BACKGROUND/RATIONALE:
VA is the world's largest integrated healthcare system for individuals with SCI/D, a lifelong condition requiring ongoing management and novel ways to promote access to care. Patient-facing technologies like My HealtheVet (MHV), VA's integrated, web-based personal health record (PHR) portal have great potential to improve care for Veterans with SCI/D; however, adoption and use of the system in this population is low.

OBJECTIVE(S):
1) To understand perceptions and use of MHV among Veterans with SCI/D and VA SCI/D healthcare providers; 2) To implement and assess 2 MHV promotional campaigns for Veterans with SCI/D and their healthcare providers.

METHODS:
Based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework, we conducted a two-phase mixed methods study at 2 SCI Centers. Phase 1 encompassed semi-structured face-to-face interviews and background questionnaires with VA SCI/D healthcare providers, mail survey of Veterans with SCI/D, and chart reviews to understand perceptions and use of MHV. Phase 2 implemented the MHV promotional campaigns: site 1 was characterized by enhanced facilitation and site 2 by basic facilitation. Phase 2 data included follow-up interviews with healthcare providers, follow-up mail survey and semi-structured telephone interviews with Veterans, and chart reviews.

FINDINGS/RESULTS:
Chart reviews were used to determine the number of Veterans who completed a MHV identify verification process known as in-person authentication (IPA). During the intervention period, IPA rates at Study Site 1 increased 100% (from 24 to 48), and at Site 2 77.8% (from 18 to 32). 792 surveys were mailed to Veterans in Phase 1, 292 were completed, and 32 were returned by the post office (38.4% response rate). In Phase 2, 174 of 746 Veterans completed surveys and 15 were returned by the post office (23.8% response rate). A majority of Phase 1 respondents (65%) reported using a computer, 70% of those reported daily computer use and about two-thirds (64%) reported using the Internet, with 70% using the Internet at least once per week. Half of the Phase 1 respondents (50%) reported having heard of MHV compared to (66.3%) of Phase 2 respondents. We interviewed 26 healthcare providers in Phase 1, and completed follow-up interviews with 16 in Phase 2. Providers visiting MHV increased from 69% to 81.3% over the intervention period, and their likelihood of recommending MHV to Veterans increased from 65% to 75%. Providers also described the ability to share information with patients and other providers and extend medical record data as potential advantages to MHV use, but expressed a need for training about MHV and concerns over its implications for the provider-patient relationship. Finally, 26 Veteran interviews conducted in Phase 2 revealed frequent use of specific MHV features (e.g., prescription refills), but also strong preference for other features, including the ability to view and make appointments, see laboratory results, and exchange messages with providers.

IMPACT:
Implementation and sustained use of patient-facing technologies is a priority for VA. Promotional campaigns were effective in increasing knowledge and use of MHV by Veterans with SCI/D and their providers.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Nazi KM, Hogan TP, Wagner TH, McInnes DK, Smith BM, Haggstrom D, Chumbler NR, Gifford AL, Charters KG, Saleem JJ, Weingardt KR, Fischetti LF, Weaver FM. Embracing a health services research perspective on personal health records: lessons learned from the VA My HealtheVet system. Journal of general internal medicine. 2010 Jan 1; 25 Suppl 1:62-7. [view]
2. Hogan TP, Hill JN, Locatelli SM, Weaver FM, Thomas FP, Nazi KM, Goldstein B, Smith BM. Health Information Seeking and Technology Use Among Veterans With Spinal Cord Injuries and Disorders. PM & R : the journal of injury, function, and rehabilitation. 2016 Feb 1; 8(2):123-30. [view]
3. Hill JN, Smith BM, Weaver FM, Nazi KM, Thomas FP, Goldstein B, Hogan TP. Potential of personal health record portals in the care of individuals with spinal cord injuries and disorders: Provider perspectives. The journal of spinal cord medicine. 2018 May 1; 41(3):298-308. [view]
4. Hill JN, Guihan M, Hogan TP, Smith BM, LaVela SL, Weaver FM, Anaya HD, Evans CT. Use of the PARIHS Framework for Retrospective and Prospective Implementation Evaluations. Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing. 2017 Apr 1; 14(2):99-107. [view]

Conference Presentations

1. Hill JN, Bauer ED, Hogan TP, Smith BM, Weaver FM. Assessing eHealth Literacy in a Complex Patient Population Using eHEALS. Poster session presented at: Kentucky Conference on Health Communication; 2012 Apr 20; Lexington, KY. [view]
2. Hill JN, Guihan M, Hogan TP, Smith BM, LaVela SL, Weaver FM, Anaya HD, Evans (Mayfield) CT. Conducting Retrospective and Prospective Implementation Evaluations Using the PARIHS Framework. Poster session presented at: National Institutes of Health / AcademyHealth Conference on the Science of Dissemination and Implementation; 2016 Dec 14; Washington, DC. [view]
3. McInnes DK, Hogan TP, Houston TK, Turvey CL, Nazi KM. Opportunities for the New eHealth QUERI: Developing Approaches to Increase Veteran Adoption and use of my HealtheVet. Presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD. [view]
4. Hogan TP, Hill JN, Bauer ED, Nazi KM, Smith BM, Thomas FP, Richardson MS, Weaver FM, Weaver FM, Smith BM. Personal Health Information Management and the Role of a Personal Health Record in a Complex Patient Population. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 25; Orlando, FL. [view]
5. Hogan TP, Hill JN, Smith BM, Nazi KM, Guihan M, Thomas FP, Richardson MS, Wallen E, Goldstein B, Weaver FM. Promoting implementation of My HealtheVet (MHV) among Veterans with spinal cord injuries and disorders (SCI/D). Poster session presented at: VA HSR&D Field-Based Quality Improvement in Parallel Circuits Meeting on VA System Redesign, Operational Systems Engineering, and Implementation Research; 2010 Jul 14; Indianapolis, IN. [view]
6. Hill JN, Hogan TP, Smith BM, Barrera L, Zuccarello MA, Bauer ED, Locatelli (House) SM, Guihan M, Smith BM, Weaver FM, Nazi K. Promotion of a Web-based personal health record in a complex patient population. Poster session presented at: International Conference on Communication in Healthcare; 2011 Oct 17; Chicago, IL. [view]
7. Hogan TP, Smith BM, Hill JN, Nazi K, Thomas FP, Richardson M, Weaver FM. The implications of personal health records for provider patient interactions. Poster session presented at: International Conference on Communication in Healthcare; 2011 Oct 17; Chicago, IL. [view]
8. Hill JN, Guihan M, Hogan TP, Evans (Mayfield) C, Smith BM, Weaver FM. Using a Common Framework to Implement Clinical Practice Change: Experiences in the Spinal Cord Injury System of Care. Poster session presented at: VA HSR&D National Meeting; 2012 Jul 18; National Harbor, MD. [view]

DRA: Health Systems Science, Brain and Spinal Cord Injuries and Disorders
DRE: Research Infrastructure, Prevention, Technology Development and Assessment
Keywords: Informatics, Self-care, Spinal cord injury
MeSH Terms: none