107 My HealtheVet

1. #107 My HealtheVet/Secure Messaging Rich Moran Bryan Volpp

2. 2 HOUSEKEEPING Cell Phones Please turn off or change to vibrate If you must answer a call or text message, please leave the room. Before we get started we need to take care of some Housekeeping issues. This is a XX hour XXXXX session. Please turn off or change your cell phones to vibrate. If you must answer a call, for the convenience of the other participants we ask that you please leave the roomBefore we get started we need to take care of some Housekeeping issues. This is a XX hour XXXXX session. Please turn off or change your cell phones to vibrate. If you must answer a call, for the convenience of the other participants we ask that you please leave the room

3. 3 HOUSEKEEPING Please, No questions during the presentation. Questions written on a 3X5 card will be answered at the conclusion of the presentation, time permitting. All questions and answers will be posted on the web including those not answered during class. No questions will be taken during the presentation. If you have any questions please write them on the 3X5 card provided. Answers to your questions will be posted on the VEHU website. So please check the website when you return home.No questions will be taken during the presentation. If you have any questions please write them on the 3X5 card provided. Answers to your questions will be posted on the VEHU website. So please check the website when you return home.

4. 4 Where is Secure Messaging? Program is part of My HealtheVet Nationwide incremental rollout underway One VAMC per VISN by 9/30/10 All VAMCs by 9/30/11 All facilities primary care teams 9/30/11 All facilities - all services including non-clinical 9/30/12 We can answer that question in many ways. On a macro level it is contained in MHV. On a timeline it is being rolled out in phases across the nation. The goal is at least one site up and running in each visn. The response has been very good. Many more sites are interested that was initially expected. This is very good. We can answer that question in many ways. On a macro level it is contained in MHV. On a timeline it is being rolled out in phases across the nation. The goal is at least one site up and running in each visn. The response has been very good. Many more sites are interested that was initially expected. This is very good.

5. 5 Added to Tools Bar for VA staff Access Secure Messaging should be added to your Computerized Patient Record System (CPRS) Tools Bar Link requires you to edit the station number The program is normally added to the CPRS Tools bar for easy access. For CIS/CACs the besides adding a link to your CPRS Tools Menu you just need to edit the supplied link with your station number. Instructions for adding in the implementation materials if needed. The program is normally added to the CPRS Tools bar for easy access. For CIS/CACs the besides adding a link to your CPRS Tools Menu you just need to edit the supplied link with your station number. Instructions for adding in the implementation materials if needed.

6. 6 What Does It Look Like?-Provider Once activated the CPRS tools link takes you to the Secure Messaging website for log in using network User name and Password. Once activated the CPRS tools link takes you to the Secure Messaging website for log in using network User name and Password.

7. 7 First Screen SM has an IN, DRAFT, SENT, COMPLETED, and DELETED folders that look like email. The ESCALATED box is a SM feature. Program allows a team design for handling in coming messages. Veterans send messages to a team not a person. The team can triage the message in whatever way works for them. In a telephone tree design the clinic clerk would be first in line. Anything the clerk could not answer would be ASSIGNED to the next level perhaps a nurse. The last level would be the PROVIDER. At some point the message would be marked complete. We have three business days to complete the message or it will become ESCALATED. SM has an IN, DRAFT, SENT, COMPLETED, and DELETED folders that look like email. The ESCALATED box is a SM feature. Program allows a team design for handling in coming messages. Veterans send messages to a team not a person. The team can triage the message in whatever way works for them. In a telephone tree design the clinic clerk would be first in line. Anything the clerk could not answer would be ASSIGNED to the next level perhaps a nurse. The last level would be the PROVIDER. At some point the message would be marked complete. We have three business days to complete the message or it will become ESCALATED.

8. 8 Preference Choices Now let�s talk about additional preferences � Manage Personal Distribution Groups and Surrogate Message Forwarding. 1) Set up your New Message Notification to send a PING message to your outlook when a new SM arrives. No PII in the message just a notification. 2) Inbox view All messages, only assigned to me, Unassigned messages 3) Personal distribution groups Patient groups and staff groups 4) Surrogate settings as in CPRS except you can choose a team as well as a single provider. You have the ability to create your own Personal Distribution Groups. Click on Create a Personal Distribution Group link.Now let�s talk about additional preferences � Manage Personal Distribution Groups and Surrogate Message Forwarding. 1) Set up your New Message Notification to send a PING message to your outlook when a new SM arrives. No PII in the message just a notification. 2) Inbox view All messages, only assigned to me, Unassigned messages 3) Personal distribution groups Patient groups and staff groups 4) Surrogate settings as in CPRS except you can choose a team as well as a single provider. You have the ability to create your own Personal Distribution Groups. Click on Create a Personal Distribution Group link.

