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My HealtheVet - US Department of Veterans Affairs

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					     My HealtheVet:
     The Big Picture
               Theresa Hancock, PAHM
Acting Director, Veterans Consumer Health Informatics
                        Office

           Rashida S. Fleming, BSN, MBA
             Deputy Program Manager
          Objectives


• Understand the need and benefits of a
Personal Health Record
• Integrate Strategic Initiative 1.2
• Address Changes and Roles in My
HealtheVet
• Provide Attendees with Important
Release descriptions and Timelines
• Questions

                                          2
          Vision of the Personal Health
            Information Environment

A personal health information environment that:

• Allows patients, consumers, and caregivers to
  take a very active role in health and health care.
• Supports communication between physicians and
  other health providers and the individuals and
  families in their care.
• Improves the quality of health care.
• Enhances safety.
• Emphasizes continuity and convenience of care.
• Safeguards patient privacy.
• Earns and keeps the veteran’s trust.
                       The Smart Patient

• Who are they?                           Healthcare
• What smart patients                    Professions
  want to know                      may only interact with
• How can they get                  a chronic disease for a
  there?                             few hours a year……
• Who are the VA                     The rest of the time
  patients?  “Hey, Doc,               patients care for
            I have Heart Failure,
             Shouldn’t I be on an       themselves.
               ACE Inhibitor ?”
               Adapting and Changing
         with our Population and Situations

• Returning veterans from Iraq
• Seniors/Persons with Disabilities
  – Accelerating Internet broadband
    deployment in the United States.
  – VA demographics for seniors.
    • The VA population is typically male, older than
      55 and with significant more health problems.

  Health Care systems world wide are faced
     with a challenge of responding to the
     needs of people with chronic medical
   conditions such as Diabetes, Heart failure
               and Mental illness
             ( World Health Organization 2002)
                                VA’s Aging Population

• Between today and 2010, VA’s Veterans aged 85 and over
  will increase from 750,000 to ~ 1.2 million
  2,000

  1,800
            Even if Affordable, There are Better Ways . . .
  1,600

  1,400

  1,200

  1,000

   800

   600

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          Veterans 85 & Over,
     0
          Number in 1,000’s
    00

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                      Additional Driving Forces

• The President’s Mandate
• President’s New Freedom Commission on
  Mental Health Report, Adapted to VA
  Context
• VA/DoD Collaborations
• American Health Information Community
  – Dr. Brailler: Share or Fail

 Dr. Jonathon Perlin, Acting Under Secretary for Health stated that the single most
 important challenge facing VHA is ensuring that service members and Veterans who
 have been wounded in OIF/OEF receive the best health care available anywhere. “VHA
 has no higher calling, no greater mission, than this.” VAnguard, March/April 2005.
    Strategic Initiative 1.2


• Fully implement VA’s
Personal Health Record
  – MHV will be transformational in
    how VA delivers Health Care by
    providing veterans and VA
    employees capabilities to
    become an informed and active
    partner in managing their own
    health
       VA’s Personal Health Record

   My HealtheVet is a web-based
application that creates a new, online
environment where veterans, family,
 and clinicians may come together to
optimize veterans’ health care. Web
  technology will combine essential
 health record information enhanced
by online health resources to enable
             and encourage
    patient/clinician collaboration.
           A Challenging Year for VA Health IT


• Lots of changes
  –   Oversight
  –   Budget
  –   Processes and Procedures
  –   Organizational Structure
  –   Leadership
  –   Security Issues
                       Needed to Rebaseline Program

•   Severe Budget Reductions in FY06/FY07 Forced Restructure
    – Content Removed
    – Schedule Milestones Pushed Out
    – Entire Development Plan Revamped


                               VistA-HeV FY06 Development Budget




                                    * My HealtheVet budget cut by 47 percent.
              VHA PHR Awarded

• This year, My HealtheVet has been
  honored as a winner of the
  Excellence.Gov Award. It won for its
  excellence in leveraging technology to
  enhance collaboration.
                         MHV Benefits

MHV will create a partnership
between patient and provider and,
through its web-based interface,
improve access to care.
                           -- It affords the Veterans
Health Administration the opportunity to
revolutionize its health care delivery strategy
through business process changes that will put the
veteran at the center of the healthcare system, and
in so doing become a far more efficient and
accessible system.
                      MHV Benefits

