Docstoc

My HealtheVet in the Medical Home_ Session 110_606_ VHA eHealth

Document Sample
My HealtheVet in the Medical Home_ Session 110_606_ VHA eHealth Powered By Docstoc
					Session 110/606
   My HealtheVet
in the Medical Home
        Session Overview
•   My HealtheVet and The Medical Home
•   Patient Engagement and Online Tools
•   Secure Messaging Experience
•   Implementing Secure Messaging
   My HealtheVet: A Tool to Deliver
Patient Centered Medical Home (PCMH)
Engaging Patients Using Secure Messaging


             Paul Nichol, MD
          Susan Woods, MD, MPH
           New Models of Care
..enhance ability of Veterans and families to access
health information. One example is…tools such as
MyHealtheVet. These systems will facilitate the
Veteran involvement in his or her own care…
VA Universal Services Task Force Report, 2009
Personal Health Records (PHR) and Secure
      Messaging: Integral to PCMH

  American College of Physicians Homebuilder Survey
   Uses e-mail to provide appropriate care
   Uses website that enables patients to initiate appt.
   Allows the PHR linked to the practice record
   Allows patient to import record to PHR
  National Committee for Quality Assurance (NCQA)
   Advanced Electronic Communications
   Availability of interactive website
   Electronic Care Management support
           Patient Centered Primary Care Teamlet
  Administrative                      Provider                     Veteran                     RN Care Manager                 Clinical Support
    Support                      (Physician, NP, PA)

