My HealtheVet 126: Optimizing Patient Education

Slide 1:My HealtheVet #126: Optimizing Patient Education

Kathleen Charters, PhD, RN, CPHIMS, CNE Kathleen Painter, RN, MSN, CHM Kathleen Charters: My name is Kathleen Charters. I am a Clinical Information Systems Specialist for the My HealtheVet Program Management Office. I would like to acknowledge the contributions to this presentation by Rose Mary Pries, the Program Manager for the Office of Veterans Health Education and Information at the VA National Center for Health Promotion and Disease Prevention in Durham, NC. Rose Mary is the Chair of the My HealtheVet Clinical Advisory Board Patient Education Sub-group. Kathleen Painter is the Patient Education Lead for My HealtheVet, and a member of the Patient Education Sub-group. Kathleen Painter and I will share ways that you can assess patient’s needs and use My HealtheVet to help patients find the information and develop the skills they need to self-monitor and self-manage their conditions, and communicate more effectively with the healthcare team. Kathleen Charters: My name is Kathleen Charters. I am a Clinical Information Systems Specialist for the My HealtheVet Program Management Office. I would like to acknowledge the contributions to this presentation by Rose Mary Pries, the Program Manager for the Office of Veterans Health Education and Information at the VA National Center for Health Promotion and Disease Prevention in Durham, NC. Rose Mary is the Chair of the My HealtheVet Clinical Advisory Board Patient Education Sub-group. Kathleen Painter is the Patient Education Lead for My HealtheVet, and a member of the Patient Education Sub-group. Kathleen Painter and I will share ways that you can assess patient’s needs and use My HealtheVet to help patients find the information and develop the skills they need to self-monitor and self-manage their conditions, and communicate more effectively with the healthcare team.

Slide 2:Objectives

Demonstrate how to find specific health & patient education information on My HealtheVet Assess patient needs in a time-limited clinical encounter Use My HealtheVet to leverage existing educational resources & programs Identify strategies to optimize patient education by focusing on specific health needs of an individual patient State how to request content development & modifications to clinical information & patient education Kathleen Charters: At the end of this session you will be able to: Find specific health and patient information on My HealtheVet Use evidence-based techniques to quickly assess your patients needs Use My HealtheVet to optimize educational resources and programs Optimize your patient education by focusing on the specific needs of the patient Request My HealtheVet content development and modifications to clinical information and patient educationKathleen Charters: At the end of this session you will be able to: Find specific health and patient information on My HealtheVet Use evidence-based techniques to quickly assess your patients needs Use My HealtheVet to optimize educational resources and programs Optimize your patient education by focusing on the specific needs of the patient Request My HealtheVet content development and modifications to clinical information and patient education

Slide 3:Housekeeping

Questions Use 3x5 cards Hold until end of presentation Responses will be discussed & posted on-line Kathleen Charters: During our presentation, please use the 3x5 cards to write down your questions. At the conclusion we’ll pick them up and answer as many as time permits. Responses will also be posted on-line.Kathleen Charters: During our presentation, please use the 3x5 cards to write down your questions. At the conclusion we’ll pick them up and answer as many as time permits. Responses will also be posted on-line.

Slide 4:Needs Assessment

Show of hands Are you using My HealtheVet in your clinical practice? How many of you think your patients are using My HealtheVet? Written responses What health information topics would you most frequently refer your patients to? Would you find self-entered information helpful in your clinical practice? Send to Kathleen.Painter2@va.gov Kathleen Charters: Please raise your hand if you are using My HealtheVet in your clinical practice. [Pause] Thank you. Please raise your hand if you think your patients are using My HealtheVet. [Pause] Thank you. If you are viewing this on-line, you may e-mail your responses to Kathleen Painter. We asked focus groups, “What health information topics would you most frequently refer your patients to? Would you find self-entered information helpful in your clinical practice?” This information helps us to provide a more useful service. Now Kathleen Painter will talk about what My HealtheVet can do for you.Kathleen Charters: Please raise your hand if you are using My HealtheVet in your clinical practice. [Pause] Thank you. Please raise your hand if you think your patients are using My HealtheVet. [Pause] Thank you. If you are viewing this on-line, you may e-mail your responses to Kathleen Painter. We asked focus groups, “What health information topics would you most frequently refer your patients to? Would you find self-entered information helpful in your clinical practice?” This information helps us to provide a more useful service. Now Kathleen Painter will talk about what My HealtheVet can do for you.

Slide 5:Overview

What Can My HealtheVetDo for Me? KATHLEEN Painter: Today we will orient you to what is available on My HealtheVet, with a focus on the Research Health and Track Health offerings. KATHLEEN Painter: Today we will orient you to what is available on My HealtheVet, with a focus on the Research Health and Track Health offerings.

Slide 6:Introduction

Introduction to My HealtheVet Who uses My HealtheVet Research Health Healthy Living Conditions Mental Health Medical Library Track Health Value of My HealtheVet in Clinical Practice KATHLEEN Painter: We will provide a brief overview of what My HealtheVet is and who uses it, an outline of the Research Health section, which includes Healthy Living centers, Disease and Condition centers, a Mental Health section, and a Medical Library. Then we will present an overview of the Track Health section. Finally, we will illustrate the value of incorporating use of My HealtheVet in your clinical practice.KATHLEEN Painter: We will provide a brief overview of what My HealtheVet is and who uses it, an outline of the Research Health section, which includes Healthy Living centers, Disease and Condition centers, a Mental Health section, and a Medical Library. Then we will present an overview of the Track Health section. Finally, we will illustrate the value of incorporating use of My HealtheVet in your clinical practice.

Slide 7:What Is My HealtheVet?