9. 9 Send Message Screen You can send message to patients or groups You can send message to patients or groups

10. 10 Recipient Options Send a message to: 1) Patients 2) Clinicians and staff 3) Triage team Staff 4) A Distribution groupSend a message to: 1) Patients 2) Clinicians and staff 3) Triage team Staff 4) A Distribution group

11. 11 When you click the Send button the Finish Message Options pop-up window will appear. You have the option to reassign the message to another member of your team (when you do this the ability to Complete the message is disabled); you can change the message status to Complete; you can save the message as a CPRS Progress Note; you can enter any comments for the other members of the health care team (these are internal messages and not sent to the patient). This example we selected Yes to mark as Complete, No to save as CPRS Progress Note, and click Done.When you click the Send button the Finish Message Options pop-up window will appear. You have the option to reassign the message to another member of your team (when you do this the ability to Complete the message is disabled); you can change the message status to Complete; you can save the message as a CPRS Progress Note; you can enter any comments for the other members of the health care team (these are internal messages and not sent to the patient). This example we selected Yes to mark as Complete, No to save as CPRS Progress Note, and click Done.

12. 12 Reassign? Complete? Save as CPRS Progress Note? Any comments (internal) and click DoneReassign? Complete? Save as CPRS Progress Note? Any comments (internal) and click Done

13. 13 Reassign � notice in this scenario we are reassigning to QUINCY (PCP) and the ability to Complete the message is disabled Any comments � recommend making internal comments (why reassign, what did you reply to patient already, need to be marked as Completed) and click DoneReassign � notice in this scenario we are reassigning to QUINCY (PCP) and the ability to Complete the message is disabled Any comments � recommend making internal comments (why reassign, what did you reply to patient already, need to be marked as Completed) and click Done

14. 14 In the Internal Health Care Team Communications box click the drop-down arrow for Assign to, select the appropriate member of the team for this message.In the Internal Health Care Team Communications box click the drop-down arrow for Assign to, select the appropriate member of the team for this message.

15. 15 You can Enter a Comment (these are internal and not included in message sent to patient). Click Submit button. (Software should take you back to Inbox showing this message status as In process but for some reason it doesn�t� so after you click the Submit button click the Inbox link.)You can Enter a Comment (these are internal and not included in message sent to patient). Click Submit button. (Software should take you back to Inbox showing this message status as In process but for some reason it doesn�t� so after you click the Submit button click the Inbox link.)

16. 16 Because we elected to save as CPRS Progress Note in this scenario you will get a screen like this. It allows you to double-check the entire message thread and make sure you want to save in the patient�s record. Based on your local processes, if the message warrants being saved in CPRS then click the Save as CPRS Progress Note button.Because we elected to save as CPRS Progress Note in this scenario you will get a screen like this. It allows you to double-check the entire message thread and make sure you want to save in the patient�s record. Based on your local processes, if the message warrants being saved in CPRS then click the Save as CPRS Progress Note button.

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18. 18 Provider may Save a Message to Computerized Patient Record System (CPRS) Save a whole message string Secure Messaging limits �Save to CPRS� to users designated as providers in the Secure Messaging setup at this time Saved messages become CPRS notes For providers the message string can be saved to CRPS as a progress note. Note that all of the SM strings are saved and discoverable as part of the medical record. Saving to CPRS makes the string easily accessible to other members of your team or other providers as needed. For providers the message string can be saved to CRPS as a progress note. Note that all of the SM strings are saved and discoverable as part of the medical record. Saving to CPRS makes the string easily accessible to other members of your team or other providers as needed.

19. 19 Save a Message to CPRS - Issues All messages go to single default Text Integrated Utility (TIU) title Business Rules: Cosign Not available-Users requiring cosign can not save messages Encounter data Historical no credit Note saved to single default clinic These defects are being fixed All notes are saved as Secure Messaging note, the encounters are historical. CPT has been assigned but All notes are saved as Secure Messaging note, the encounters are historical. CPT has been assigned but

20. 20 Enhancements in My HealtheVet My HealtheVet may induce interest in Secure Messaging Coming soon - Allergies from Vista data (Health Data Repository (HDR)) - Lab results (7 day delay) - View Appointments (National clinic naming project)

21. 21 Benefits of In-Person Authentication Medication names in Pharmacy section Not just the Rx number View Wellness Reminders See other extracts from their electronic medical record i.e. appointments, labs. Secure Messaging

22. 22 Bryan Volpp Setup and Requirements

23. 23 Requirements for Secure Messaging For a patient to have access to Secure Messaging, they need In-person authentication Staging � a temporary process of activating Secure Messaging for individual patients Expected to become an �off/on� switch by facility someday Link to a Triage team

24. 24 Getting Set Up to UseSecure Messaging Identifying eligible patients � authenticated users Increasing authentications Staging authenticated patients Setting up the Triage Teams Members Rules Association/links with patients

25. 25 In-person Authentication (IPA) Only patients who are IPA�d are eligible to participate in Secure Messaging Only a limited number of patients at each facility are authenticated Only those who have a provider or team that is participating in Secure Messaging would be potential candidates