                                                                                             Direct Patient Care              Direct Patient Care
Customer Service                Direct Patient Care
•Initial point of contact       •Scheduled Clinic Visits        Schedule                     •Scheduled Clinic Visits         •Assist with triage
•Patient Advocate               •Walk in or Urgent Visits       appointments                 •Walk in or Urgent Visits        •Assist providers with
•Address customer service       •Group Visits                   As needed or requested       •Group Visits                    exams/procedures
concerns & coordinating                                         by primary care team         •Telephone Visits                •Perform treatments (EKGs,
                                •Telephone Visits                                            •Incoming telephone demand
solutions.
•Hand-off communication         •Incoming telephone demand                                   •Triage/place orders by          V/S, blood sugar, etc)
                                •Pertinent Clinical Reminders   Appointment check in
                                                                                             protocol                         •Administer meds, wound
                                                                (including correct ID)       •Pertinent Clinical Reminders
Assists providers                                               •Utilizes kiosk to check                                      care
•Prepare paperwork              Secure Messaging                                                                              •Pertinent Clinical Reminders
requested by the Veteran                                        in when available            Secure Messaging
                                •Triaged messages from
and/or PCP                      patients
                                                                (performs In-Person          •Triaged messages from
•Specialty consult completion   •E-mail with consultants
                                                                Authentication)              patients                         Secure Messaging
tracking                                                        •Updates insurance &         •E-mail with consultants         •Triage messages from
•Coordinate information                                         demographic info                                              patients
exchange for the co-            Care Management                                              Care Management
managed patient                 •Virtual review of patients     Face to Face Visits          •Virtual/F2F in-depth and
•Manage telephone demand        including inpatients            •Arrive on time
                                                                                             ongoing review of patients       Care Management
(receiving and documenting)     •Identify high risk for                                      including inpatients             •Track/administer required
•Manage appointment                                             •Bring medications           •Identify high risk for
                                hospitalization.                •Required Paperwork                                           immunizations
scheduling including EWL &      •Appropriate for CCHT,                                       hospitalization.
recall.                                                         •Health risk assessment      •Initiate appropriate            •Triage phone calls for
•Pre-visit patient reminder     OEF/OIF, HBPC                   completion (with RN)         consultations for CCHT, CM,      appointments
calls                           •Preventive care needs          •Lab work completion         OEF/OIF, HBPC,                   •Coordinate group visits
                                •Non VA records                                              hospice/palliative care
                                •View alerts                                                 •Discuss care with specialty     •Identify additional services
Face to Face Visits                                             Prepare for Primary
•Appointment check in           •Diagnostic result                                           consultants                      needed by Veteran/Family
•Assists w/My HealtheVet                                        Care Visit                   •Preventive/chronic disease
                                •Discuss care with/refer to     •Discuss concerns and
registration                    specialty consultants                                        care needs                       Team Work
•Performs In-Person             •Traveling veterans
                                                                plan of care                 •Triage to other team members    •Daily huddle
Authentication                  •Medication Reconciliation      •Utilize My HealtheVet       as appropriate
•Assists with updating and                                                                   •Non VA records                  •Team meetings
                                •Refer to other team members    •Contact PC “teamlet”
verifying demographics and                                      with any                     •View alerts
insurance information           as appropriate
                                                                problems/concerns that       •Follow-up calls                 Education
                                                                arise during/after face to   Team Work                        •New patient orientation
Team Work                       Team Work
•Daily huddle                   •Daily huddle                   face encounter.              •Daily huddle                    •Assist with patient education
•Team Meeting                   •Team Meeting                                                •Team Meeting
                                •Midlevel Collaboration         Participate                                                   Clinic Support
Clinic support                                                  •Attend committees,          Education                        •Daily equipment/supply
•Identify & prepare required                                    patient advisory groups,     •New patient orientation
forms, documents/records        Education                                                    •Mentor/precept nurse trainees   checks
                                •New patient orientation        and task forces
prior to clinic session                                                                      •Patient health                  •Keep exam rooms stocked
•Faxing, copying, mail mgt      •Provider CME , Grand                                        education/coaching
•Manage clinic grids            Rounds
•Manage office supplies &       •Teaching trainees
setup
           Patient Centered Primary Care Teamlet
  Administrative                      Provider                     Veteran                     RN Care Manager                  Clinical Support
    Support                      (Physician, NP, PA)
Customer Service                Direct Patient Care
•Initial point of contact       •Scheduled Clinic Visits        Schedule                     Direct Patient Care              Direct Patient Care
•Patient Advocate                                               appointments                 •Scheduled Clinic Visits         •Assist with triage
                                •Walk in or Urgent Visits                                    •Walk in or Urgent Visits
•Address customer service       •Group Visits                   As needed or requested                                        •Assist providers with
concerns & coordinating                                         by primary care team         •Group Visits
solutions.                      •Telephone Visits                                            •Telephone Visits                exams/procedures
•Hand-off communication         •Incoming telephone demand                                   •Incoming telephone demand       •Perform treatments (EKGs,
                                •Pertinent Clinical Reminders   Appointment check in         •Triage/place orders by
                                                                (including correct ID)                                        V/S, blood sugar, etc)
Assists providers                                                                            protocol
                                                                •Utilizes kiosk to check     •Pertinent Clinical Reminders    •Administer meds, wound care
•Prepare paperwork              Secure Messaging
requested by the Veteran                                        in when available                                             •Pertinent Clinical Reminders
                                •Triaged messages from                                       Secure Messaging
and/or PCP                                                      (performs In-Person
•Specialty consult completion   patients                                                     •Triaged messages from
                                                                Authentication)                                               Secure Messaging
                                •E-mail with consultants                                     patients
tracking                                                        •Updates insurance &         •E-mail with consultants         •Triage messages from
•Coordinate information                                         demographic info
exchange for the co-            Care Management                                                                               patients
managed patient                 •Virtual review of patients                                  Care Management
•Manage telephone demand        including inpatients
                                                                Face to Face Visits          •Virtual/F2F in-depth and
(receiving and documenting)     •Identify high risk for
                                                                •Arrive on time              ongoing review of patients
                                                                •Bring medications           including inpatients             Care Management
•Manage appointment             hospitalization.
scheduling including EWL &                                      •Required Paperwork          •Identify high risk for          •Track/administer required
                                •Appropriate for CCHT,                                       hospitalization.
recall.                                                         •Health risk assessment                                       immunizations
•Pre-visit patient reminder     OEF/OIF, HBPC
                                                                completion (with RN)         •Initiate appropriate            •Triage phone calls for
calls                           •Preventive care needs                                       consultations for CCHT, CM,
                                •Non VA records
                                                                •Lab work completion         OEF/OIF, HBPC,                   appointments
Face to Face Visits             •View alerts                                                 hospice/palliative care          •Coordinate group visits
•Appointment check in           •Diagnostic result
                                                                Prepare for Primary          •Discuss care with specialty     •Identify additional services
•Assists w/My HealtheVet                                        Care Visit                   consultants
                                •Discuss care with/refer to                                                                   needed by Veteran/Family
registration                    specialty consultants
                                                                •Discuss concerns and        •Preventive/chronic disease
•Performs In-Person                                             plan of care                 care needs
                                •Traveling veterans                                          •Triage to other team members    Team Work
Authentication
                                •Medication Reconciliation      •Utilize My HealtheVet
•Assists with updating and                                      •Contact PC “teamlet”        as appropriate                   •Daily huddle
verifying demographics and      •Refer to other team members                                 •Non VA records                  •Team meetings
                                as appropriate                  with any                     •View alerts
insurance information
                                                                problems/concerns that       •Follow-up calls
Team Work                       Team Work                       arise during/after face to                                    Education
•Daily huddle                   •Daily huddle                   face encounter.              Team Work                        •New patient orientation
•Team Meeting                                                                                •Daily huddle                    •Assist with patient education
                                •Team Meeting                                                •Team Meeting
                                •Midlevel Collaboration         Participate
Clinic support                                                  •Attend committees,          Education                        Clinic Support
•Identify & prepare required                                    patient advisory groups,
forms, documents/records        Education                                                    •New patient orientation         •Daily equipment/supply
                                •New patient orientation        and task forces              •Mentor/precept nurse trainees
prior to clinic session                                                                                                       checks
•Faxing, copying, mail mgt      •Provider CME , Grand                                        •Patient health
                                                                                             education/coaching               •Keep exam rooms stocked
•Manage clinic grids            Rounds
•Manage office supplies &       •Teaching trainees
setup
What is the experience of health
 systems using patient portals
 and personal health records?
        Experience at Group Health
n   Secure Email is core function of MyGroupHealth
n   Dispelling Myths
    n   Patients respectful of clinician time
    n   Patient connect to clinicians as trusted source of information
    n   Opportunity to manage challenging patients
n   Workflow efficiencies
    n   Triage – filter, asynchronous communication
    n   Time motion study suggests Secure Message/e-visit takes
        half the time of a phone visit
n   Improved documentation of care
               Dr. Matt Handley, presentation to VA Secure
                   Messaging Workgroup, December 2009
       Shifting Demand:
If e-mail were not available, would you...