My HealtheVet is a web-based application designed for veterans, their families, & their friends with the goal of optimizing veterans’ healthcare Holistic Supporting body, mind, & spirit VA benefits, programs, & services Personal Health Record Self-entered personal & health-related information (patient participation) Extracts from the VA electronic medical record KATHLEEN Painter: What is My HealtheVet? My HealtheVet is a Web-based one-stop shop for access to trusted health care resources supporting body, mind and spirit, and information on VA benefits, programs, and services. My HealtheVet provides veterans, their family and their friends a user-friendly, secure, and interactive on-line Personal Health Record. My HealtheVet combines self-entered information with extracts from the VA electronic medical record to create a holistic integrated view of personal health information. It encourages patients and their families actively participate in their health care. My HealtheVet empowers veterans to share their information with others to help improve the quality of care they receive.KATHLEEN Painter: What is My HealtheVet? My HealtheVet is a Web-based one-stop shop for access to trusted health care resources supporting body, mind and spirit, and information on VA benefits, programs, and services. My HealtheVet provides veterans, their family and their friends a user-friendly, secure, and interactive on-line Personal Health Record. My HealtheVet combines self-entered information with extracts from the VA electronic medical record to create a holistic integrated view of personal health information. It encourages patients and their families actively participate in their health care. My HealtheVet empowers veterans to share their information with others to help improve the quality of care they receive.

Slide 8:Who Uses My HealtheVet?

2006 06 n = 253,869 2007 06 n = 430,784 KATHLEEN Painter: As of June 2007, over 430,000 people have registered to use My HealtheVet. The age distribution has slightly shifted to the right since 2006. The median age is now 60, and registrants aged 60 to 64 represent almost 80,000 My HealtheVet users in that group alone. This is the baby boomer population. If you look at the graph and visualize a bell curve, you see that 67% of our patient population falls between 40 and 69 years of age, which has significant implications for healthcare providers. Generally, people in their 40s are becoming more concerned about health issues, whereas people at the far end of the spectrum are dealing with co-morbidities and end of life issues. This information can be very valuable and influence the content that we develop and how we present health information to our patient population. The My HealtheVet Product Web site provides monthly updates of statistics; it is available at http://vaww1.va.gov/MyHealtheVet.KATHLEEN Painter: As of June 2007, over 430,000 people have registered to use My HealtheVet. The age distribution has slightly shifted to the right since 2006. The median age is now 60, and registrants aged 60 to 64 represent almost 80,000 My HealtheVet users in that group alone. This is the baby boomer population. If you look at the graph and visualize a bell curve, you see that 67% of our patient population falls between 40 and 69 years of age, which has significant implications for healthcare providers. Generally, people in their 40s are becoming more concerned about health issues, whereas people at the far end of the spectrum are dealing with co-morbidities and end of life issues. This information can be very valuable and influence the content that we develop and how we present health information to our patient population. The My HealtheVet Product Web site provides monthly updates of statistics; it is available at http://vaww1.va.gov/MyHealtheVet.

Slide 9:General Health Issues

Co-morbidities Diabetes Hypertension COPD Activities of Daily Living Social Isolation Sedentary life style Malnutrition (excess weight gain/loss) Diminished sexual function KATHLEEN Painter: Some general health issues our veteran population is dealing with include but are not limited to co-morbidities, such as diabetes, hypertension, and COPD. They experience alterations in activities of daily living. Many of our patients are socially isolated, live a sedentary life style, experience malnutrition, or diminished sexual function. To help veteran’s deal with these issues, My HealtheVet provides both information and tools to help them track their health status. KATHLEEN Painter: Some general health issues our veteran population is dealing with include but are not limited to co-morbidities, such as diabetes, hypertension, and COPD. They experience alterations in activities of daily living. Many of our patients are socially isolated, live a sedentary life style, experience malnutrition, or diminished sexual function. To help veteran’s deal with these issues, My HealtheVet provides both information and tools to help them track their health status.

Slide 10:Using My HealtheVet

To use My HealtheVet go to www.myhealth.va.gov KATHLEEN Painter: To use My HealtheVet enter www.myhealth.va.gov in your browser. KATHLEEN Painter: To use My HealtheVet enter www.myhealth.va.gov in your browser.

Slide 11:Splash Page

KATHLEEN Painter: This is what you see when you enter the URL www.myhealth.va.gov in your browser. Click on a link to go to the My HealtheVet Home page.KATHLEEN Painter: This is what you see when you enter the URL www.myhealth.va.gov in your browser. Click on a link to go to the My HealtheVet Home page.

Slide 12:Home Page

KATHLEEN Painter: This is the July home page for My HealtheVet. Here users find a plethora of service related and health care information. My HealtheVet also provides opportunities for the user to build a partnership with their health care provider. Two areas in particular of interest to the health care provider/educator are the Research Health and Track Health sections. The Research Health information is available to anyone, and does not require creating an account. The Track Health features require creation of an account in order to store self-entered information. Anyone may create an account. Once they have an account, veterans receiving care within the VA system can order medication refills on-line. If veterans receiving care within the VA system go to a medical facility and are In-person Authenticated, they can see the names of their VA prescription medications in My HealtheVet in addition to the prescription number.KATHLEEN Painter: This is the July home page for My HealtheVet. Here users find a plethora of service related and health care information. My HealtheVet also provides opportunities for the user to build a partnership with their health care provider. Two areas in particular of interest to the health care provider/educator are the Research Health and Track Health sections. The Research Health information is available to anyone, and does not require creating an account. The Track Health features require creation of an account in order to store self-entered information. Anyone may create an account. Once they have an account, veterans receiving care within the VA system can order medication refills on-line. If veterans receiving care within the VA system go to a medical facility and are In-person Authenticated, they can see the names of their VA prescription medications in My HealtheVet in addition to the prescription number.

Slide 13:Research Health

KATHLEEN Painter: We will address four areas under the Research Health tab: Healthy Living Centers, Diseases + Conditions Centers, Mental Health, and the Medical Library.KATHLEEN Painter: We will address four areas under the Research Health tab: Healthy Living Centers, Diseases + Conditions Centers, Mental Health, and the Medical Library.

Slide 14:Healthy Living

KATHLEEN Painter: In the Research Health section, under the Healthy Living Centers tab, there are currently three Healthy Living centers: Healthy Eating, Physical Activity, and Smoking and Tobacco Cessation. A future release of My HealtheVet will add a Spirituality center. This new Spirituality center will feature a movie, Spirituality: Inspiring Hope in Healing, as well as information about developing spiritual coping skills.KATHLEEN Painter: In the Research Health section, under the Healthy Living Centers tab, there are currently three Healthy Living centers: Healthy Eating, Physical Activity, and Smoking and Tobacco Cessation. A future release of My HealtheVet will add a Spirituality center. This new Spirituality center will feature a movie, Spirituality: Inspiring Hope in Healing, as well as information about developing spiritual coping skills.

