initiative, Bedford, Massachusetts, USA Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Susan S Woods
- VA Maine Healthcare System, Togus, Maine, USA Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
23
|
Nazi KM, Turvey CL, Klein DM, Hogan TP, Woods SS. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes. J Am Med Inform Assoc 2014; 22:380-9. [PMID: 25352570 DOI: 10.1136/amiajnl-2014-003144] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. METHODS A web-based survey of VA patient portal users from June 22 to September 15, 2013. RESULTS 33.5% of respondents knew that clinical notes could be viewed, and nearly one in four (23.5%) said that they had viewed their notes at least once. The majority of VA Notes users agreed that accessing their notes will help them to do a better job of taking medications as prescribed (80.1%) and be better prepared for clinic visits (88.6%). Nine out of 10 users agreed that use of visit notes will help them understand their conditions better (91.8%), and better remember the plan for their care (91.9%). In contrast, 87% disagreed that VA Notes will make them worry more, and 88.4% disagreed that access to VA Notes will be more confusing than helpful. Users who had either contacted their provider or healthcare team (11.9%) or planned to (13.5%) primarily wanted to learn more about a health issue, medication, or test results (53.7%). CONCLUSIONS Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication.
Collapse
Affiliation(s)
- Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Informatics &Analytics, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA
| | - Carolyn L Turvey
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Dawn M Klein
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), A VA HSR&D Center of Innovation, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, eHealth Quality Enhancement Research Initiative, Bedford, Massachusetts, USA Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Susan S Woods
- VA Maine Healthcare System, Togus, Maine, USA Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
24
|
Hogan TP, Nazi KM, Luger TM, Amante DJ, Smith BM, Barker A, Shimada SL, Volkman JE, Garvin L, Simon SR, Houston TK. Technology-assisted patient access to clinical information: an evaluation framework for blue button. JMIR Res Protoc 2014; 3:e18. [PMID: 24675395 PMCID: PMC4004159 DOI: 10.2196/resprot.3290] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/14/2014] [Indexed: 11/22/2022] Open
Abstract
Background Patient access to clinical information represents a means to improve the transparency and delivery of health care as well as interactions between patients and health care providers. We examine the movement toward augmenting patient access to clinical information using technology. Our analysis focuses on “Blue Button,” a tool that many health care organizations are implementing as part of their Web-based patient portals. Objective We present a framework for evaluating the effects that technology-assisted access to clinical information may have on stakeholder experiences, processes of care, and health outcomes. Methods A case study of the United States Department of Veterans Affairs' (VA) efforts to make increasing amounts of clinical information available to patients through Blue Button. Drawing on established collaborative relationships with researchers, clinicians, and operational partners who are engaged in the VA’s ongoing implementation and evaluation efforts related to Blue Button, we assessed existing evidence and organizational practices through key informant interviews, review of documents and other available materials, and an environmental scan of published literature and the websites of other health care organizations. Results Technology-assisted access to clinical information represents a significant advance for VA patients and marks a significant change for the VA as an organization. Evaluations of Blue Button should (1) consider both processes of care and outcomes, (2) clearly define constructs of focus, (3) examine influencing factors related to the patient population and clinical context, and (4) identify potential unintended consequences. Conclusions The proposed framework can serve as a roadmap to guide subsequent research and evaluation of technology-assisted patient access to clinical information. To that end, we offer a series of related recommendations.
Collapse
Affiliation(s)
- Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), eHealth Quality Enhancement Research Initiative (QUERI), National eHealth QUERI Coordinating Center, Bedford, MA, United States.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Veterans represent a unique population in need of accessing health services online. Data from a random-digit dialed survey conducted by the Pew Research Center's Internet & American Life Project were used to assess differences in online use of health information among Veterans in the Veterans Health Administration (VHA) of the U.S. Department of Veteran Affairs (VA), Veterans not in VA, and non-Veterans. This survey of 3,001 U.S. citizens oversampled lower-income households. Questions assessed Veteran status and use of VA health care services, self-reported Internet use and Internet searching for health-related information, and social engagement related to health online. Overall results suggest Veterans represent an opportune population to utilize personal health records and health services via the Internet. Veterans in VA are more likely to search for health issues related to Alzheimer's disease and memory loss (odds ratio = 3.07; confidence interval = 1.41-8.28) compared to Veterans not in VA. Veterans receiving VA health care also reported higher proportions of social engagement related to health about tracking diet, weight, and exercise than Veterans not in VA, although not statistically significant. Veterans in VA are using the Internet for health information, and there is an opportunity to engage them more.
