BACKGROUND/RATIONALE:
Consumers have strong interest in having access to health records and using the Internet for health-related transactions. Personal health records (PHR) have been developed to promote patient access to shared electronic records, health information and online services. My HealtheVet (MHV), the VA's PHR, allows patients to refill medications, receive prevention reminders, use secure messaging to communicate with providers, view some test result and track self-reported data. MHV offers a convenient and effective way to improve self-care and patient-provider interactions. With the rising burden of chronic illness among Veterans, PHRs could offer considerable value. However, little is known about factors that affect the use and impact of MHV. A crucial step in understanding PHR adoption is to gain insights into My HealtheVet users and usage. We conducted an exploratory study of patient newly authenticated for MHV, following subjects for at least 6 months.

OBJECTIVE(S):
Our study goals were to describe a cohort of Veteran patients who had completed in-person identity proofing (authentication) for MHV, and to identify key factors associated with MHV usage, including demographics, literacy levels, Internet use, health status, adherence, activation levels, and preventive and self-management behaviors.

METHODS:
We conducted an exploratory, prospective cohort study of newly authenticated MHV users that examined user characteristics and factors related to MHV usage. All participants were enrolled in the study after completing the in-person authentication process in the My HealtheVet office at the Portland VA Medical Center (PVAMC) in Portland, Oregon. At baseline, participants completed surveys at PVAMC to assess user experience and level of comfort with the internet, methods of internet access, use of the internet to seek out health and medical information, eHealth literacy, health literacy, patient activation level, and demographic data. At follow-up, participants completed surveys in either an online or paper format, designed to assess their frequency of internet use, ability and level of comfort with the internet, use of My HealtheVet during the previous 6 months, most and least used features of the MHV site, technical problems with the site, and patient activation level. Enrollment began December 2010.

FINDINGS/RESULTS:
At baseline, 270 participants were enrolled and 230 (84.2%) participants completed the follow-up survey. The majority of the sample were male (84%), between the ages of 51 and 70 years of age (61.5%), reported their race/ethnicity as White (83.3%), had attended at least some college or vocational school (80.4%), and were married or living as married (51.9%). The majority of participants in this study used the internet at least occasionally (97%) with 89.2% of the sample rating their ability to use the internet as intermediate or higher. When asked about using WiFi services and mobile technology, 54.1% indicated that they have used wireless internet services in public places such as airports, coffee shops, and restaurants while 41.9% reported going online using a wireless handheld device such as an iPhone, iPod, cell phone, Blackberry, or Palm.

The primary outcome of interest in this study was a measure of MHV usage. The investigators were unable to obtain access to MHV Activity Logs (successful and unsuccessful logins). As an alternative, a follow-up question was utilized to estimate PHR usage. Participants were asked, "On average, how frequently did you visit the My HealtheVet site in the past 6 months?" There were no statistically significant differences in mean scores on this item by age, gender, or level or education. Overall, only comfort with the internet assessed at follow-up was a statistically significant independent predictor of MHV usage.

We conducted a paired samples t-test In order to examine any possible differences in patient activation at baseline and at follow-up. The results indicate that there is a statistically significant difference between levels of patient activation before intervention compared to after, with patients scoring significantly higher at baseline compared with that at follow-up.

IMPACT:
Further exploration of the construct "comfort with the internet" may be needed to better understand its relationship with use of the My HealtheVet website. In addition, items designed to assess level of comfort with using the internet to find health information may warrant future analysis to better understand their relationships with variables such as age, gender, health literacy, and comfort with the internet.

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External Links for this Project

NIH Reporter

Grant Number: I01HX000351-01
Link: https://reporter.nih.gov/project-details/7873664

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PUBLICATIONS:

Journal Articles

1. Hesse BW, Ahern DK, Woods SS. Nudging best practice: the HITECH act and behavioral medicine. Translational behavioral medicine. 2011 Mar 28; 1(1):175-181. [view]

DRA: Health Systems
DRE: Research Infrastructure, Technology Development and Assessment
Keywords: none
MeSH Terms: none