My HealtheVet (MHV) is a secure web-based portal that offers patients access to trusted health information. Despite this initiation and an effective piloting of the program to over 50,000 veterans, there have been some delays in fostering system-wide implementation of the portal. Relatively little is known about the barriers and facilitators to the implementation.
The purpose of the proposed study is to identify factors impacting patient use of MHV and explore how to engage patients in the best use and navigation of MHV. For example, we are interested in which features of MHV do patients use/prefer/not prefer and investigate the barriers and facilitators of optimal use by patients.
The proposed study first performed semi-structured interviews with eight patients who previously used MHV to inform the design of our usability test. We then conducted usability testing of MHV on a convenience sample of 24 veterans and at the VA HSR&D Human-Computer Interaction (HCI)/IT Laboratory at the Roudebush VAMC. Our test focused on efficiency, errors, and satisfaction. For each scenario, statistical comparisons between target and observed values were conducted to highlight significant differences. We also collected qualitative data by recording video to provide a record of the users' actions and verbalizations to analyze for confusion and difficulty meeting task goals.
We first performed semi-structured interviews with eight patients who previously used MHV to inform the design of our usability test. The eight interviews were transcribed verbatim. Themes guiding the interviews were identified by two raters. The themes were: current use, reason of use, ease of use, functionality of MHV (available and desired), learnability, health management, privacy and confidentiality. Observed time performance for three of the scenarios (registration, track health, and search tasks) were significantly higher (p < .01) than target task performances. Conversely, the observed task performance for prescription refill was significantly lower (p < .01) than target task performance. The observed errors for search tasks were significantly lower than the usability error target. Participants rated four of the nine usability statements significantly below the target levels on issues such as error messages that clearly inform the user how to fix problems, recovering easily and quickly when making a mistake, and ease of finding the information needed. Five usability issues emerged from the qualitative data: password criteria and instructions; error messages; required fields; on-screen instructions; and expectations of use.
Managers and policymakers of MHV are continually expanding the capabilities of MHV to deliver more services and provide communication from veterans to their physicians. Consequently, information garnered from the proposed study provided important data to help tailor the program so that more veterans can use MHV and those who do so will repeatedly use it. The findings from the usability assessment offered rapid feedback for managers and designers involved in the MHV implementation to a design team so that the appropriate modifications can be made iteratively during the design cycle.
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