                                MyGroupHealth Satisfaction Survey,
2004                               N=630 (2004), N=646 (2006)




                     2006
How would you rate the value of secure
 e-mail in enhancing in person visits?



                          “This is the best health care I have
                          ever had! I love the online services
                          the friendly employees and GHC's
                          overall desire to help me be
                          healthy. I'm from California and
                          GHC beats any health care they
                          had to offer.”


                            MyGroupHealth Satisfaction Survey,
                                N=645 (2004), N=666(2006)
Kaiser – Patient Portal Usage
“The laying on of hands will increasingly
include the pressing of keys. This emerging
model will improve the practice of medicine but
will also bring new challenges.”
                                 - JH Stone

Communication between physicians and patients in the era of e-
medicine. New England Journal of Medicine, 2007
    Complementary Tools: EHR & PHR
VA Electronic                                 My HealtheVet
Health Record                                 Personal Health
(EHR)                                         Record (PHR)




   Comprehensive record    Secure web-based portal
   At all care sites         Patient & family centered
   Decision support          Information and services
   Clinical reminders        Multiple levels of access
   Patient safety            Increasing offerings over time
 Internet Use in the U.S., 2008
• 74% of adults in U.S.
• 87% ages 18-29; 72% ages 50-64
• 41% age 65 and older
• 64% living in rural areas
• 77% white, 64% black, 58% Hispanic
• 57% if < $30,000 per year
                      Pew Internet & American Life Project
                                http://www.pewinternet.org
Our Veterans and their families are
increasingly online and engaged in
     their own health and care.
   My HealtheVet Use (May 31, 2010)

1, 012, 224 Registered

199,202 Authenticated
   Requires in-person process
   Required to use secure messaging