Slide 15:Diseases + Conditions

KATHLEEN Painter: The newest Diseases + Conditions Centers are for Hepatitis C and HIV/AIDS.KATHLEEN Painter: The newest Diseases + Conditions Centers are for Hepatitis C and HIV/AIDS.

Slide 16:Medical Library

KATHLEEN Painter: The Medical Library contains both MedlinePlus and HealthWise.KATHLEEN Painter: The Medical Library contains both MedlinePlus and HealthWise.

Slide 17:Mental Health

KATHLEEN Painter: Mental Health features screening tools. The next area of development is My Recovery Plan, which will be interactive.KATHLEEN Painter: Mental Health features screening tools. The next area of development is My Recovery Plan, which will be interactive.

Slide 18:Track Health

KATHLEEN Painter: This is what you would see if you had not logged into My HealtheVet . To use Track Health features, you must create an account. Anyone can create an account in My HealtheVet. KATHLEEN Painter: This is what you would see if you had not logged into My HealtheVet . To use Track Health features, you must create an account. Anyone can create an account in My HealtheVet.

Slide 19:KATHLEEN Painter: When you log-in you see there are numerous options for self-entered information under the Tab Track Health, such as vitals and readings, labs and tests, health history, and journals. Self-entered information, if numeric, will be graphed In addition, the patient can create a summary sheet printout to share self-entered information with their healthcare providers. KATHLEEN Painter: When you log-in you see there are numerous options for self-entered information under the Tab Track Health, such as vitals and readings, labs and tests, health history, and journals. Self-entered information, if numeric, will be graphed In addition, the patient can create a summary sheet printout to share self-entered information with their healthcare providers.

Slide 20:e-Rx

http://vaww1.va.gov/MyHealtheVet/ KATHLEEN Painter: You can download this as a document from the product Website under the Clinical Advisory Board section, look for My HealtheVet Information Prescription  and customize it to meet the learning needs of your patient. KATHLEEN Painter: You can download this as a document from the product Website under the Clinical Advisory Board section, look for My HealtheVet Information Prescription  and customize it to meet the learning needs of your patient.

Slide 21:Patient Action Plan

KATHLEEN Painter: There will be an action plan for each condition center that will help guide your choices for the e-Rx. When you provide an electronic prescription to a patient, be sure to document your My HealtheVet intervention in CPRS, along with your assessment of the patients’ learning needs and any identified barriers to learning. KATHLEEN Painter: There will be an action plan for each condition center that will help guide your choices for the e-Rx. When you provide an electronic prescription to a patient, be sure to document your My HealtheVet intervention in CPRS, along with your assessment of the patients’ learning needs and any identified barriers to learning.

Slide 22:What My HealtheVetCan Do For You…

A tool for patient education Provides information for shared decision making Activities that involve the patient in own care Material has been vetted by the VA Collaborative information sharing Efficient use of your time with patient Comprehensive view of patient’s health Blended view of patient’s medications KATHLEEN Painter: My HealtheVet provides an opportunity for you to build a strong patient partnership. I encourage you to take advantage of My HealtheVet’s exceptional patient education materials which have been tailored to the learning needs of our veteran population. Kathleen Charters will now present techniques to help you identify your patient’s educational needs. KATHLEEN Painter: My HealtheVet provides an opportunity for you to build a strong patient partnership. I encourage you to take advantage of My HealtheVet’s exceptional patient education materials which have been tailored to the learning needs of our veteran population. Kathleen Charters will now present techniques to help you identify your patient’s educational needs.

Slide 23:Patient Educational Needs

Kathleen ChartersKathleen Charters

Slide 24:Quick Ways to AssessPatient Education Needs

Salient belief model Experiences of patient’s family & friends Self-efficacy theory Kathleen Charters: There are three evidence-based frameworks you can use to quickly identify your patient’s educational needs. They are: Salient belief model Experiences of patient’s family and friends Self-efficacy theoryKathleen Charters: There are three evidence-based frameworks you can use to quickly identify your patient’s educational needs. They are: Salient belief model Experiences of patient’s family and friends Self-efficacy theory

Slide 25:Salient Belief Model

Based on the work of Miller Limited number 7 plus or minus 2 strong beliefs about any topic “Salire” to jump—obvious, significant “When you think of , what do you think of? How to use this info To identify the patient’s concerns To tailor what you want to teach about to the patient’s concerns Kathleen Charters: The Salient Belief Model is based on the work of Miller. Miller found that people have a limited number (7 plus or minus 2) of strong beliefs about any topic. Salient comes from the Latin word “salire” to jump. When you ask the salient belief needs assessment question, people’s responses “jump” out. This needs assessment is asking the simple question, “When you think of BLANK, what do you think of?” Let’s try it. I’m going to ask you a question, please call out your answer. “When you think of the 4th of July, what do you think of?” [Pause] How do I use this information? Given your responses, I’d tailor what I tell each of you next about the 4th of July to what you said, for example, “fireworks, picnics, family reunions, etc.” Here’s a clinical example. Dr. Kate Lorig of the Stanford University Patient Education Research Center, designed the Arthritis Foundation’s patient education program. She used the Salient Belief Model question, “When you think of arthritis, what do you think of?” with hundreds of arthritis patients. The majority responded “pain” when asked this question. Everything this program teaches, (medication, physical activity, etc.), is taught about relative to how the topic helps patients manage pain. Kathleen Charters: The Salient Belief Model is based on the work of Miller. Miller found that people have a limited number (7 plus or minus 2) of strong beliefs about any topic. Salient comes from the Latin word “salire” to jump. When you ask the salient belief needs assessment question, people’s responses “jump” out. This needs assessment is asking the simple question, “When you think of BLANK, what do you think of?” Let’s try it. I’m going to ask you a question, please call out your answer. “When you think of the 4th of July, what do you think of?” [Pause] How do I use this information? Given your responses, I’d tailor what I tell each of you next about the 4th of July to what you said, for example, “fireworks, picnics, family reunions, etc.” Here’s a clinical example. Dr. Kate Lorig of the Stanford University Patient Education Research Center, designed the Arthritis Foundation’s patient education program. She used the Salient Belief Model question, “When you think of arthritis, what do you think of?” with hundreds of arthritis patients. The majority responded “pain” when asked this question. Everything this program teaches, (medication, physical activity, etc.), is taught about relative to how the topic helps patients manage pain.

