Spotlight: Enhancing eHealth for Veterans

November 2011

In Crossing the Quality Chasm, the Institute of Medicine began to emphasize that care should not occur just within face-to-face visits, but that "access to care should be provided over the Internet" to foster continuous healing relationships. Subsequent reports have continued to support the eHealth model of care, which is meant to augment, not replace, traditional healthcare services such as telephone contacts and in-person clinical visits. The primary function of access to eHealth is to facilitate more continuous care between visits and increase support for patient self-management and participation in care.

VA/HSR&D's eHealth Quality Enhancement Research Initiative's (eHealth-QUERI) mission is to work with VA program offices to implement and evaluate eHealth as a model of care for augmenting high-quality evidence-based services to Veterans and their families. Unlike other QUERI Centers, eHealth-QUERI's focus is not disease-specific; its "clinical" focus is eHealth, which is applicable across all health conditions. Initially, eHealth-QUERI's main focus is on My HealtheVet.

VA created My HealtheVet (MHV) to provide Veterans with an online personal health record that is available 24/7, wherever there is Internet access. A personal health record is a set of computer-based tools that allow people to access and coordinate their health information and to make appropriate parts of it available to those who need it. Veterans who use the VA healthcare system and are registered for MHV are able to:

• Refill VA prescriptions,
• Receive VA wellness reminders,
• View VA appointments,
• View VA chemistry/hematology laboratory results, and
• Participate in secure messaging with their health care team. Secure messaging is available through some VA clinics and is expanding throughout 2011.

Partnering to Enhance My HealtheVet

eHealth-QUERI forged relationships within the MHV Program Office in the Veterans and Consumer Health Informatics Office, which keeps them informed about the latest data on My HealtheVet users' needs and preferences. Currently, the American Consumer Satisfaction Index survey, fielded by the MHV Program Office, is the primary means for assessing the needs and preferences of Veterans who use My HealtheVet. In February 2011, QUERI put out a special solicitation for research studies that could provide a more in-depth examination of Veterans' use and preferences regarding the following My HealtheVet's priority areas:

• Secure messaging,
• Blue Button (allows Veterans to view, print or save their personal information), and
• Increasing in-person authentication (IPA) rates for Veterans using My HealtheVet. IPA confirms a Veteran user's identity to allow for an upgraded account, so the Veteran can view, print, and download parts of their official VA health record.

Since its inception earlier this year, eHealth-QUERI has developed several studies that focus on increasing access to My HealtheVet (MHV) and augmenting meaningful use of MHV functions for patient self-management and participation in collaborative care. Studies will focus on:

• Using clinical reminders to promote enrollment in MHV;
• Evaluating the secure messaging function in MHV from both patient and provider perspectives;
• Developing a database that will track Veterans' MHV adoption and analyze use across sites, and by Veterans' sociodemographic and clinical characteristics;
• Integrating MHV into Patient-Aligned Care Teams (PACT) through development of a Diabetes Virtual Group Medical Access toolkit; and
• Evaluate satisfaction with the MHV Blue Button, which allows Veterans to integrate self-entered and VA health record data in one location, and to print the information to share with other providers.

Visit the QUERI national website to learn more about this unique quality improvement program with a focus on implementation science, as well as the other nine QUERI Centers.