Over 15 million Rx Refills Processed
   Averaging 111,000 refills weekly in 2010
Authenticated Users Can:
• Refill Prescriptions
• View Medications
• Research Health
    Information
•   Get Wellness Reminders
•   Track & Graph Their
    Metrics
•   Use Health Journals
•   Use Self-Assessment
•   See Wellness Calendar
•   Access eBenefits
Manage Medications
Manage Medications
Track Health Data
               Vitals &
               Readings
               Labs & Tests
               Health History
               Family Health
               History
               Military History
               Allergies
               Immunizations
               Journals
               Personal Health
               Summary
Track Health Data

               Vitals &
               Readings
               Labs & Tests
               Health History
               Family Health
               History
               Military History
               Allergies
               Immunizations
               Journals
               Personal Health
               Summary
1.    Hypertension
2.    Influenza Vaccine
3.    Pneumococcal Vaccine
4.    Colorectal Cancer Screening
5.    Lipid Measurement
6.    LDL Target
7.    Body Mass Index (BMI)>25.0
8.    Diabetes Foot Exam
9.    Diabetes Hemoglobin A1C
10.   Diabetes Retinal Exam
11.   Mammography Screening
12.   Cervical Cancer Screening




                                    30
My HealtheVet Website Survey

 • 96% login from home
 • 1 out of 2 login monthly
 • 1 out of 4 login weekly or more
 • 3 out of 4 login for Rx refill
 • 64% would like to securely email their provider

                  American Customer Satisfaction Survey (ASCI)
                                 October 2007 – October 2009
What is Secure Messaging?
 Secure, encrypted within My HealtheVet
 Electronic, bi-directional communication
 Asynchronous (not at same time)
 For enrolled participants only
 For non-urgent issues
 Can triage messages across a team
 Can save messages to Computerized Patient
  Record System (CPRS)
               VA Secure Messaging Pilot Sites
                                                   BEDFORD
                                   ERIE            HC Team 11
   PUGET SOUND                     HC Team    29   Patients 116
   HC Team 37                      Patients   62
   Patients 330                                          BOSTON
                                                         HC Team 60
PORTLAND
                                                         Patients 479
HC Team 56
Patients 380
                                                    WASHINGTON DC
                                                    HC Team  65
                                                    Patients 767
MARTINEZ
HC Team  25
Patients 357




                  ALASKA
                  HC Team    18
                  Patients   85
    Effective Messaging
 Respond within 3 business days
 Triage to appropriate person
 Simple, conversational language
 Higher level of care if appropriate
 Use surrogates as needed
Hello. I just received a new bottle
 of the blood pressure medicine.
  It’s the same name but the pill
doesn’t look the same. Should I
               take it?
Hello. I just received a new bottle
 Dr. Woods –
 of the blood pressure medicine.
 You told me at the clinic
  It’s the same I should the pill
 yesterday thatname but get the
doesn’t look the same. Should I
 shot for shingles. But I didn’t get
               take I wait or do I
 the shot. Should it?
 need to come back in?
Hello. I just received a new bottle
 Dr. Woods –
 ofAs you probably know, I started radiation
     the blood pressure medicine.
                  at the clinic
 You told me University Hospital. I go 5
    treatment at
               that I through the pill
  It’s the same name but get the
 yesterday a week should January.
         times
 shot forlook the same. Should
doesn’tI was wondering, how do I get Ian
     Also, shingles. But I didn’t get
                 take wait
 the shot. Should it? clinic doget that
   eye exam? Do I callIeye or or I
               from you.
                back in?
 need to comehave a happy holiday!
    Thanks and
VA Secure Messaging Experience
 Is patient centered
  o   Patients find it convenient and personal

 Takes a healthcare team
  o   Triage model = specific team roles

 Offers efficiencies of care
  o   With positive patient feedback

 Is used as intended
Meeting My HealtheVet Goals

• Improving Access to Services
• Enhancing Health Literacy
• Improving Communication
• Increasing Satisfaction

           “This is a great thing for us. I
           love being able to refill
           prescriptions.”
Veteran-Provider Interaction
with My HealtheVet Secure
        Messaging