26. 26 In-Person Authentication Process Patient Registration in My HealtheVet Orientation Video Release of Information Form 10-5345a-MHV Present Picture ID Facility Authenticate veterans in the My HealtheVet Admin Portal

27. 27 Authentication Nationally only 4% of patients are authenticated Varies by VISN, Facility and clinic

28. 28 In-Person Authentication per Enrolled Patients

29. 29 VISN In-Person Authenticated Patients

30. 30 Facility In-Person Authentications per unique

31. 31 Identifying In-Person Authenticated Patients for Secure Messaging Identify them individually in Computerized Patient Record System � MHV Button Run a report on a PCMM panel to get a list Reminder report works well for this List can be saved (staging) Depends on entry in the Treating Facility file of 200MH

32. 32 Encouraging In-Person Authentication Postcards/letters to users of the medication refill option who are not already authenticated Mailing flyers to patients Emails to patients Education in clinic on My HealtheVet and IPA for unauthenticated patients

33. 33 Prescription Refills from My HealtheVet Stored in file 52.43 (PRESCRIPTION REFILL REQUEST) Use a Fileman inquiry to create a list of SSNs of patients who have used this option Create an OE/RR team list from the SSNs and run a reminder on it to get a list of the unauthenticated users (store in a patient list) Generate the addresses from the reminder patient list

34. 34 Appointment Letter Flyer

35. 35 Emails The PATIENT file (file #2) has a field for an email address Generate a list of enrolled patients who are unauthenticated, pull the email address on that patient list. OI created dummy Outlook account to send out messages 20-30% of the addresses are �bad� None@none.com Very low response rate � some complaints

36. 36 Education in Clinic

37. 37 Other Interventions Phone calls One facility is calling patients who use the refill option who are not authenticated Providers using Secure Messaging have been requesting patients to go through the In-Person Authentication process Geography � intercepting patients at visits Waiting room fliers

38. 38 Staging Extra step required to give patients access to Secure Messaging This step is projected to be dropped when Secure Messaging is fully implemented At that point, Secure Messaging will be turned on by facility and not for individual patients Patient name and Internal Control Number (ICN) are required for staging Submitted to the My HealtheVet Program Office

39. 39 Staging Patients Create a list of patients for staging by identifying the In-Person Authenticated patients for the team that is to be set up Reminder report on a PCMM team or clinic Generate the name and Internal Control Number (ICN) from the patient list via Fileman Or use a menu option or Fileman inquire on individual patients Submit the names and ICNs to the Program Office Keep a list of those patients submitted

40. 40 Linking Patients to their Team The setup for the Triage teams allows you to link patients to those teams based on: PCMM provider Clinic visits in the past 1Y or appointments in the next 1Y OE/RR team Individual patient If a patient is staged, then they will have access to the teams that they are linked to by one of the above

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53. 53 Wellness Reminders Released in patch PXRM*2*3 in March 2005 Moved from pilot to display for all authenticated patients in April 2009 Local mapping is required to maintain and display local data elements: labs, immunizations, etc. Mapping instructions distributed: 3/05, 10/08, 3/09 Health summaries specifically for patient reminders should be displayed in Computerized Patient Record System (CPRS)

54. 54 Wellness Reminders - 12 VA-MHV Immunizations: Pneumococcal, Influenza Cancer Screen: PAP, Mammogram, CRC BMI>25 HTN Diabetes: Foot exam, Eye exam, HbA1c Lipids for Diabetes and IHD: LDL measurement and LDL control Usage: CPR

55. 55 Wellness Reminders: Usage The Usage field for the national My HealtheVet wellness reminders is set to CPR Local reminders that are not meant for patient display should not have a �P� This caused major problems when the reminders were released to the patients 35 sites were not in compliant and patients complained Sites no longer have the option to create and display local reminders

56. 56 Wellness Reminders Patient View

57. 57 Wellness Reminders detail view

58. 58 Computerized Patient Record System Health Summary view

59. 59 Rich Moran Nationally Funded New Position

60. 60 My HealtheVet Coordinator Positions Descriptions and Funding have been released to VISNs Position is Now being called: My HealtheVet Change Agent Recommended to reside under Chief of Staff/Clinical Informatics line Find your funding it went someplace. Position has strong clinical components. Requires someone who can work with both Veterans and clinical staff. At this time a bit of geek ability is also helpful. Find your funding it went someplace. Position has strong clinical components. Requires someone who can work with both Veterans and clinical staff. At this time a bit of geek ability is also helpful.

61. 61 My HealtheVet Change Agent Insure Secure Messaging Administration done Insure adequate training for both clinical staff and Veterans Use VA approved social media to advance My HealtheVet and Secure Messaging use by Veterans and clinical staff Promote the link between My HealtheVet/Secure Messaging and the Medical Home May have more than one SM admin at a site. Not to many! May have more than one SM admin at a site. Not to many!

62. 62 Questions? Thanks for coming Questions?