• Increased patient self care and management
  (patient and family centric care)
  – Patients will be more involved in their own care,
    self-management, increased demand to know
    about the quality of their care,
  – Increased access to health information from many
    sources, More emphasis on and tools to support
    patient education
  – Increased communication between providers and
    patient
  – More reliance on family members for care
  – More ways to provide information for patients
    with hearing impairment, low vision, cognitive
              VHA’s First Forward Facing Portal
                         Application

• Business Drivers
  – Usability responsive to veterans and active
    duty service-persons
  – Partnering with TriCareONLINE – common
    look and feel
  – A key enabler to VA health care that is
    •   Safe
    •   Effective
    •   Efficient
    •   Compassionate
                 MHV Pilot - Veterans Day 2005
•   Self entered information
     – Contact information
     – Emergency contacts
     – Health Care Providers
     – Health Insurance
•   Medical Information
     – Meds, OTCs, Herbals
     – Allergies
     – Tests
     – Medical Events
     – Food Journal
     – Activity Journal
•   HealtheLog
     – Blood Pressure
     – Blood Sugar
     – Cholesterol
     – Body Temperature
     – Body Weight
     – Heart Rate
     – Pain
     – Pulse Oximetry
•   Rx Refill
•   Military Health History
•   Print formats of all areas
•   Emergency contact wallet card
                          Clinical Functions

• Self entered Metrics
  Important to achieve results
  – Identifies key areas
  – Supports progress
• Organization of Information
  to save time during clinic          Self-entered Metrics:
  visits                                •Blood  pressure
                                        •Blood sugar


• Better value of home BP               •Cholesterol

                                        •Weight


  measurements                          •Food Journal

                                        •Pulse Oximetry

                                        •Heart rate

                                        •Pain
     • Ref: Bobrie et. Al.: JAMA        •Activity Journal

       291;1342,2004
         My HealtheVet National Capabilities

• Personal Health Record (PHR): All VistA
  data belonging to a patient (health and
  administrative) + Self-Entered Information
• Health Transactions: Currently Online Rx
  Refill; future Request Appointments, Co-pay
  Balance Payments
• Clinical Content Management to support use
  and patient education
• MHV IAM must support VHIT, OneVA IAM,
  OneVA Portal Single Sign-on, and E-Auth
  (e-Gov Agenda)
                 Taking Charge of His Health
•   WHO
     – Orlando Sellers, a Vietnam
       War Vet, and patient and
       human resources specialist
       at the VA Medical Center,
       Washington, DC.
•   WHAT
     – Sellers can pull up his
       electronic medical record in
       My HealtheVet and enter
       his daily blood pressure
       reading.
     – If he sees it spiking he can
       send an email to his doctor
       who may then ask him to
       come in for a brief check-
       up.
     – Sellers’ doctor also checks
       his daily blood pressure
       entries.
•   WHAT THEY SEE
                                      Consumer Reports
     – Patients view the basic           March 2006
       information in their record,
       but clinicians get much
              VHA’s First Forward Facing Portal
                         Application

• Technology / Approach
  –   Developed as an enterprise system
  –   New Java / Oracle platform
  –   Iterative Development Lifecycle
  –   Federated, service oriented architecture
  –   Veteran centered design
                           How Does It Work?                            eVAult
                                                                     (aka MHVDR)
                           www.myhealth.va.gov
                                                                     SEI        VistA



                                                                           ADR
MPI                        MHV Middleware                            Appointments
                                                                      Demographics




  Treating Facility 1        Treating Facility 2      Treating Facility n…

  Lab      Rx     Vitals     Lab      Rx     Vitals    Lab      Rx         Vitals


  Appts   Demo
                  …          Appts   Demo
                                             …         Appts   Demo
                                                                           …
               It Is More Than Just a
                  Technology Issue

• Need to involve 10N,
  HIM, DSS, PCS,
  Program Offices,
  VSOs, communities,        Veteran/Consumer
                            Health Informatics
                                                 Enterprise Strategy
                                                   Management

  data “owners”
• Need to look at
                                                                Clinical
  systems and             Business Owner
                                                             Advisory Board

  databases – I/P, O/P,
  CBOCs, scheduling,                        Veteran Health
                                             Information

  billing, VistA, CPRS,                       Technology


  Mental Health, etc.
                 What Do Veterans Want?
Veterans want:
• Secure timely access
  to their health
  information
• An active role in
  managing their own
  health
• To make informed,               CARE COORDINATION

  educated health care         The Clinic (Care Coordinator)
                               Becomes Aware that the Patient
  decisions                           Is Beginning to
                                    “Get Into Trouble,”

• To refill prescriptions          Proactively, The Patient

  and have access to
                              Is Called To Come Into Clinic . . .