  U.S. Army Veteran Devin Nuszbaum
  David M. Douglas, MD
I’m out of refills. Now what?
                       The dreaded phone tree???
                                                                                            2: Directory
                                                                         0: Operator          XXXXX
                                                                                                                                               AudioCare
                                                                                             3: Enrollment/                                    Application
                                                                                                                                                                                                           Pharmacy CSS
                                                                       1: Direct Transfer       Eligibility
                                                                                                                                                                                                              X 50810
                                                                                              DID x 55069
                                                                                                                                                                                                         (pm: Dayton 51850)
                               0                                                            (pm: voicemail)
                               1
                               2                                                                                          AudioInquiry                       Order Refills
                               3
Start                          4                                                                                         Appt Reminders
             Main Greeting     5                                                             4. AudioCare       1          for 45 days
                53651          6                                                                                2                          9
                                                                                              Automated                                                       Check on the
                               7                                                                Services                                                     Status of Refills
                                                                                                                                           1
                                                                                             DID x 55201                                   2
                                all others                                                                                 AudioCare
                                star                                                                                                       4                   Request a                                             Primary Care
                                                                   1                                                    Pharmacy options
                                                                                                                                                               Renewal                                         Pt’s directed to call team
                                                 Incorrect entry   2                                                                       8
                                                                                                                                                                                                                extension via DID line
                                                    YYYYY          0
                                                                   9
                                                                                            5. Scheduling Agents                                                                                                        Portland 1
                                                                                                DID & x 53494                                                      1                                                   DID x 51495
                                                                                               (after 8-4:30: VM                                MPC Portland       2                                                (pm: Dayton 51850
                                               Voicemail Access                                                                                                    3
                                                                                                   message)                                       x 50960
                                                                                                                                                                   4
                                                                                                                                                (pm: Dayton
                                                                                                                                                  51850)                                                                Portland 2
                                                                                                                                                                                    Vancouver 1                       DID x 51497
        PDX VA Phone Tree – v1.0 rev 2.1.08                                                                         1                                              1
                                                                                                                                                                                       x 31665
                                                                                                                                                                                 (pm: Dayton 51850)
                                                                                                                                                                                                                   (pm: Dayton 51850)
                                                                                                                    2                          MPC Vancouver       2
         Themes                                                                               6: Primary Care       3                             x 50970
                                                                                                                    4                           (pm: Dayton                         Vancouver 2                         Portland 3
                                                                                                  x 50980           5
         ·     Patient and caller self management                                                                   6
                                                                                                                                                  51850)                               x 31901                        DID x 51496
                                                                                                                                                                                 (pm: Dayton 51850)                (pm: Dayton 51850)
         ·     Simple, clear menus
         ·     Pleasant, calm, consistent voice                                                                                                     PC Salem
                                                                                                                                                  DID x 51499
         ·     Fail safe loops for incorrect actions – no dead                                                                                                                                                          Portland 4
                                                                                                                                               (pm: Dayton 51850)
               ends for caller                                                                                                                                                                                        DID x 51498
                                                                                             7: Specialty Clinics
                                                                                                                                                                                                                   (pm: Dayton 51850)
                                                                                                  x 50820
                                                                                            (pm: Dayton 51850)                                      PC Bend
                             2008 QWEST phone book                                                                                                DID x 51494
                             numbers grossly incorrect                                                                                         (pm: Dayton 51850)                     East Portland 1
                             Eligibility and Information                                                                                                                               DID x 51007
                                    503-273-5289                                                                                                                                    (pm: Dayton 51850)
                                                                                                                                                 PC North Coast
                                                                                                                                                     x 52593
                             Currently AudioCare appt                                                                                          (pm: Dayton 51850)                    East Portland 2
                              pressing 9 goes to 50950                                                                                                                                DID x 51008
                             chg to 53494. At times this                                                                                                                           (pm: Dayton 51850)
                                                                                                                                                                       1
                                 also cycles back to                                                                                                                   2
                                                                                                                                                PC East Portland
                                  Audiocare 55201!                                                                                                                     3
                                                                                                                                                     x 50960           4             East Portland 3
                                                                                                                                               (pm: Dayton 51850)                     DID x 51009
                                                                                                                                                                                   (pm: Dayton 51850)