Collapse
Affiliation(s)
- Thomas K Houston
- eHealth Quality Enhancement Research Initiative and Center for Health Quality, Outcomes and Economic Research, Department of Veterans Affairs, 200 Springs Road (152), Bedford, MA 01730, USA
| | | | | | | | | | | |
Collapse
|
26
|
Nazi KM. The personal health record paradox: health care professionals' perspectives and the information ecology of personal health record systems in organizational and clinical settings. J Med Internet Res 2013; 15:e70. [PMID: 23557596 PMCID: PMC3636319 DOI: 10.2196/jmir.2443] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/30/2013] [Accepted: 01/31/2013] [Indexed: 02/04/2023] Open
Abstract
Background Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. Objective The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. Methods In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Results Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals’ accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of secure messaging implementation and its impact on organizational actors and their use of technology, influencing workflow, practices, and the flow of information. In effect, secure messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships. Conclusions Study findings have direct implications for the development and implementation of PHR systems to ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and secure messaging use in clinical practice settings.
Collapse
Affiliation(s)
- Kim M Nazi
- Veterans and Consumers Health Informatics Office, Veterans Health Administration, Department of Veterans Affairs, Albany NY 12208, USA.
| |
Collapse
|
27
|
Woods SS, Schwartz E, Tuepker A, Press NA, Nazi KM, Turvey CL, Nichol WP. Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study. J Med Internet Res 2013; 15:e65. [PMID: 23535584 PMCID: PMC3636169 DOI: 10.2196/jmir.2356] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/24/2013] [Accepted: 02/06/2013] [Indexed: 11/29/2022] Open
Abstract
Background Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. Objective A qualitative study with purposeful sampling sought to examine patients’ views and experiences with reading their health records, including their clinical notes, online. Methods Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Results Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Conclusions Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared records may or may not impact overall clinic workload, it is likely to change providers’ work, necessitating new types of skills to communicate and partner with patients.
Collapse
Affiliation(s)
- Susan S Woods
- Portland VA Medical Center, Health Services Research & Development, Portland, OR, United States.
| | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Turvey CL, Zulman DM, Nazi KM, Wakefield BJ, Woods SS, Hogan TP, Weaver FM, McInnes K. Transfer of information from personal health records: a survey of veterans using My HealtheVet. Telemed J E Health 2012; 18:109-14. [PMID: 22304439 DOI: 10.1089/tmj.2011.0109] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Personal health records provide patients with ownership of their health information and allow them to share information with multiple healthcare providers. However, the usefulness of these records relies on patients understanding and using their records appropriately. My HealtheVet is a Web-based patient portal containing a personal health record administered by the Veterans Health Administration. The goal of this study was to explore veterans' interest and use of My HealtheVet to transfer and share information as well as to identify opportunities to increase veteran use of the My HealtheVet functions. MATERIALS AND METHODS Two waves of data were collected in 2010 through an American Customer Satisfaction Index Web-based survey. A random sample of veterans using My HealtheVet was invited to participate in the survey conducted on the My HealtheVet portal through a Web-based pop-up browser window. RESULTS Wave One results (n=25,898) found that 41% of veterans reported printing information, 21% reported saving information electronically, and only 4% ever sent information from My HealtheVet to another person. In Wave Two (n=18,471), 30% reported self-entering medication information, with 18% sharing this information with their Veterans Affairs (VA) provider and 9.6% sharing with their non-VA provider. CONCLUSION Although veterans are transferring important medical information from their personal health records, increased education and awareness are needed to increase use. Personal health records have the potential to improve continuity of care. However, more research is needed on both the barriers to adoption as well as the actual impact on patient health outcomes and well-being.