                                     Or Visited at Home!
  their medical or                 Before S/He “Crashes”
  health record online
           Understanding Provider Roles



• VHA health care providers cannot
  access the information entered by a
  veteran into MHV; therefore, there is
  no expectation or responsibility for the
  provider to act on this information
  unless it is discussed during care.
• A disclaimer is provided to the veteran
  when he/she logs into their MHV
  account addressing this point.
                                           MHV Usage

             My HealtheVet July 2007
                              Over 11.2 Million visits TOTAL since My HealtheVet debuted 11/11/2003
                    VISITS
                              We average about 89,000 visits weekly.
                              Over 450,000 registrants

                              We average about 15,000 per month.


             REGISTRANTS




                              Over 3.3 Million Rx refills processed since Rx Day One, 8/31/ 2005

ONLINE PRESCRIPTION REFILL    We average about 54,000 Rx refills weekly.

                              June 25 - First day ever over 10,000
                              From January through July, over 27,000 veterans have come into VA facilities
                             for IPA.
IN-PERSON AUTHENTICATION           IPA is the first step in providing veterans on-line access to copies of key portions of VA
                    (IPA)          medical information.

                                   Today IPA enables authenticated veterans to view their VA medication names in addition to the
                                   prescription number.

  • Pilot Portal still up supporting 7500 users at 9 pilot
          MHV Global and National Presence
                                   We now have over 450,000 My HealtheVet
                                                    Registrants.
                                     They live all over the world --in over 100
                                                     countries
                                   But mostly they live in the United States - in
                                    every state. Texas, Florida and California
                                         top the list of most registrants.




But mostly they live in the United States - in
 every state. Texas, Florida and California
      top the list of most registrants.
                 MHV Adoption

• Every one across the organization shares
  “ownership” of the vision
• Sustain unequivocal support of clinical
  leadership and staff.
• Components broken down into specific
  action steps to make this vision operational
• Specific, detailed plans, clear methods for
  measuring success, guide towards
  implementation and beyond
                MHV Adoption

• Every Include clinicians in the decision
  making process.
• Become integrators of change.
• Drive change and set the stage for using
  MHV as a tool to improve health outcomes.
• Create smooth transition from a national
  level to local level.
• – Business processes and workflow
   – Making the commitment
                         Engage and Empower the Staff

• Linking local strategic goals to MHV tool
                                                              VISN 17 FY07 MHV Registration Progress
                End FY '06
      29000                                                                                                                                                                       36
                                                                                                                                                                          34.0    34
                                                                                                                                                                          28249   32
      28000
                                                                                                                                                            30.2                  30
                                                                                                                                                            27458

      27000                                                                                                                                                                       28
                                                                                                                                               26.0
                                                                                                                                               26567                              26
                                                                                                                                                                                  24
      26000
                                                                                                                           21.7                                           22.7
                                                                                                                              25647                                               22
                                                                                                                                                                                  20
      25000                                                                                                                                                 19.2
                                                                                                               24715                                                              18
                                                                                                               17.2
                                                                                                                                                                                  16
                                                                                                                                               15.4
      24000                                                                                     23882                                                                             14
                                                                                                13.3
                                                                                                                               11.4
                                                                                                                                                                                  12
      23000                                                                        23026
                                                                                                                                        FY200710% (Goal for                       10
                                                                                  9.2
                                                                   22404                                                                                                          8
                                                                                                               7.3
      22000                                                        6.3                                                                                                            6
                                                    21797
                                                                                                3.7                                                                               4
                                                    3.4
      21000                          21082
                                                                                                                                                                                  2
                       20470         0.0                                          0.0                                                                                             0
      20000                                                                                                                                                                       -2
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                                           Number of Registrants         Percentage increased         FY2006 Percentage Increase of Enrollment
                       Clinical Adoption
• The same spirit that helped VA overcome
  obstacles imposed by Hurricane Katrina…
• The same people that made CPRS the
  benchmark Electronic Health Record.
• You are the MacGyvers that will take on the
  challenge of working with patients and
  creating a new generation patient / provider
  partnership
• It is a privilege to serve with you… Thank
            VA had the people and tools.
  you… VA also has a culture of creativity and adaptability.
                                 Dr. Robert Lynch
                                 VeHU 2006
                                 Opening session
              MHV Program Management
                      Office