Slide 26:Experiences of Patient’s Family & Friends

Have you had a family member or friend who ? What was their experience? Confirm the positive Correct misconceptions Offer hope Kathleen Charters: The experiences of the patient’s family or friends with the same problem or condition is also very easy to use. You ask the patient if he/she has had any family member or friend with the same condition or health problem and ask what their experience was. What the patient tells you permits you to confirm the positive, offer updates on current therapies or interventions, correct misconceptions and offer hope regarding current therapies. You can let them know adherence to the recommended treatment can help them achieve a better outcome. You can also provide reassurance if the person they describe didn’t fare well.Kathleen Charters: The experiences of the patient’s family or friends with the same problem or condition is also very easy to use. You ask the patient if he/she has had any family member or friend with the same condition or health problem and ask what their experience was. What the patient tells you permits you to confirm the positive, offer updates on current therapies or interventions, correct misconceptions and offer hope regarding current therapies. You can let them know adherence to the recommended treatment can help them achieve a better outcome. You can also provide reassurance if the person they describe didn’t fare well.

Slide 27:Self-efficacy Theory

Based on the work of Alfred Bandura Ability to perform a given action Not concerned with the skills needed but the belief There are no self-efficacious people It’s behavior & situation specific Kathleen Charters: Self-efficacy Theory is based on the work of the Stanford University psychologist, Dr. Alfred Bandura. Self-efficacy deals with a person’s belief about his/her level of confidence regarding performing a specific action. There are no self-efficacious people. How many of you think that, barring unforseeable events, you’ll be able to successfully get dressed tomorrow morning? [Pause] Here’s an example of another behavior. I’m a circus owner. My unicycle rider has just walked out, it’s 2:30 pm and I have a 3:00 pm matinee. I need a unicycle rider to lead the parade around the big tent. I’m offering you 20 minutes of practice riding a unicycle. [Pause] On a scale of 1 to 10, with 1 being sure you couldn’t do it successfully and 10 being certain you could, what number would you give yourself? [Ask the audience to call out their numbers. Compare the differences in these numbers with the numbers they gave themselves about their ability to successfully get dressed tomorrow. The difference in their scores between the 2 activities demonstrates that there are no self-efficacious people.] Self-efficacy is very behavior specific. If I have to make a hiring decision based on the numbers you’ve called out, I’d definitely hire one of you who gave yourself a score of 7 or higher. Self-Efficacy Theory says that a score of 7 or higher indicates a strong confidence that you can ride a unicycle with 20 minutes of practice. Bandura’s research found that people who were confident about their ability to perform a behavior were very likely to perform it successfully. Let’s talk about the reasons why you gave yourselves the numbers you did. Let’s start with the people who gave themselves a score of 7 or higher. Why did you give yourself the score you did? Those who gave themselves a high score may have based this on experience riding a bicycle or unicycle as a child, good sense of balance, just like to try challenging physical activities, etc. Those who gave themselves a lower score may have based this on a fear of heights, poor balance, never able to ride a two-wheel bike well, etc. People have very different reasons at both ends of the spectrum. Kathleen Charters: Self-efficacy Theory is based on the work of the Stanford University psychologist, Dr. Alfred Bandura. Self-efficacy deals with a person’s belief about his/her level of confidence regarding performing a specific action. There are no self-efficacious people. How many of you think that, barring unforseeable events, you’ll be able to successfully get dressed tomorrow morning? [Pause] Here’s an example of another behavior. I’m a circus owner. My unicycle rider has just walked out, it’s 2:30 pm and I have a 3:00 pm matinee. I need a unicycle rider to lead the parade around the big tent. I’m offering you 20 minutes of practice riding a unicycle. [Pause] On a scale of 1 to 10, with 1 being sure you couldn’t do it successfully and 10 being certain you could, what number would you give yourself? [Ask the audience to call out their numbers. Compare the differences in these numbers with the numbers they gave themselves about their ability to successfully get dressed tomorrow. The difference in their scores between the 2 activities demonstrates that there are no self-efficacious people.] Self-efficacy is very behavior specific. If I have to make a hiring decision based on the numbers you’ve called out, I’d definitely hire one of you who gave yourself a score of 7 or higher. Self-Efficacy Theory says that a score of 7 or higher indicates a strong confidence that you can ride a unicycle with 20 minutes of practice. Bandura’s research found that people who were confident about their ability to perform a behavior were very likely to perform it successfully. Let’s talk about the reasons why you gave yourselves the numbers you did. Let’s start with the people who gave themselves a score of 7 or higher. Why did you give yourself the score you did? Those who gave themselves a high score may have based this on experience riding a bicycle or unicycle as a child, good sense of balance, just like to try challenging physical activities, etc. Those who gave themselves a lower score may have based this on a fear of heights, poor balance, never able to ride a two-wheel bike well, etc. People have very different reasons at both ends of the spectrum.

Slide 28:Self-efficacy Theory

Self-efficacy effects Behavior choices Activities to be attempted & avoided Effort people will expend; how long they’ll persist Stay with a task longer & make renewed efforts after problems Kathleen Charters: What does self-efficacy have to do with health behavior change? It gives us an indication about: Activities people will be willing to attempt Activities they’ll avoid How much effort they’ll be willing to expend in attempting How long they’ll persist How willing they’ll be to make renewed efforts in the face of problems (this is especially important in life-long management of chronic disease) Kathleen Charters: What does self-efficacy have to do with health behavior change? It gives us an indication about: Activities people will be willing to attempt Activities they’ll avoid How much effort they’ll be willing to expend in attempting How long they’ll persist How willing they’ll be to make renewed efforts in the face of problems (this is especially important in life-long management of chronic disease)

Slide 29:Using Self-efficacy Theory

Ask patient’s how confident they are on a scale from 1 (totally uncertain) to 10 (totally certain) about following treatment recommendations If they respond less than 7, it’s unlikely they’ll be willing to take the recommended action Your cue to find out why Ask what would have to happen to get them to raise their score Problem solve with the patient Don’t dictate your solution to the patient’s problem Kathleen Charters: To integrate self-efficacy into your clinical practice: Ask the patient “On a scale of 1 to 10, with 1 being that you are sure you will not be able to, and 10 being absolutely sure you will be able, how confident are you that you’ll be able to …?” Kathleen Charters: To integrate self-efficacy into your clinical practice: Ask the patient “On a scale of 1 to 10, with 1 being that you are sure you will not be able to, and 10 being absolutely sure you will be able, how confident are you that you’ll be able to …?”

