VA My HealtheVet Personal Health Record Update - PowerPoint

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					              My Healthevet
                     Personal Health Record




Kim M. Nazi, FACHE
Veterans Health Administration
Office of Information
kim.nazi@va.gov                               December 2008

                                                              1
     Topics


• Current My Healthevet
  Evaluation Efforts
• Opportunities for Research
• Strategies to Promote
  Research Collaboration
• Focus on Barriers, Gaps,
  Infrastructure, Challenges,
  Needs, …and Solutions

                                2
         Performance Evaluation Goals

   Optimize program to improve veterans health care
   Evidence-based knowledge to support clinical adoption
   New collaborative relationships with VA Research
   Agency requirements (OMB 300 Program)
   Inform external partnerships (e.g., AHIC, Markle Foundation)
   Contribute to field of health care informatics


                           Inform
                          Engage
                          Activate

                                                               3
           Research Paradigms: EHR & PHR


 VA Electronic                                    My Healthevet
Health Record                                     Personal Health
        (EHR)                                     Record (PHR)


 • Well established policies,   • New frontier
 processes, and procedures      • Veteran “owns” information
 • Accessible data              • Veteran controls access
 infrastructure                 • Paucity of PHR research
 • Proven successes             evidence
 • Rich history                 • Different data sources
                                • Lack of established policies,
                                processes, and procedures
                                                                  4
My Healthevet

                www.myhealth.va.gov
                Website?
                Portal?
                Education Tool?
                E-service Gateway?
                Personal Health Record?
                VHA Program?
                Intervention?




                                          5
                       Performance Evaluation Framework




*An extension of the
RE-AIM Framework
 www.re-aim.org
                                                          6
       Performance Evaluation Framework



RE-AIM
                         • Number of registrations
Reach                    & visits over time
Effectiveness/Efficacy   • Demographic profiles of
Adoption                 registered users
                         • Target populations who
Implementation
                         can most benefit from use
Maintenance



                                                     7
         Performance Evaluation Framework



RE-AIM
                         Identify and assess
Reach                    key targeted outcomes:
Effectiveness/Efficacy   Quality (clinical outcomes)
Adoption                 Access (utilization management)
Implementation           Value (cost)
                         Satisfaction (perceptions)
Maintenance



                                                           8
         Performance Evaluation Framework



RE-AIM                   • Track PHR adoption by
Reach                    patients & providers
                         • Compare adoption across
Effectiveness/Efficacy
                         sites & settings
Adoption                 • Identify how PHR tools
Implementation           offer clinical utility in
Maintenance              practice




                                                     9
         Performance Evaluation Framework



RE-AIM
Reach                    • System Availability
Effectiveness/Efficacy   • Cost Analysis
                         • Component Utilization
Adoption
                         • Implementation Benchmarks
Implementation           • Best Practices
Maintenance



                                                       10
         Performance Evaluation Framework



RE-AIM
                         • Longer term impacts of
Reach                    targeted outcomes
Effectiveness/Efficacy   (> 6 months)
Adoption                 • Program milestones
Implementation           • Clinical adoption patterns
Maintenance              • Sustainability




                                                        11
         Performance Evaluation Strategies




• Web analytic tools to monitor usage patterns
• Customized indicators for relevant dimensions of RE-AIM
• Satisfaction surveys to measure/track satisfaction and enable
direct feedback (e.g., ACSI, VHA SHEP, Pilot Surveys)
• Research collaborations to address research agenda
questions in scientifically rigorous studies
• Dissemination of results
• Program optimization based on evaluation results
                                                               12
                                                              12
      Performance Evaluation Roadmap


Purpose: provide a comprehensive guide to potential
evaluation strategies that are appropriate for each
phase in the development of a new feature, service,
or content area.

It is intended that the roadmap should be used as a
tool to support a customized approach for designing
a strategic evaluation of new features and services
leading to a consistent, comprehensive, and effective
approach to evaluation.
                                                        13
Performance Evaluation Strategies




                                    14
Performance Evaluation Strategies

          •   Solicit direct stakeholder input on
              needs and preferences
          •   Solicit input from technical, clinical,
              and organizational subject matter
              experts to inform requirements
          •   Conduct environmental scan
          •   Define requirements for metrics and
              reports
          •   Define web analytics
          •   Define success criteria
          •   Conduct Table Top Exercises
          •   Conduct usability testing with task
              driven scenarios



                                                        15
    Performance Evaluation Strategies

•   Track initial usage using web
    analytics
•   Validate metrics and reports
•   Solicit stakeholder feedback through
    surveys, focus groups, personal
    interviews
•   Evaluate education, training, and
    communication support products
•   Continue usability testing
•   Clinical adoption
•   Evaluation feedback repository
•   Testing issues repository




                                           16
    Performance Evaluation Strategies

•   Apply RE-AIM Framework
•   Track usage using web analytics
•   Measure stakeholder satisfaction with
    standardized tools
•   Develop a prioritized research agenda
•   Feature specific metrics and reports
•   Utilize custom surveys for feature-
    specific assessments




                                            17
Performance Evaluation Strategies

         •   Support research collaboration to
             generate evidence-based findings
         •   Monitor feedback channels to identify
             product enhancements
         •   Monitor satisfaction using
             standardized methods and tools
         •   Evaluate success criteria
         •   Indentify new requirements
         •   Develop effective channels for
             knowledge sharing and innovation




                                                     18
         Connecting Operations & Research

Effective collaboration to produce evidence-based
  knowledge to inform program optimization:
• Focus on research agenda priorities
• Create effective processes for collaboration
• Align with existing methods for solicitation, approval,
  monitoring, compliance, and support
• Ensure operational program office support for studies
• Identify and address relevant policy needs
• Define and implement technical infrastructure to
  support appropriate data access strategies

                                                        19
        Research Opportunities

• How are veterans are using MHV and how
  does use enhance “access”? (Reach/Adoption)
• What are the reasons for non-adoption and
  barriers to use? (Adoption)
• Does use of MHV translate into outcomes?
  (Efficacy)
• How can the program keep users engaged and
  connected? (Maintenance)
• What is the impact of e-services on bricks and
  mortar operations (e.g., does secure
  messaging decrease telephone workload?)
  (Implementation)                                 20
        Strategies to Promote Collaboration

• Multidisciplinary Performance Evaluation Workgroup
• Strong collaboration for current studies
• Development of a RE-AIM based research agenda
• Development of an Evaluation Roadmap
• My Healthevet Research SharePoint Site
• My Healthevet Research Interest Teleconferences
• Consultation with Health Data and Informatics and
  Privacy Office subject matter experts
• Environmental scan of PHR research policy
• Workshops (HSR&D 2/08, QUERI 12/08)
                                                       21
You Are Here!




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