 To catalyze the widespread changes necessary to realize the full
benefits of Personal Health Record, while protecting patient privacy
           and the security of personal health information.
                   IT Reorganization

• The Veterans Health Administration (VHA)
Office of Information (OI) has just undergone a
major reorganization. The entire development,
implementation and operations arm of the System
Development Lifecycle (SDLC) is being
transferred to the VA CIO (Office of Information
and Technology (VA OI&T)).
   – VHA is retaining the Business Strategy
     responsibilities of establishing investment
     priorities and then devising customer
     requirements in order for another VA
     organization in this case the Office of
     Information & Technology (OI&T), to
     develop, deliver and operate the IT solution.
                   IT Reorganization

• OI&T will have the responsibility to see that
those requirements are successfully interpreted
into appropriate system designs and then fully
develop an Information Technology (IT) product,
deliver it to VHA, and support the operations in a
manner that meets business needs.
   – VHA is retaining the responsibility to ensure
     that users (clinical, administrative, and
     veterans) have appropriate input to assure
     that the product is usable and delivers the
     value described in the original business case.
              The bottom line…

• The VA…


• It’s all about the   VeterAn…
            MHV Current Release Schedule

• Oct 2002: Project Start Date
• Dec 2006: Release 7.0
   – Personal Health Record (Phased Release), Prescription
     Naming
• May 2007: Release 7.1
   – E-Authentication
• August 2007: Release 8.0
   – Calendaring v1.5, User forgot password updates,
     Heathwise updates, Account activity, Terms and Conditions
     Reacceptance, Blended Medications
• 2008: Release 8.1
   – PHR: Chemistry/Lab, IPA:MPI, Appointments v1, Rx Refill
     update, Secure Messaging, Wellness Reminders
                  Future Releases

• Delegation
• User views for clinical alerts
• Check-In; this allows an MHV user to
  virtually check into a clinical visit upon
  arrival to the facility.
• Drug Interaction Checking
• Treatment (Action) Plans; plan developed by
  a clinician in collaboration with patient to
  map out treatment course.
• Personalization: Information Therapy
              Release Dependencies

• Master Patient Index (MPI)
• Supported VistA APIs for Electronic Health
  Record
• Remote Procedure Call (RPC) Broker
• Computerized Patient Record System (CPRS)
• Wellness Reminders
• Text Integration Utility (Data
  Standardization 101)
• Austin Automation Center (AAC)
              Next Steps: What You Can Do to
                 Prepare For the Releases
•   Designate a point of contact (POC) at the CBOC.
•   Distribute MHV fact sheet to local staff.
•   Identify space for displaying materials.
•   Engage staff and volunteers to promote MHV.
•   Provide space for and utilize MHV PCs and
    associated furniture/equipment.
•   Display Signage (i.e., posters promoting MHV,
    banners and various MHV PC signs) in prominent
    locations.
•   Identify goals and report results.
•   Report to facility POC regarding implementation
    efforts and challenges at CBOC.
•   Identify and resolve local issues, as needed.
            Next Steps: What You Can Do to
               Prepare For the Releases
• Post promotional and training materials in a
  prominent location.
• Promote and offer local training for staff and
  veteran users.
• Offer timely responses to provider and MHV user
  questions/concerns.
• Collaborate with facility MHV POC to stay current
  with MHV program updates and implementation
  strategies.
• Identify someone to advocate/champion MHV to
  CBOC staff and patients (i.e., CBOC coordinators,
  CBOC managers).
• Work with contracting specialists to address unique
  circumstances at contracted CBOCs.
               Check it out…

• My HealtheVet National Demo Account
   – www.myhealth.va.gov
      • Username: mhvuser
      • Password: mhvdemo#1
• My HealtheVet Pilot
   – http://www.health-evet.va.gov/
      • Username: demouserb
      • Password: password_$1
• Look for additional information on the My HealtheVet
  Product website:
   – http://vaww.va.gov/MyHealtheVet/
• For Training and Education check out the website:
   – http://vaww.vistau.va.gov/vistau/mhv
Questions




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