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Research Highlight

My HealtheVet Supports Veterans' Management of Diabetes

The My HealtheVet (MHV) patient portal and personal health record allows patients convenient access to a subset of information contained in their electronic health records, including laboratory, pathology, and radiology results, clinical progress notes, wellness reminders, immunization records, and medication history. The MHV portal also contains benefcial features such as secure messaging, online reflls, trusted health information resources, and the ability to self-enter and track health information. While the upcoming electronic health record migration to Cerner may impact the content and appearance of My HealtheVet, the future version of the portal will no doubt continue to provide VA patients with access to these valuable features.

Nearly 25 percent of Veterans receiving care from VA have diabetes.¹ Current work at the Bedford VA examines how Veterans use MHV for their diabetes management. As part of this research, 40 Veterans participated in interviews in which they described their overall management of diabetes and how MHV and other technologies support their diabetes management.

Secure Messaging

Secure messaging (SM) emerged from our data as an important and widely used feature of MHV. First introduced in 2008, SM is a secure email message exchange that enables asynchronous patient-provider communication outside of the traditional face-to-face clinical visit. Nearly 2 million Veterans have opted in to use SM; research has found that SM is helpful to Veterans for requesting medication renewals and reflls, scheduling appointments or tests, and reporting or asking about medication or other health issues.²

For rural Veterans, SM enables increased access to healthcare teams. In our interviews, one Veteran described living far away from the nearest hospital or clinic in an area with unreliable cellular phone service. SM became a platform to enable the patient to maintain reliable and clear communication with their healthcare team despite these obstacles. For other Veterans, SM enabled them to ask questions or express concerns as they came up, whether on the weekend or in the evenings.

Blue Button

The Blue Button enables Veterans to view, download, and print or share important health information extracted from their electronic health record. A number of those we interviewed reported that, following a visit, they will look at their notes to remember important information, confrm changes to their care plan, or contact their provider and correct any information that they believe was entered incorrectly. Veterans mentioned notes as being especially helpful at the time of a health crisis, such as a new cancer diagnosis, making it easier to share accurate health information with family members.

Veterans most frequently cited their ability to view lab and test results as a benefcial feature of the Blue Button, helping them to prepare questions for upcoming face-to-face visits with care providers. Others stated that they download and print their results so that they have a paper copy to take with them to visits with any non-VA care providers.

Medication Reflls

In our study, Veterans reported that the most helpful aspect of MHV was their ability to refll prescriptions. One Veteran commented that they combine this feature with other medication management strategies so they know when they are running low and can plan ahead to order reflls. For those who live far from a hospital or pharmacy, the medication refll feature means that they can stay current with their medications without needing to travel.

Not every MHV feature is perceived as helpful, however. While measuring and tracking one’s blood glucose is important for diabetes management, patients preferred to do so outside of MHV. The design of the portal is such that patients must log in and click through multiple screens in order to enter and track their readings. Many patients track their readings manually, or via phone apps, instead of using MHV. However, patients report that, if developed, they would choose an MHV app over their existing options. Veterans’ experiences can inform wish lists for future improvements to MHV.

MHV features such as medication reflls and SM enable Veterans to accomplish important self-management tasks from home in a timely manner. The introduction of electronic communication features and the Blue Button empower patients to engage and participate in their own care. Overall, Veterans were enthusiastic about their experience with MHV. The team is currently working with three Veteran co-Investigators who are helping us incorporate these lessons learned into an MHV training for Veterans with diabetes.

References

1. US Department of Veterans Affairs. “Close to 25 percent of VA Patients Have Diabetes.” 2015. https://www.va.gov/health/NewsFeatures/20111115a.asp
2. Shimada SL, Petrakis BA, Rothendler JA, et al. “An Anal­ysis of Patient-provider Secure Messaging at Two Vet­erans Health Administration Medical Centers: Message Content and Resolution through Secure Messaging,” Journal of American Medical Informatics Association 2017; 24(5):942-9.