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					        My HealtheVet
Tools for Chronic Disease Management
             Session #108
                Overview
• Using My HealtheVet Secure Messaging
  to Enhance The Experience of Your
  Patients

• Integrating My HealtheVet into Your
  Clinical Practice




                                         2
Using My HealtheVet
Secure Messaging to
Enhance The Patient
  Care Experience


                      3
Vision for An Organization
 Messenger of sympathy and love

    Servant of parted friends

      Consoler of the lonely

   Bond of the scattered family

   Enlarger of the common life

                                  4
Vision for An Organization
  Carrier of news and knowledge

  Instrument of trade and industry

 Promoter of mutual acquaintance

     Of peace and of goodwill

     Among men and nations

                                     5
 What sort of organization describes
           itself this way?

A) Case Management Society of America
B) Department of Veterans Affairs
C) Caesars Palace
D) U.S Postal Service
E) (Angelina) Jolie - (Brad) Pitt family


                                           6
National Postal Museum
   (Washington, DC)
        1912
                         7
        Missions May Change, Visions Evolve
The US Postal Service vision has changed, resting on three
major strategies:
1) Focus on what matters most to customers
2) Leverage strengths to create customer value and profits
to invest in continued improvement
3) Embrace change in the way we respond to emerging
customer needs and a rapidly evolving business environment


                                                             8
 Patient-Centered Medical Home

VA’s new care delivery!




                                 9
 Patient-Centered
Medical Home Goals
     Access Goal
     Offering patients
 non-appointment options
Practice Redesign Goal
      right person
  does the right work
    at the right time
 on behalf of the patient
                            10
   What is Secure Messaging?

 Electronic bi-directional communication for
  non-urgent health care questions and issues
 Provides efficient and secure communication
  based on proven and widely accepted IT
  protocols
 Based in My HealtheVet Web portal
  (Secure Messaging is not Email)
 Secure Messaging is not Instant Messaging

                                                11
       Patient Centered Primary Care Teamlet
                                            Veteran

                                         Schedule
                                         appointments
                                         As needed or requested
                                         by primary care team

                                         Appointment check in
                                         (including correct ID)
 Administrative         Provider         •Utilizes kiosk to check
                   (Physician, NP, PA)
                                                                       RN Care Manager    Clinical Support
   Support                               in when available
                                         (performs In-Person
                                         Authentication)
                                         •Updates insurance &
                                         demographic info

                  Secure Messaging       Face to Face Visits
                                                                                         Secure Messaging
Assists w/My                             •Arrive on time
                                                                      Secure Messaging   Triages messages
HealtheVet        Triages messages       •Bring medications           Triages messages
registration      from patients          •Required Paperwork
                                                                      from patients      from patients
                                         •Health risk assessment
                                         completion (with RN)
                                         •Lab work completion
                                         Prepare for Primary
                                         Care Visit
                                         •Discuss concerns and
                                         plan of care
                                         •Utilize My HealtheVet
                                         •Contact PC “teamlet”
                                         with any
                                         problems/concerns that
                                         arise during/after face to
                                         face encounter.

                                         Participate
                                         •Attend committees,
                                         patient advisory groups,
                                         and task forces


                                                                                                     12
If You Build It, They Will Come




   engage, educate, enroll and evolve

                                        13
   Get Your “All Access” Pass
■ Bronze: Read-only version
■ Silver: Registration – Username
  and password
     • Order prescriptions (#‟s only)
■ Gold: Complete video, ROI, IPA
     • Wellness Reminders
     • Now: pharmacy profile
       with names
     • Soon: Appointments
       and Chemistry/Hematology
■ Platinum: Secure Messaging

                                        14
             Same As It Never Was
          Telephone                       Secure Messaging
■ Tag, you‟re it!                     ■ No phone tag
■ Leave a message?                    ■ Message goes to whom it
  Not sure who will hear it             was intended
■ Waiting is the hardest part         ■ Resolve message in real
                                        time or when you have time
■“While I have you on the             ■ Less rambling – more
  phone...”                             focused discussion
■ Release of Information              ■ My HealtheVet release
  (ROI) issues                          resolves the Release of
                                        Information issues
VA World: Postal distress (packaging, addressing, transporting)

                                                                  15
Benefits of Secure Messaging




 Increased patient satisfaction    Improved patient-
 Improved self-management           provider collaboration
 Improved accessibility            Communicate with patients
 Minimize “telephone tag”           between visits
 Provides patients with a          Increased opportunity for
  sense of “personal touch”          information sharing



                                                             16
                       Patient View




Shows up only after IPA and “Staging” (set up Process for Secure Messaging)




                                                                        17
Patient Sends a Message




                          18
 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

                                     19
The Power of “Reverse”
  Secure Messaging


  Care Management




                         20
Care Coordination and
 Management Goals

  Care Coordination
   Providing the right care
      in the right place
      at the right time

  Care Management
         Making sure
  the right things get done
       at the right time
                              21
  Secure Messaging has an
 important role in augmenting
and facilitating communication
    between patients and
   healthcare professionals


                                 22
  Case or Care Management
Monitor and stay in contact with
     your patients through
    personalized messages
Post-visit follow-up
   Labs
   Exam results
   Procedure education
   Interim communication

                                   23
 Using Secure Messaging for
    Anticoagulation Clinic
     SM sent to pt w/ health questions

Patient responds back to provider within 24
   hours of anticoagulation appointment
 If responses are benign, patient comes to
clinic for blood work only, then goes home!
INR results are reviewed by clinic provider

Secure Message sent to patient with results,
dosing instructions and expected return date
 Patient responds by Secure Message that
  results and instructions were received
                                               24
Hidden Benefit of Secure Messaging




        There is more room to…
     “Pahk the cah in the pahkin loht”
                                         25
                           Clinics

■   Use for patients who are unable to
    attend face-to-face appointments
■   Goal setting/sharing
■   Problem solving
■ MOVE!    Along….. Virtual MOVE!


