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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1119 — My HealtheVet Clinical Reminder: Formative Evaluation of Clinic Structures, Organization, Culture, and Workflow to Develop a Clinic-Based Intervention

Fix GM, Center for Health Quality, Outcomes, and Economic Research (CHQOER); HIV/Hepatitis & eHealth QUERIs; Archambeault C, New England Veterans Engineering Resource Center; Stewart M, VA Boston Healthcare System; Martin TL, VA New England Healthcare System; McInnes DK, VA New England Healthcare System; HIV/Hepatitis & eHealth QUERIs; Hogan TP, Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital; Spinal Cord Injury and eHealth QUERIs; Grochow R, Boston University School of Medicine; Simon SR, VA Boston Healthcare System; eHealth QUERI;

My HealtheVet (MHV), VA’s web-based personal health record portal, allows patients to track health, view VA electronic medical record extracts, communicate electronically with their healthcare team, and access health education materials. Low adoption rates, however, continue to impede MHV’s potential to transform the delivery and receipt of VA care. Only 3% of VA patients have completed In-Person Authentication (IPA), necessary for access to key MHV features. VA primary care clinics present an opportunity to engage non-IPA’d patients; however, little is known about how best to intervene. Working with the MHV Program Office, the VISN MHV coordinator, and the Veterans Engineering Resource Center, we sought to develop an intervention to increase MHV adoption by 1) characterizing current approaches used in primary care to promote MHV; 2) understanding the system-wide context within which MHV is deployed; and thereafter, 3) piloting a primary care-based intervention.

Using direct observations, we characterized barriers and facilitators of MHV registration and IPA in three primary care clinics at a metropolitan VAMC. A systems engineering approach was used to assess the environment and processes surrounding MHV patient education. Observations focused on an existing clinical reminder [CR], workflow, practice variation, physical space, material artifacts, and patient-provider interactions. To complement these data, we interviewed 16 VHA-wide key informants with national perspectives on MHV. We iteratively coded data using an emergent, thematic strategy.

We observed high variability in primary care clinic processes surrounding MHV, including: presence of clinical champions; limited standardization of MHV documentation; and inconsistent, shallow descriptions of MHV. Veterans seemingly lacked clarity on what MHV is, might not see personal relevancy to their healthcare, nor know the steps needed to IPA. Key informants described a range of MHV promotion strategies, including programs to complement the MHV CR, and emphasized the need for outreach about the benefits of MHV.

The observed, high single-site variability suggests larger national variation, which may impact enrollment. A clinical champion, consistent materials, and social marketing could facilitate MHV adoption.

Study results will guide the development of an intervention to support MHV adoption in primary care clinics, piloted, spring 2012, and subsequently disseminated broadly.

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