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Health Services Research & Development

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FORUM - Translating research into quality health care for Veterans

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Research Highlight

eHealth is a multidisciplinary field focused on the delivery or enhancement of health information and health services through information and communication technologies. 1 eHealth also improves access to health care services by offering novel channels for communication and information flow that complement existing systems.2 eHealth QUERI investigators are leading a project focused on identifying and evaluating patientfacing eHealth-specific metrics. The goal of this project is to conduct a thorough review of potential metrics that could be used in any study involving eHealth interventions in Veterans, and to create a standardized compendium of recommended metrics that will support both U.S. Department of Veterans Affairs (VA) operations and research.

The project team includes investigators from the Iowa City (Bonnie Wakefield, Carolyn Turvey) and Bedford (Tim Hogan, Stephanie Shimada) VAs, and the My HealtheVet program office (Kim Nazi) under the auspices of the eHealth QUERI, directed by Thomas Houston. Following a systematic review of the literature to identify potential metrics, investigators are utilizing a standardized review form to document metric properties. We also invite investigators across VA to submit suggested measures for review and inclusion in the compendium.

eHealth implementation has several unique characteristics that warrant investigation of effective metrics. First, eHealth implementation requires the evaluation of technology platforms for their usability, functionality, and availability to target users. Metrics pertaining to technology platforms are most often seen in design, technology, and engineering literature. For eHealth implementation, however, these metrics must be tailored for use in health care settings. Second, eHealth implementation assumes that a particular technology is being promoted to improve aspects of quality like efficiency or accessibility. For example, eHealth may reduce the distance between services and the target user, or reduce physician or patient work load for a specific task. Though intervention studies may include metrics that attempt to quantify these characteristics, as of yet, there are no widely agreed upon measures. Without such metrics, one can imagine how cost analyses and related initiatives may fall short in determining the full benefit of an eHealth intervention to Veterans and to VA. Finally, almost all eHealth interventions aim to improve communication in one form or another. Metrics are needed that quantify the degree to which communication is improved.

Ultimately, consistent and well-validated metrics of design, efficiency, and improved communication are necessary to determine the true benefit of any eHealth intervention. Without such metrics, VA cannot: (1) calculate return on investment of eHealth technology; (2) effectively address barriers to adoption that are revealed by these metrics (i.e., usability, accessibility of a technology); or (3) accurately estimate the likelihood of adoption. For example, VA operations may use My HealtheVet Secure Messaging to disseminate a health education message. Optimally, that approach would be evaluated both in terms of the workload burden on providers and the accuracy of patient comprehension of medical advice provided electronically. Metrics identified in this project could inform VA operations of the value of using Secure Messaging versus other dissemination strategies. Furthermore, the identification of metrics will assist VA operations offices to select effective measures that support 'post-market surveillance' of currently deployed technologies.

VA has made a substantial investment in eHealth technologies to improve care for Veterans. The proportion of proposals in both the HSR&D and QUERI pipeline where eHealth is a component has risen dramatically. VA's ability to gauge the impact of this work hinges on the measurement tools that investigators have available and ultimately choose to use. The measures identified by this project will be critical to initiatives across a number of operations offices, including the My HealtheVet Program Office, the Connected Health Office, the broader Office of Informatics and Analytics, the Office of Telehealth Services, and even resource centers like VIReC. The results of this project will provide critical insights into existing eHealth measures and identify gaps where new metrics are needed. The results can also inform future studies, ensuring that investigators can meaningfully compare and synthesize across projects.

The author invites investigators across VA to submit suggested measures for review and inclusion in the compendium to

  1. Eysenbach G. "What is e-health?" Journal of Medical Internet Research 2001; 3(2).
  2. Hogan, T.P. et al. "Promoting Access through Complementary eHealth Technologies: Recommendations for VA's Home Telehealth and Personal Health Record Programs," Journal of General Internal Medicine 2011; 2:628-35.

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