                                         26
Announce Special Clinics


 ■ Seasonal flu
 ■ H1N1
 ■ HIV testing week
 ■ Special educational programs


                                  27
      Primary Care Pre-planning

■ Arrive early
■ Bring updated medication list
■ Communicate concerns
■ Do labs
■ Ensure updated shared care info is forwarded
■ Fax number
■ Give administrative staff updated demographics/
  insurance/community provider list

                                                    28
Integrating My HealtheVet into Clinical
               Practice
• Objectives
  – Identify partnership opportunities
  – Identify patient tools for clinical collaboration
  – Build bridges that extend current practice with
    new tools
  – Apply My HealtheVet tools for management of
    chronic disease




                                                    29
The „Point of Care‟ Has Changed




                             30
 T13 initiatives and My HealtheVet
• Implement Virtual          • Blue Button project
  Lifetime Electronic        • My Recovery Plan
  Record                     • Patient Education
• Improve Veteran mental       Management System
  health                     • Health Risk Assessment
• Design a Veteran-centric   • Veterans Health Library
  healthcare model
                             • Research collaboration
• Expand healthcare
  access for Veterans        • Secure Messaging
• Ensure preparedness to     • Environmental alerts
  meet emergent national     • Emergency
  needs                        Preparedness Center
                             • Articles

                                                         31
32
       My HealtheVet Principle

Knowledgeable patients are better able to
  make informed health care choices,
    stay healthy, and seek services
         when they need them


                 Inform
                 Engage
                 Activate


                                            33
                    Complementary
VA                                                             My HealtheVet
Electronic                                                     Personal
Health                                                         Health
Record                                                         Record


  Authoritative medical record          Secure; Web-based portal
  Bar Code Medication Administration    Veteran “owns” information
  Imaging                               Veteran controls access
  Clinical reminders                    Consumer empowerment
  Decision support                      Easy access to information, tools,
  Remote data view                       courses and resources
                                         Self-entered information
                                         Incremental addition of extracts copied
                                          from the VA electronic health record


                                                                              34
              Clinical Adoption
Integrate My HealtheVet into
    VA Clinical Practice

 Identify subpopulations who will
  most benefit
 Provide button in electronic
  health record
 Identify clinical utility across
  care settings
 Engage health care teams in
  new conversations



                                     35
   64 yr
 Caucasian
   male


                            PC Prevention
                            Appointment
< 50% Service
                            at VA Medical
  Connected
                                Center

                                                             Checks in

Wife present                  Last visit:
                             August 2009

                                                            My HealtheVet
                                                                Kiosk

                The case presented is fictitious and does
                 not represent actual patient data. The
                  photos seen in this presentation are      Patient record
                  actors playing a part to enhance the       has “MHV”
                   visual experience of the audience.           button
                                                                             36
             My HealtheVet Button
VA                                       My HealtheVet
Electronic                               Personal
Health                                   Health
Record                                   Record


                        Synchronization of My
                         HealtheVet account with VA
                         Master Patient Index
                        Electronic health record
                         header contains the My
                         HealtheVet button indicator
                         for authenticated users
                        MHV button links to My
                         HealtheVet for easy access
                                                       37
    Sit in
   waiting
    area

                     Goes back
   TV plays           to Exam
      My               Room
  HealtheVet
 Perfect Visit;
  Bob’s Med                             Waits in
  Wreck; In-                          Exam Room
    Person        Height 73 inches;
 Authenticatio    Weight 303 pounds
       n           Blood Pressure
                       158/72;          Reviews
                      Pulse 58;       questions to
My HealtheVet      Respirations 17        ask
  Fact Sheets
   available
                   Patient provides
                   My HealtheVet
                    Doctor Sheet
                                                     38
Provider enters
     room



                       Logs into
Greets patient;          CPRS
asks for Doctor
  Sheet and                               Performs
   Complete                                Clinical
Medications List    Works thru clinical     Exam
                   reminders/patient’s
                   wellness reminders


                    Opens Meds Tab        Reviews
                       to display          Meds
                    Outpatient Med
                          List

                                                      39
Provider updates
      CPRS




                      Patient Medication List
                          Medical Events
                   Allergies and Immunizations
                      Clinical Reminders Met




                                                 40
Provider enters
     room



                       Logs into
Greets patient;          CPRS
asks for Doctor
  Sheet and                               Performs
   Complete                                Clinical
Medications List    Works thru clinical     Exam
                   reminders/patient’s
                   wellness reminders


                    Opens Meds Tab        Reviews
                       to display          Meds
                    Outpatient Med
                          List

                                                      41
              Clinical Adoption

               Strategies

 Brochures and Fact Sheets
 My HealtheVet Points of Contact
 Veteran Canteen Service Campaign
 Communications Resources
 Outreach and Promotion
 Consistent Branding
 Executive Leadership Report
 My HealtheVet Widget



                                     42
    My HealtheVet

National My HealtheVet Portal
www.myhealth.va.gov

My HealtheVet Demo Account
   username: mhvuser
   password: mhvdemo#1

                                43
My HealtheVet Resources

My HealtheVet Product Website
vaww.va.gov/myhealthevet/

My HealtheVet Training Site
vaww.vistau.med.va.gov/vistau/mhv/

Clinical Adoption and Communication Toolkits
vaww.va.gov/myhealthevet/promotion_communication.asp




                                                   44
If you have any questions, please contact
             Tracey Martin at:
          Tracey.Martin@va.gov
         or Kathleen Charters at:
        Kathleen.Charters@va.gov
                                            45

				
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