Slide 30:Ways to Enhance Self-efficacy

Short-term goal setting Stage tasks Provide “crutches” Practice Use models (mastery & coping) Help patients manage anxiety Provide feedback (self-monitoring) Help patients recall past successes Kathleen Charters: You can enhance a patient’s self-efficacy by: Setting short-term goals of the patient’s choosing Stage your approach by offering easier to do recommendations first Offer crutches in My HealtheVet: Condition centers, self-monitoring logs Offer skill practice with targeted feedback Use models that are as like the patient as possible; Models should be people who have mastered the task, as well as those who are having difficulty but still coping Help the patient manage any anxiety or fears Provide positive feedback about their attempts to self-monitor and offer feedback on the self-monitoring values they share with you Remind them of past successes and help them recall the skills they used to solve problems and cope Using these three patient education needs frameworks, we will present two case scenarios.Kathleen Charters: You can enhance a patient’s self-efficacy by: Setting short-term goals of the patient’s choosing Stage your approach by offering easier to do recommendations first Offer crutches in My HealtheVet: Condition centers, self-monitoring logs Offer skill practice with targeted feedback Use models that are as like the patient as possible; Models should be people who have mastered the task, as well as those who are having difficulty but still coping Help the patient manage any anxiety or fears Provide positive feedback about their attempts to self-monitor and offer feedback on the self-monitoring values they share with you Remind them of past successes and help them recall the skills they used to solve problems and cope Using these three patient education needs frameworks, we will present two case scenarios.

Slide 32:Findings

5 feet 3 inches Weight 180 lbs Body Mass Index 31.88 BP is elevated (150/94) Mother died due to diabetic complications Father treated for hypertension Kathleen Charters: One Veteran is initially seen by the clinic nurse, who takes her vitals and does an intake assessment. Her findings show One Veteran to be 5 feet 3 inches, with a weight of 180 lbs and Body Mass Index of 31.88. Although One Veteran denies a history of hypertension, her BP is elevated (150/94). Eliciting the patient’s experience, the nurse learns that One Veteran’s mother died at the age of 60 due to diabetic complications and her 76 year old father is being treated for hypertension. When asked about her mother’s health, One Veteran expresses concern that she will develop diabetes and experience complications similar to her mother’s. This information can be used with the Salient Belief Model.Kathleen Charters: One Veteran is initially seen by the clinic nurse, who takes her vitals and does an intake assessment. Her findings show One Veteran to be 5 feet 3 inches, with a weight of 180 lbs and Body Mass Index of 31.88. Although One Veteran denies a history of hypertension, her BP is elevated (150/94). Eliciting the patient’s experience, the nurse learns that One Veteran’s mother died at the age of 60 due to diabetic complications and her 76 year old father is being treated for hypertension. When asked about her mother’s health, One Veteran expresses concern that she will develop diabetes and experience complications similar to her mother’s. This information can be used with the Salient Belief Model.

Slide 33:Needs Assessment:Experience of Family & Friends

Both her parents were overweight Her mother developed diabetes when she was 55 years old Concerned weight gain may lead to diabetes Heard about dangers for overweight children Kathleen Charters: Next we will show how My HealtheVet can be used by the veteran to help her learn about diabetes and to achieve the goals she and her provider set by the end of the visit.Kathleen Charters: Next we will show how My HealtheVet can be used by the veteran to help her learn about diabetes and to achieve the goals she and her provider set by the end of the visit.

Slide 34:Concerns

Concerned about the weight she has gained Afraid of getting Diabetes & ending up like her mother Not as physically active Concerned about the health of her children Kathleen Charters: After reviewing her health history and completing the physical examination, her provider asks One Veteran how she feels about her overall health. This is an example of using the patient’s experience. One Veteran shares that she is concerned about the weight she has gained since getting out of the service and her fear of getting Diabetes. She saw what Diabetes did to her mother and does not want that for herself. She also shares that she is not as physically active as she used to be and she is concerned that her poor health choices and diet could affect the health of her children. Kathleen Charters: After reviewing her health history and completing the physical examination, her provider asks One Veteran how she feels about her overall health. This is an example of using the patient’s experience. One Veteran shares that she is concerned about the weight she has gained since getting out of the service and her fear of getting Diabetes. She saw what Diabetes did to her mother and does not want that for herself. She also shares that she is not as physically active as she used to be and she is concerned that her poor health choices and diet could affect the health of her children.

Slide 35:Kathleen Charters: Her provider lets her know they will draw a fasting blood glucose to rule out Diabetes as well as perform other tests (lipid profile, CBC, Chem-7, and a routine urinalysis) to evaluate her overall health status. Her provider also talks to One Veteran about her weight, elevated blood pressure and explores any emotional issues she may have been experiencing. NOTE: Glycosolated hba1c is used to track glycemic control over time, not diagnose diabetes. See http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/ Kathleen Charters: Her provider lets her know they will draw a fasting blood glucose to rule out Diabetes as well as perform other tests (lipid profile, CBC, Chem-7, and a routine urinalysis) to evaluate her overall health status. Her provider also talks to One Veteran about her weight, elevated blood pressure and explores any emotional issues she may have been experiencing. NOTE: Glycosolated hba1c is used to track glycemic control over time, not diagnose diabetes. See http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/

Slide 36:Healthcare Team

Obesity Elevated blood pressure r/o hypertension Altered self-identity Lowered self-esteem Possible PTSD Kathleen Charters: One Veteran’s provider identifies the following health issues: obesity, elevated blood pressure r/o hypertension, r/o diabetes, altered self-identity since leaving the service, lowered self-esteem due to change in body image and possible PTSD. To address all One Veteran’s healthcare concerns, her provider then talks with her about developing a partnership with other members of the healthcare team. One Veteran will be working with the nurse educator, nutritionist and possibly a mental health provider. Kathleen Charters: One Veteran’s provider identifies the following health issues: obesity, elevated blood pressure r/o hypertension, r/o diabetes, altered self-identity since leaving the service, lowered self-esteem due to change in body image and possible PTSD. To address all One Veteran’s healthcare concerns, her provider then talks with her about developing a partnership with other members of the healthcare team. One Veteran will be working with the nurse educator, nutritionist and possibly a mental health provider.

