My Health e Vet Personal Health Record and Secure Messaging Department of Veterans Affairs (VA)

1. My HealtheVetPersonal Health Record andSecure MessagingDepartment of Veterans Affairs (VA) Tracey Martin RN BSN VISN 1 My HealtheVet Coordinator Mini Mac presentation 2/7/11 Providence VAMC

2. Back to the Beginning • My HealtheVet (MHV) was launched on Veterans Day, November 11, 2003, and began providing veterans with an online environment to register, and access to VHA-developed health information, and a health library full of information. • MHV Tradition: Building on that foundation with exciting and incremental upgrades and new releases.

3. My HealtheVet Vision Knowledgeable patients are better able to make informed health care choices, stay healthy, and seek services when they need them. Inform Engage Activate

4. Transforming Health Care “…access to care should be provided over the Internet, by telephone, and by other means in addition to in person visits … Instead of a $65 office visit and a half day off from work, a 2 minute email communication could meet many patients’ needs more responsively and at lower cost.” Institute of Medicine, 2001 “… enhance the ability of veterans and their families to access personal health information. One example is enhanced Internet communication for enrolled veterans, using such tools as My HealtheVet. These systems will facilitate the veteran’s active involvement in his or her care, and provide easy access to health information, as well as health-care services...” VA Universal Services Task Force Report, 2009

5. Complementary Tools My HealtheVet Personal Health Record (PHR) VA Electronic Health Record (EHR) • Award-winning, comprehensive electronic record for all care sites • Authoritative medical record • Computerized Patient Record System (CPRS), Veterans Health Information Systems and Technology Architecture (VistA) • Decision support • Clinical reminders • Patient safety • Award-winning PHR for Veterans • Secure, web-based portal • Easy access to information, tools, and resources • Veteran “owns” information • Self-entered information • Incremental addition of data extracts copied from the EHR for VA patients • Veteran controls access • Consumer empowerment

6. My HealtheVet Overview www.myhealth.va.gov • 3-Tier Access Model: • Visitors • Registrants • In-Person Authenticated (IPA) Users • November 2010: • Over 45 Million visits • Over 1.15 Million registered users (75% are VA patients) • Over 252,000 users have an IPA account • Over 18.5 Million VA prescription refills since August 2005

7. Get more with the Authentication Pass ■ Bronze (Visitor) Read-only version ■ Silver: (Registrant) Registration creates a Username and password Order prescriptions (numbers only/no names) ■ GOLD: (In-Person Authentication) Complete video, Release of Information signed, show ID • Wellness Reminders • Pharmacy profile with names • Appointments • Some VistA/CPRS extracts available for “blue button” download for veteran users. • Soon: Chemistry/Hematology ( late winter/early spring targeted release) ■ PLATINUM:Secure Messaging (when the primary care team is set up to receive messages) 7

8. My HealtheVet Features Today • Personal information (contacts, providers, etc.) • Personal, family, and military health history • Personal health summary • HealtheLogs (blood pressure, weight etc.) • Medications (over the counter drugs, herbals, etc.) • Allergies and immunizations • Medical events • Food and activity journals • Online VA prescription refills, VA prescription history* • My Complete Medications (printable summary)*

9. My HealtheVet Features Today • Health calendar • Trusted health education information ( interactive education) • Self-assessment tools • Mental health resources (including online courses) • VA Wellness reminders* • Secure Messaging (currently at selected VA sites)* • The VA Blue Button: Download My Data* • View VA Appointments ( soft release 1/8/11)* • * available with free one-time account upgrade (IPA)

10. Challenges to In person Authentication process • Concern: Release of Information is centered in the Business office Goal: roll-out point of care/service including CBOC’s • Concern: Limited patient facing computers/VA rules re: patient utilizing VA network computers Goal: find underused equipment ? have it re-assigned, work with VAVS for donated equipment, find funding for air cards for outreach events

11. Challenges to In person Authentication process • Concern: • Staff education/Veteran education occuring at a time of great change. Practice re-design is time consuming at the upstart. Goal: ongoing education and outreach to staff and veterans ( go to where the “users” are...)

12. My HealtheVet Secure Messaging (SM) • Only for non-urgent communication • Integration into clinical workflows are critical to enable effective processes • Patients can request appointments, prescription renewals, ask health or administrative questions, etc. • Health care team responds within 3 business days • Patients can receive notifications of new Secure Messages via e-mail • Patients must be In-Person Authenticated (IPA) to participate Secure Messaging is a new eHealth clinical service that includes an online tool for secure electronic communication between VA patients and their health care teams.

13. Secure Messaging Compared To E-Mail Secure MessagingE-Mail Can only be sent to other Secure Messaging participants Can be sent to anyone with an e-mail address Messages can be made part of the patient’s VA electronic health record Totally separate from patient health records Launched from My HealtheVet and Computerized Patient Record System (CPRS) Requires the launch of a separate application or browser instance Designed to have messages read by the addressee only Allows for triaging of messages prior to clinician involvement Does not require the users to have e-mail service Requires users to have e-mail service By default, messages can sit in an Inbox indefinitely Automated escalation process to facilitate timely responses Self-contained within the My HealtheVet system which resides behind VA firewalls Requires an e-mail server that is usually shared with other systems

14. Secure Messaging Benefits • Improved patient-provider collaboration • Communicate with patients between visits • Increased opportunity for information sharing • Increased patient satisfaction • Improved self-management • Improved accessibility • Minimize “telephone tag” • Provides patients with a sense of “personal touch”

15. Secure Messaging (SM)Statistics As of 1/31/11 • Each VISN 1 VAMC has at least one team offering SM. Expansion of all SM activities at sites: • 80% of all PC teams at Boston, Manchester & Northampton poised to offer SM by Feb. 28, 2011 • 80% of all PC teams at Togus, Bedford and WRJ poised to offer SM by April 30, 2011 • 80% of all PC teams at CT and PROV poised to offer SM by June 30, 2011

16. VISN 1 My HealtheVet Coordinators • Bedford: Interviewing • Boston: Carla Azersky RN • Manchester: Judith DeCarteret • Northampton: Anne-Marie Sheerman • Providence: Eileen Kirshenbaum, RN • Togus: Michael L’abbe’ • VA Connecticut: Reposting position • White River Junction: Thomas Mock, LICSW • VISN: Tracey Martin, RN

17. SM statistics as of 1/23/11 * * Providence and VA CT brought online for Secure M essaging 1/28/11

18. Questions?