Collapse
Affiliation(s)
- Carolyn L Turvey
- Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa 42286, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
BACKGROUND Electronic personal health record (PHR) systems are proliferating but largely have not realized their potential for enhancing communication among patients and their network of care providers. OBJECTIVE To explore preferences about sharing electronic health information among users of the U.S. Department of Veterans Affairs (VA) PHR system, My HealtheVet. DESIGN Web-based survey of a convenience sample. SETTING My HealtheVet Web site from 7 July through 4 October 2010. PARTICIPANTS 18 471 users of My HealtheVet. MEASUREMENTS Interest in shared PHR access and preferences about who would receive access, the information that would be shared, and the activities that users would delegate. RESULTS Survey respondents were predominantly men (92%) and aged 50 to 64 years (51%) or 65 years or older (39%); approximately 39% reported poor or fair health status. Almost 4 of 5 respondents (79%) were interested in sharing access to their PHR with someone outside of their health system (62% with a spouse or partner, 23% with a child, 15% with another family member, and 25% with a non-VA health care provider). Among those who selected a family member other than a spouse or partner, 47% lived apart from the specified person. Preferences about degree of access varied on the basis of the type of information being shared, the type of activity being performed, and the respondent's relationship with the selected person. LIMITATIONS The survey completion rate was 40.8%. Results might not be generalizable to all My HealtheVet users. CONCLUSION In a large survey of PHR users in the VA system, most respondents were interested in sharing access to their electronic health information with caregivers and non-VA providers. Existing and evolving PHR systems should explore secure mechanisms for shared PHR access to improve information exchange among patients and the multiple persons involved in their health care. PRIMARY FUNDING SOURCE Veterans Health Administration and The Robert Wood Johnson Foundation Clinical Scholars Program.
Collapse
Affiliation(s)
- Donna M Zulman
- Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California 94025, USA.
| | | | | | | | | | | |
Collapse
|
31
|
Hogan TP, Wakefield B, Nazi KM, Houston TK, Weaver FM. Promoting access through complementary eHealth technologies: recommendations for VA's Home Telehealth and personal health record programs. J Gen Intern Med 2011; 26 Suppl 2:628-35. [PMID: 21989614 PMCID: PMC3191221 DOI: 10.1007/s11606-011-1765-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many healthcare organizations have embraced eHealth technologies in their efforts to promote patient-centered care, increase access to services, and improve outcomes. OBJECTIVE Using the Department of Veterans Affairs (VA) as a case study, this paper presents two specific eHealth technologies, the Care Coordination Home Telehealth (CCHT) Program and the My HealtheVet (MHV) personal health record (PHR) portal with integrated secure messaging, and articulates a vision of how they might be implemented as part of a patient-centric healthcare model and used in a complementary manner to enhance access to care and to support patient-centered care. METHODS Based on our experience and ongoing work with both programs, we offer a series of recommendations for pursuing and ultimately achieving this vision. CONCLUSION VA's CCHT and MHV programs are examples of an expanding repertoire of eHealth applications available to patients and healthcare teams. VA's new patient-centric healthcare model represents a significant shift in the way that services are delivered and a profound opportunity to incorporate eHealth technologies like the CCHT and MHV programs into clinical practice to increase access to care, and to ensure the responsiveness of such technologies to the preferences and circumstances of patients.
Collapse
Affiliation(s)
- Timothy P Hogan
- Center for Management of Complex Chronic Care & Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines, Jr. VA Hospital, 5000 S. 5th Avenue, Hines, IL 60141, USA.
| | | | | | | | | |
Collapse
|
32
|
McInnes DK, Solomon JL, Bokhour BG, Asch SM, Ross D, Nazi KM, Gifford AL. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives. BMC Res Notes 2011; 4:295. [PMID: 21843313 PMCID: PMC3173346 DOI: 10.1186/1756-0500-4-295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 08/15/2011] [Indexed: 12/12/2022] Open
Abstract
Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs) become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA) health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising methods to smooth the flow of patients getting screened. When provided a choice between unsecured emails versus PHRs as the delivery mechanism for disease screening messages, both patients and providers preferred PHRs. Conclusions There is considerable potential to use PHR systems for electronic outreach and social marketing to communicate to patients about, and increase rates of, disease screening, including for HIV. Planning for direct-to-patient communications through PHRs should include providers and address provider reservations, especially about workload increases.