Slide 37:Local Point of Contact

vaww1.va.gov/MyHealtheVet Kathleen Charters: Her provider also learns that One Veteran regularly uses the Internet to look up information. The health care provider talks with One Veteran about using My HealtheVet, explaining how easy it is to use and provides a business card with the URL for My HealtheVet. This card is available on the My HealtheVet Product Web site and can be downloaded and modified to meet the needs of each facility. Her provider shares that by using My HealtheVet One Veteran will become more knowledgeable about her health and more prepared for her visits. Sharing the information she enters into My HealtheVet will help her develop a stronger partnership with members of the health care team.Kathleen Charters: Her provider also learns that One Veteran regularly uses the Internet to look up information. The health care provider talks with One Veteran about using My HealtheVet, explaining how easy it is to use and provides a business card with the URL for My HealtheVet. This card is available on the My HealtheVet Product Web site and can be downloaded and modified to meet the needs of each facility. Her provider shares that by using My HealtheVet One Veteran will become more knowledgeable about her health and more prepared for her visits. Sharing the information she enters into My HealtheVet will help her develop a stronger partnership with members of the health care team.

Slide 38:e-Rx

Kathleen Charters: One Veteran is also given an e-Rx Pad that identifies tools she can use in My HealtheVet to track her health and a treatment plan with jointly identified goals. Kathleen Charters: One Veteran is also given an e-Rx Pad that identifies tools she can use in My HealtheVet to track her health and a treatment plan with jointly identified goals.

Slide 39:e-Rx

Kathleen Charters: Her provider makes arrangements for One Veteran to see the nurse educator about using My HealtheVet as part of her treatment program and the nutritionist about weight management. If One Veteran is diagnosed with diabetes, she’ll be taught to monitor her blood glucose at home and track her values in My HealtheVet.Kathleen Charters: Her provider makes arrangements for One Veteran to see the nurse educator about using My HealtheVet as part of her treatment program and the nutritionist about weight management. If One Veteran is diagnosed with diabetes, she’ll be taught to monitor her blood glucose at home and track her values in My HealtheVet.

Slide 45:Kathleen Charters: One Veteran can also look up information about conditions such as diabetes and hypertension in the Diseases + Condition CentersKathleen Charters: One Veteran can also look up information about conditions such as diabetes and hypertension in the Diseases + Condition Centers

Slide 46:Kathleen Charters: The nutritionist suggested One Veteran use the My HealtheVet Food and Activity Journals. The nutritionist documented her My HealtheVet intervention in CPRS. One Veteran recorded food intake as well as what she was feeling and what helped, and tracked her daily activity.Kathleen Charters: The nutritionist suggested One Veteran use the My HealtheVet Food and Activity Journals. The nutritionist documented her My HealtheVet intervention in CPRS. One Veteran recorded food intake as well as what she was feeling and what helped, and tracked her daily activity.

Slide 47:Kathleen Charters: Before her visit One Veteran went to My HealtheVet under Track Health, clicked on the Health History section, where she selected the Personal Health Summary to create a doctor sheet. One Veteran returns to her provider well prepared. She has with her the blood pressure printout with graph, her personal health history printout, her wallet card, entries in her food and activity journals and a list of questions regarding her health. She also chose to bring a printout of her PTSD screening results. Kathleen Painter will now present the second scenario.Kathleen Charters: Before her visit One Veteran went to My HealtheVet under Track Health, clicked on the Health History section, where she selected the Personal Health Summary to create a doctor sheet. One Veteran returns to her provider well prepared. She has with her the blood pressure printout with graph, her personal health history printout, her wallet card, entries in her food and activity journals and a list of questions regarding her health. She also chose to bring a printout of her PTSD screening results. Kathleen Painter will now present the second scenario.

Slide 49:KATHLEEN Painter: The Urologist also learns that Two Veteran regularly uses the Internet to look up information. The My HealtheVet Research Health Tab provides several health information options to explore. KATHLEEN Painter: The Urologist also learns that Two Veteran regularly uses the Internet to look up information. The My HealtheVet Research Health Tab provides several health information options to explore.

Slide 50:KATHLEEN Painter: The Medical Library contains both MedlinePlus and HealthWise. KATHLEEN Painter: The Medical Library contains both MedlinePlus and HealthWise.

Slide 51:Medical Library Resources

Medline Plus® – Related Topics Prostate Diseases (text) Tests & Diagnostic Procedures Ultrasound (Interactive Tutorial) HealthWise® Prostate Ultrasound - Medical Test [Medical Test] Prostate-Specific Antigen (PSA) - Medical Test [Medical Test] KATHLEEN Painter: Here are some of the specific resources available through Medline Plus and HealthWise. Note the interactive tutorial, which can be done as voice and sound, or printed out as a .pdf.KATHLEEN Painter: Here are some of the specific resources available through Medline Plus and HealthWise. Note the interactive tutorial, which can be done as voice and sound, or printed out as a .pdf.

Slide 52:e-Rx Pad

KATHLEEN Painter: The urologist feels the following health information would best meet Two Veteran’s learning needs at this time. The urologist documents his My HealtheVet intervention in CPRS, along with the patient’s learning needs and any identified barriers to learning.KATHLEEN Painter: The urologist feels the following health information would best meet Two Veteran’s learning needs at this time. The urologist documents his My HealtheVet intervention in CPRS, along with the patient’s learning needs and any identified barriers to learning.

Slide 53:Local Point of Contact

vaww1.va.gov/MyHealtheVet KATHLEEN Painter: The Urologist gives Two Veteran a business card with information about how to access My HealtheVet and suggests that Two Veteran might benefit from meeting with the local VA Urology Support Group, where he can talk with other veterans.KATHLEEN Painter: The Urologist gives Two Veteran a business card with information about how to access My HealtheVet and suggests that Two Veteran might benefit from meeting with the local VA Urology Support Group, where he can talk with other veterans.

