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?
Pages to are hidden for
"My HealtheVet in the Medical Home_ Session 110_606_ VHA eHealth "Please download to view full document