Collapse
Affiliation(s)
- D Keith McInnes
- Center for Health Quality, Outcomes & Economic Research, ENRM VA Medical Center, Bedford, MA, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Nazi KM. Veterans' voices: use of the American Customer Satisfaction Index (ACSI) Survey to identify My HealtheVet personal health record users' characteristics, needs, and preferences. J Am Med Inform Assoc 2010; 17:203-11. [PMID: 20190065 PMCID: PMC3000775 DOI: 10.1136/jamia.2009.000240] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 11/27/2009] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Consumer research reveals considerable interest in the use of Personal Health Records (PHRs), yet adoption remains relatively low. Both adopters and nonadopters represent important perspectives from which to understand this paradox. OBJECTIVE This study focuses on direct feedback from adopters obtained using the American Customer Satisfaction Index (ACSI) survey on the My HealtheVet PHR portal (http://www.myhealth.va.gov) of the Veterans Health Administration (VHA). The results represent a source of direct feedback with which to better understand veterans' needs and preferences. METHODS The ACSI Survey was implemented in October 2007 to measure satisfaction and elicit information about characteristics and preferences of My HealtheVet PHR adopters. The data represent a continuous random sample of site visitors who have navigated at least four pages on the site. A total of 100 617 surveys were completed (17.2%). RESULTS Satisfaction with My HealtheVet is high (8.3/10.0), and users are highly likely to return to the site (8.6/10.0) and recommend the site to other veterans (9.1/10.0). The majority of system adopters are male (91%), between the ages of 51 and 70 (68%), and served in the Vietnam War (60%). Most veterans currently visit the site to utilize pharmacy-related features. CONCLUSION VHA has used the ACSI to monitor satisfaction, and to better understand the characteristics, needs, and preferences of early adopters. The data provide an important source of direct feedback to inform program development. Future research will include monitoring the impact of enhancements and new features on satisfaction, and conducting additional research with nonadopters to identify barriers to adoption and use.
Collapse
Affiliation(s)
- Kim M Nazi
- Department of Veterans Affairs, Veterans and Consumers Health Informatics Office, Office of Health Information, Veterans Health Administration, Washington, DC, USA.
| |
Collapse
|
34
|
Nazi KM, Hogan TP, Wagner TH, McInnes DK, Smith BM, Haggstrom D, Chumbler NR, Gifford AL, Charters KG, Saleem JJ, Weingardt KR, Fischetti LF, Weaver FM. Embracing a health services research perspective on personal health records: lessons learned from the VA My HealtheVet system. J Gen Intern Med 2010; 25 Suppl 1:62-7. [PMID: 20077154 PMCID: PMC2806958 DOI: 10.1007/s11606-009-1114-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Personal health records (PHRs) are designed to help people manage information about their health. Over the past decade, there has been a proliferation of PHRs, but research regarding their effects on clinical, behavioral, and financial outcomes remains limited. The potential for PHRs to facilitate patient-centered care and health system transformation underscores the importance of embracing a broader perspective on PHR research. OBJECTIVE Drawing from the experiences of VA staff to evaluate the My HealtheVet (MHV) PHR, this article advocates for a health services research perspective on the study of PHR systems. METHODS We describe an organizing framework and research agenda, and offer insights that have emerged from our ongoing efforts regarding the design of PHR-related studies, the need to address PHR data ownership and consent, and the promotion of effective PHR research collaborations. CONCLUSION These lessons are applicable to other PHR systems and the conduct of PHR research across different organizational contexts.
Collapse
Affiliation(s)
- Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Health Information, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Nazi KM, Woods SS. MyHealtheVet PHR: a description of users and patient portal use. AMIA Annu Symp Proc 2008:1182. [PMID: 18999142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 08/18/2008] [Indexed: 05/27/2023]
Abstract
The My HealtheVet Personal Health Record (PHR) continues to demonstrate significant growth, with more than 630,000 registered users logging more than 20 million visits to the site. Understanding patient user characteristics, use of and satisfaction with current features, and desires for new online services reveals important user perceptions that will further inform PHR development.
Collapse
|
36
|
Abstract
e-Health offers the rich potential of supplementing traditional delivery of services and channels of communication in ways that extend the healthcare organization's ability to meet the needs of its patients. Benefits include enhanced access to information and resources, empowerment of patients to make informed healthcare decisions, streamlined organizational processes and transactions, and improved quality, value, and patient satisfaction. A diverse array of factors affects the development and implementation of e-Health initiatives and applications. Crafting a strategic approach is critical to success, especially in this era of rapidly changing technology. The journey to implementing e-Health at this VA Network is discussed and a model described for assessing the environment, identifying critical success factors, and selecting areas of focus. Recommendations are offered for defining a strategic approach to e-Health for healthcare organizations.
Collapse
Affiliation(s)
- Kim M Nazi
- Network Knowledge Management Officer, VA Healthcare Network Upstate New York: VISN 2, Knowledge Management Office, 113 Holland Avenue, Albany, New York 12208, USA.
| |
Collapse
|
37
|
|