Slide 54:KATHLEEN Painter: Two Veteran meets with Volunteer Veteran, a member of the Urology Support Group, who listens to Two Veteran’s concerns and provides support. He tells Two Veteran about My HealtheVet, how he can use it to learn more about his own condition and become more involved with making informed treatment decisions along with his provider. KATHLEEN Painter: Two Veteran meets with Volunteer Veteran, a member of the Urology Support Group, who listens to Two Veteran’s concerns and provides support. He tells Two Veteran about My HealtheVet, how he can use it to learn more about his own condition and become more involved with making informed treatment decisions along with his provider.

Slide 55:KATHLEEN Painter: Two Veteran shares that he really does not understand PSA levels, what it means for him, and is concerned about loosing his ‘manhood.’ Volunteer Veteran shows Two Veteran in Research Health how he can find information and learn more about test and treatment options. KATHLEEN Painter: Two Veteran shares that he really does not understand PSA levels, what it means for him, and is concerned about loosing his ‘manhood.’ Volunteer Veteran shows Two Veteran in Research Health how he can find information and learn more about test and treatment options.

Slide 56:KATHLEEN Painter: He also shows Two Veteran under the Labs + Tests section where he can keep track of his PSA levels.KATHLEEN Painter: He also shows Two Veteran under the Labs + Tests section where he can keep track of his PSA levels.

Slide 57:KATHLEEN Painter: Volunteer Veteran shows Two Veteran that My HealtheVet offers a place to enter personal information, including a custom list of links. He shows Two Veteran several Websites in My HealtheVet where he might find helpful information. Volunteer Veteran suggests that Two Veteran may want to create his own Personal Links and add these: Prostate Cancer Prostate Helpline - Support Group [Support Group] Prostate Problems - Support Group [Support Group] (Add other links at bottom) Volunteer Veteran suggests when Two Veteran looks up information in My HealtheVet that he keeps a list of questions he wants to ask his provider during his next visit. KATHLEEN Painter: Volunteer Veteran shows Two Veteran that My HealtheVet offers a place to enter personal information, including a custom list of links. He shows Two Veteran several Websites in My HealtheVet where he might find helpful information. Volunteer Veteran suggests that Two Veteran may want to create his own Personal Links and add these: Prostate Cancer Prostate Helpline - Support Group [Support Group] Prostate Problems - Support Group [Support Group] (Add other links at bottom) Volunteer Veteran suggests when Two Veteran looks up information in My HealtheVet that he keeps a list of questions he wants to ask his provider during his next visit.

Slide 58:KATHLEEN Painter: Volunteer Veteran shows Two Veteran in My HealtheVet where he can keep a record of medications. Volunteer Veteran explains how important medication reconciliation is for the healthcare team and recommends that Two Veteran enter all his medications including over-the-counter drugs, and any herbals or supplements. Volunteer Veteran explains how important it is for Two Veteran to print the list of his blended medications for his next clinic visit, and recommends that Two Veteran go to the VAMC to be In-person Authenticated so Two Veteran can see the names of his VA prescription medications. KATHLEEN Painter: Volunteer Veteran shows Two Veteran in My HealtheVet where he can keep a record of medications. Volunteer Veteran explains how important medication reconciliation is for the healthcare team and recommends that Two Veteran enter all his medications including over-the-counter drugs, and any herbals or supplements. Volunteer Veteran explains how important it is for Two Veteran to print the list of his blended medications for his next clinic visit, and recommends that Two Veteran go to the VAMC to be In-person Authenticated so Two Veteran can see the names of his VA prescription medications.

Slide 59:KATHLEEN Painter: Volunteer Veteran also demonstrates how Two Veteran can order his VA medications on-line. KATHLEEN Painter: Volunteer Veteran also demonstrates how Two Veteran can order his VA medications on-line.

Slide 60:Follow-up Visit

KATHLEEN PAINTER: When Two Veteran returns to the urologist he brings a list of questions based on his research. The urologist is impressed with how well-informed Two Veteran has become. Now they are ready to collaborate on treatment options. These two scenarios have illustrated use of the three patient education needs frameworks: the Salient Belief Model; experiences of patient, family and friends; and Self Efficacy Theory. These scenarios also illustrate the integration of My HealtheVet in clinical practice. Now we will tell you how you can make a difference in My HealtheVet. KATHLEEN PAINTER: When Two Veteran returns to the urologist he brings a list of questions based on his research. The urologist is impressed with how well-informed Two Veteran has become. Now they are ready to collaborate on treatment options. These two scenarios have illustrated use of the three patient education needs frameworks: the Salient Belief Model; experiences of patient, family and friends; and Self Efficacy Theory. These scenarios also illustrate the integration of My HealtheVet in clinical practice. Now we will tell you how you can make a difference in My HealtheVet.

Slide 62:Overview

How we build content Clinical Advisory Board Policy Submission Form Review Process Subject Matter Experts Clinical Focus Groups KATHLEEN Painter: We will provide a brief overview of how we build content on My HealtheVet, the role of the Clinical Advisory Board, the content request policy and submission form. The process we use to review content request, the role of subject matter experts and how clinical focus groups are used. KATHLEEN Painter: We will provide a brief overview of how we build content on My HealtheVet, the role of the Clinical Advisory Board, the content request policy and submission form. The process we use to review content request, the role of subject matter experts and how clinical focus groups are used.

Slide 63:Need Content

KATHLEEN Painter: Building content that provides the user with information that is reliable, accurate, current and user friendly is what My HealtheVet is all about. Content that goes on our portal is driven by what users want. If you have material you would like to see added to My HealtheVet, let us know. We would like to post to My HealtheVet good patient/caregiver educational materials. You probably already have some of those written. We are always looking to capture content for My HealtheVet and have developed a process for content consideration.KATHLEEN Painter: Building content that provides the user with information that is reliable, accurate, current and user friendly is what My HealtheVet is all about. Content that goes on our portal is driven by what users want. If you have material you would like to see added to My HealtheVet, let us know. We would like to post to My HealtheVet good patient/caregiver educational materials. You probably already have some of those written. We are always looking to capture content for My HealtheVet and have developed a process for content consideration.