                                                                                                                                                                                     East Portland 4
                                                                                                                                                                                      DID x 51010
                                                                                                                                                                                   (pm: Dayton 51850)
Hmm, maybe Secure Messaging?
“Doc I am out of refills”
Meanwhile back at the clinic…
De-identified notification
Same username and password
The Secure Message
The Doctor replies
Veteran’s de-identified notification
No problem; Your Rx is on its way
Secure Messaging
 Best Practices
   Tracey Martin, RN BSN
       Nurse Manager
VA Boston Healthcare System
          Marketing Secure Messaging
               Perks to the Team
       Telephone                    Secure Messaging

• Tag, you’re it!            • No phone tag.
• Leave a message? Not       • Message goes to whom it
  sure who will hear it        was intended
• The waiting is the hardest • Resolve message in real
  part                         time or when you have
                               time
• “While I have you on the
                             • Less rambling/ focused
  phone….”
                               discussion

   VA World: Postal distress (packaging, addressing,
                     transporting)
   Map the Triage Process

Look at how your TEAM manages “demand” care

Plan and appoint members of the care TEAM to
      receive the initial Secure Messages.


*No one team member works in isolation!
       Primary Roles in Secure
          Messaging triage
• Medical Support Assistant, Program Support
  Assistant, Clerical staff
• Clinical Associates: Health Technician,
  Nursing Assistant, Pharmacy Technician
• Nurses: Licensed Practical Nurse, Licensed
  Vocation Nurse, Registered Nurse

• Can these staff members be the triage team?
Tertiary Roles in Secure Messaging
           Management
•   Clinical Pharmacy
•   Dietitian
•   Social Worker
•   Mental Health Provider
•   Primary Care Provider
•   Other members of the multi-disciplinary
    team
Example of a Secure Messaging Team
    The triage team receives the message, troubleshoots
      the concern and forwards or assigns to another team
      member only if needed
      Veteran
1. In-Person                    Provider_Primary Care_Site
Authenticated
2. Enrolled into
Secure Messaging         Triage Team                          Provider
                       Health Technician
                    Licensed Practical Nurse
                       Registered Nurse                        Social
                                                               Worker
                                                           Mental Health
                     Medical                                 Provider
                    Support
                    Assistant
       Pharmacist
                                               Dietitian
Traditional Secure Messaging
Requests driven by PATIENT
• Administrative Question
• Appointment Request
• Change of Address Request
• Health Information Question
• Lab or Test Results Question
• Medication Prescription Question
            Best Practices
• Secure Messaging is currently being
  utilized in various VA clinical settings
  across the nation.
• Some examples:
       Audiology
       Mental Health
       Home Based Primary Care
       Tele-health
 *******Primary Care*******
Primary Care Pre-planning
• Arrive early
• Bring updated medication list
• Communicate concerns
• Do labs
• Ensure updated shared care information is
  forwarded
• Fax number
• Give administrative staff updated
  demographics/insurance/community provider
  list.
 Utility: Using Secure Messaging for
          Anticoagulation Clinic
   SECURE MESSAGE SENT TO PATIENT WITH
           HEALTH QUESTIONS

PATIENT RESPONDS BACK TO PROVIDER WITHIN
24 HOURS OF ANTICOAGULATION APPOINTMENT

IF RESPONSES ARE BENIGN, PATIENT COMES TO
CLINIC FOR BLOODWORK ONLY & THEN GOES
HOME!
LAB RESULTS ARE REVIEWED BY CLINIC
PROVIDER
SECURE MESSAGE SENT BACK TO PATIENT WITH
RESULTS, DOSING INSTRUCTIONS & EXPECTED
RETURN DATE
PATIENT RESPONDS BY SECURE MESSAGE THAT
RESULTS AND INSTRUCTIONS WERE RECEIVED
           MOVE! Clinics
• Utilize for patients who are unable to
  attend face-to-face appointments

• Goal setting/sharing

• Problem solving

• MOVE! Along….. Virtual MOVE!
 Other Patient Centered Medical Home Uses

• Announce special clinics such as seasonal
  influenza, H1N1 influenza and special
  educational programs
• Post-visit follow-up:
  – labs/discussion, exam results, procedure education
  – interim communication
• CaSe or CaRe management

• Caregiver communication/support.
Hidden benefit of Secure Messaging




       There is more room to…
    “Pahk the cah in the pahkin loht”
Questions?

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:19
posted:12/12/2012
language:English
pages:67