Slide 64:KATHLEEN Painter: The My HealtheVet Clinical Advisory Board was created in response to a request from the Under Secretary for Health, to develop a process ensuring health/wellness information provided in My HealtheVet met current standards of care. The Clinical Advisory Board is responsible for reviewing and vetting all content request and determining what is appropriate for the My HealtheVet portal. The My HealtheVet product Web site has an overview of the Clinical Advisory Board with policy and a process flow for adding content (see http://vaww1.va.gov/MyHealtheVet/page.cfm?pg=101 ) and a Clinical Content Submission Form you can submit electronically. KATHLEEN Painter: The My HealtheVet Clinical Advisory Board was created in response to a request from the Under Secretary for Health, to develop a process ensuring health/wellness information provided in My HealtheVet met current standards of care. The Clinical Advisory Board is responsible for reviewing and vetting all content request and determining what is appropriate for the My HealtheVet portal. The My HealtheVet product Web site has an overview of the Clinical Advisory Board with policy and a process flow for adding content (see http://vaww1.va.gov/MyHealtheVet/page.cfm?pg=101 ) and a Clinical Content Submission Form you can submit electronically.

Slide 65:KATHLEEN Painter: This is the My HealtheVet Clinical Content and Web Link Request Policy and Standard Operating Procedure, which describes the content request process. You can view this document by going to the My HealtheVet Product Web site, the Clinical Advisory Board page. KATHLEEN Painter: This is the My HealtheVet Clinical Content and Web Link Request Policy and Standard Operating Procedure, which describes the content request process. You can view this document by going to the My HealtheVet Product Web site, the Clinical Advisory Board page.

Slide 66:KATHLEEN Painter: This is the short, user-friendly form. You just fill in the blanks and click on submit. KATHLEEN Painter: This is the short, user-friendly form. You just fill in the blanks and click on submit.

Slide 67:KATHLEEN Painter: This is a flow diagram of the approval process for adding clinical content to My HealtheVet. This diagram is also available on the My HealtheVet Product Web site, on the Clinical Advisory Board page.KATHLEEN Painter: This is a flow diagram of the approval process for adding clinical content to My HealtheVet. This diagram is also available on the My HealtheVet Product Web site, on the Clinical Advisory Board page.

Slide 68:Subject Matter Experts

Veterans Physicians/Physician Assistants Psychologist Nurses Educators/Librarians Pharmacist Social Workers Others with vested interest Kathleen Charters & Kathleen Painter = support KATHLEEN Painter: When developing clinical content on My HealtheVet, we involve Subject Matter Experts representing veterans, healthcare providers, and others with a vested interest in the content. KATHLEEN Painter: When developing clinical content on My HealtheVet, we involve Subject Matter Experts representing veterans, healthcare providers, and others with a vested interest in the content.

Slide 69:Focus Groups

Mental Health – Ken Weingardt Spirituality – Jeni Cook Operation Iraqi Freedom / Operation Enduring Freedom – Oyweda Moorer Clinical Adoption (VISN 8) Several additional focus groups Life cycle development Health conditions Caregivers KATHLEEN Painter: How do we know what users want to see? The best way to identify what veterans, caregivers and health care providers would like to see in My HealtheVet is to ask them. A focus group is one methodology we have used to identify these needs. These groups covered Mental Health, Spirituality, Operation Enduring Freedom / Operation Iraqi Freedom, and Clinical Adoption needs. For example: What we know from the Spirituality pilots is that the veterans who participated agreed that spirituality is related – and crucial – to emotional and physical health, and many agreed that they use spirituality as a tool for overall health. Most veterans agreed that spiritual growth is continuous and there is always room for more growth. In the future, focus groups may include topics such as life cycle development, specific health conditions, and caregivers. KATHLEEN Painter: How do we know what users want to see? The best way to identify what veterans, caregivers and health care providers would like to see in My HealtheVet is to ask them. A focus group is one methodology we have used to identify these needs. These groups covered Mental Health, Spirituality, Operation Enduring Freedom / Operation Iraqi Freedom, and Clinical Adoption needs. For example: What we know from the Spirituality pilots is that the veterans who participated agreed that spirituality is related – and crucial – to emotional and physical health, and many agreed that they use spirituality as a tool for overall health. Most veterans agreed that spiritual growth is continuous and there is always room for more growth. In the future, focus groups may include topics such as life cycle development, specific health conditions, and caregivers.

Slide 70:The Power of the Web

Kathleen.Charters@va.gov Kathleen.Painter2@va.gov KATHLEEN Painter: Like a spider’s web, the My HealtheVet program office is always looking to capture content. We look forward to hearing from you. KATHLEEN Painter: Like a spider’s web, the My HealtheVet program office is always looking to capture content. We look forward to hearing from you.

Slide 71:Summary

Find specific health & patient education information on My HealtheVet Assess patient needs in a time-limited clinical encounter Use My HealtheVet to optimize existing educational resources & programs Identify strategies to optimize patient education by focusing on the specific health needs of the individual patient Request content development & modifications to the clinical information & patient education KATHLEEN Painter: Now you know how to: Find specific health and patient information on My HealtheVet Use evidence-based techniques to quickly assess your patients needs Use My HealtheVet to optimize educational resources and programs Optimize patient education by focusing on the specific needs of the patient Use the process designed to request HealtheVet content development and modifications to the clinical information and patient educationKATHLEEN Painter: Now you know how to: Find specific health and patient information on My HealtheVet Use evidence-based techniques to quickly assess your patients needs Use My HealtheVet to optimize educational resources and programs Optimize patient education by focusing on the specific needs of the patient Use the process designed to request HealtheVet content development and modifications to the clinical information and patient education

Slide 72:Check It Out . . .

My HealtheVet National Site www.myhealth.va.gov MHV Demo Account: Username: mhvuser Password: mhvdemo#1 My HealtheVet Product Site vaww.va.gov/MyHealtheVet/ My HealtheVet Training Site vaww.vistau.med.va.gov/vistau/mhv/ KATHLEEN Painter: I invite you to check out these My HealtheVet Web sites.KATHLEEN Painter: I invite you to check out these My HealtheVet Web sites.

Slide 73:Questions & Answers

Suggestions? Kathleen Charters, PhD, RN, CPHIMS, CNE Clinical Information Systems Specialist My HealtheVet Program Management Office Silver Spring, MD (301) 734-0580 Kathleen.Charters@va.gov Kathleen Painter, RN, MSN Lead, Patient Education My HealtheVet VIRO Martinsburg, VA (304) 262-7342 Kathleen.Painter2@va.gov Kathleen Charters and KATHLEEN Painter: Are there any questions?Kathleen Charters and KATHLEEN Painter: Are there any questions?