Get documents about "136-MHV_ My HealtheVet Secure Messaging Electronic Patient
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- 8/10/2011
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Document Sample
My HealtheVet Secure Messaging
Electronic Patient/Pharmacist Communication
Presented by:
LuAnne Barron, RPh
Program Manager, PBM Clinical Informatics
Patti Morrison, RN, BSN
PVAMC Primary Care Operations Manager
1
Class Objectives
• Provide an overview of the VA Personal
Health Record – My HealtheVet
• Characterize the electronic patient-doctor
relationship
• Describe use of "secure messaging” in
clinical practice
• Show the required steps for using secure
messaging for patient care
• Understand the characteristics of clinical
adoption
2
Ground Rules
• Please write any questions on the 3X5
cards provided
– Room assistants will collect the cards and we
will attempt to respond as time permits to all
questions
– If we run out of time, your questions and
answers will be posted on the VeHU website
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My HealtheVet - National Program
My HealtheVet Personal Health Record,
a web-based health management tool,
provides veterans a single point of
access to personalized medical information,
health education information, and self-
management tools.
My HealtheVet (MHV) Services and Products
* Online Prescription Refills * Complete Medications View
* Condition Centers * Health Education Information
* Self-assessment Tools * Health Journals & e-Logs
* Seasonal Health Reminders * Secure Messaging
More than 500,000 www.myhealth.va.gov
Registered Users
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My HealtheVet Services today
• Online Prescription Refills
• Complete Medications View
• Condition Centers
• Health Education Information
• Self-assessment Tools
• Health Journals & e-Logs
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Dimensions of Engagement
• What do patient’s want?
• What does the health care team want?
• Understanding current attitudes
• What do we want our patients to do…
– Access and use their personal health
information
– Manage their own health using IT based tools
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What do patients say they want?
The survey of 2,264 adults was conducted Sept.5 through Sept. 7, 2006 (Wall Street Journal, 9/12/06)
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What do patients say they want?
The survey of 2,264 adults was conducted Sept.5 through Sept. 7, 2006 (Wall Street Journal, 9/12/06)
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Patient – Health care Team Relationships
Communication
• Face-to-face
• Written
• Telephone
• Internet
• Secure Messaging
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My HealtheVet - Secure Messaging
MHV Secure Messaging
MHV Secure Messaging is a complementary online
clinical service provided through the MHV website that
facilitates the delivery of healthcare services and may
improve healthcare outcomes by:
• Improving accessibility
• Improving patient-healthcare team collaboration
• Promoting patient self-management
Patients are asking for Secure Messaging!
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Electronic Communication
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My HealtheVet - Secure Messaging
MHV Secure Messaging
• Electronic bi-directional,
asynchronous
communication for non-
urgent health care questions
& issues
• Provides efficient and secure
communication mechanisms Response time is 3
based on proven and widely business days
accepted IT protocols
• …offeringmessaging is not e-
Secure another communications channel for patients and
mail healthcare team members.
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My HealtheVet - Secure Messaging
How is Secure Messaging Different from e-mail?
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My HealtheVet - Secure Messaging
Common Features
• Bi-directional communications
– Messages can be sent and received from the patient
and healthcare team members
• Messages routed through a triage team
– The facility or clinic practice pattern determines the
composition of the triage team
• New message notification
• Designate surrogate
• Escalation notification
• Save Secure Messages as Progress Notes
• Performance reports
14
Self-Management and Secure Messaging
Functionality
• Renew meds
• Request appointments
• Contact health care team for non-urgent
issues
• Message their provider with non-urgent
issues
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Secure Messaging
Frequent Types of Secure Messages
• Updates to Physicians 41%
• Addressed a Single Issue 83%
• Prescription Renewals 24%
• Require Physician Response 43%
• Health Questions 13%
• Test Results 11%
• Needing Referral 9%
“most messages are
• Thank You’s / Apologies 9%
direct and related to one
• Appointments 5%
• Non-Health Questions 5%
issue”
Dr. Byrne, PCP Loma Linda
• Billing 3% SM Pilot Site
• Sensitive Content 5%
• Urgent Need 0%
Source: University of Michigan - Steve Katz, MD
JAMIA, Nov.2004
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My HealtheVet - Secure Messaging
Who will utilize Secure Messaging?
– My HealtheVet registered VA patients who
have completed In-Person Authentication
– Providers who are enrolled into Secure
Messaging
– Clinical and non-clinical staff trained to assist
with message triage
All Participants Must Be MHV Registrants and Completed the
In-Person Authentication Process
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My HealtheVet - Secure Messaging
What can you do?
• Send a message
• Reply to a message
• Triage a message
• Complete a message
• Save message as TIU note
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Patient Opt In
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Healthcare Team
Logging into Secure Messaging
1. Connect to the Secure Messaging Portal
2. Type your NT Username in the UserName field.
3. Type the NT password in the Password field.
4. Click on the Login Button.
If you need assistance with your password, contact your local IT
support staff.
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My HealtheVet - Secure Messaging
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Viewing a Message
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Reading the Message
Read message
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Sending a Message
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Triage Staff Assigns a Message
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Save Messages as a TIU Progress Note
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Possible Advantages
• Patient/provider relationships
• Reduce non urgent telephone calls and
pages for providers
• Quality of care
• Communication
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Possible Advantages
• Provider and patient satisfaction
• Care efficiency
• Written record
• Messages
– Customized
– Guided messages
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Secure Messaging
Implementation
of
Secure Messaging
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Success Factors
MHV Clinical Adoption
Veterans and Consumers Health Informatics Office
(V/CHIO)
is committed to providing you the clinical adoption tools
to assist in the adoption of Secure Messaging
in your facility.
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Secure Messaging Clinical Adoption
MHV Clinical Adoption
Clinical adoption is the planning, implementation,
education, training, and monitoring of the
modification and transformation of organizational,
tactical, and behavioral clinical processes and work
flows necessary to adopt new on line clinical
services.
..provides the health care team an opportunity to
prepare for the change instead of reacting to the
change.
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Secure Messaging Clinical Adoption
• Leadership
• Strong project management
• Clear decision-making
• Organizational expertise
• Strategy for adoption
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Securing Messaging Clinical Adoption
V/CHIO Clinical Adoption Testing Process
• Establish a multidisciplinary Implementation work group
(national leadership, technologist, SMES, field
representation/front line)
• Test functionality of technical and clinical
relevance/applicability and impact.
• Develop and test clinical adoption tools and materials during
the pre-alpha phase.
• Analyze and synthesis test data and participant feedback.
• Modify clinical adoption tools as appropriate
• Provide ongoing evaluation & identification of improvement
opportunities
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Securing Messaging Clinical Adoption
SM Clinical Adoption Tools
• National Clinical Adoption Guide
• Secure Messaging Toolkit
• Implementation Team education material
• Staff education material
• Patient education material
• Communication materials
• Outreach campaign materials
Field tested tools will be provided to help you identify and
implement success strategies for your facility
34
Mapping the process
– SME started meeting with Stakeholders fall
of 2007
1.Project Team Development:
Identify management team, meeting schedule
Identify implementation team, meeting schedule
Establish communication mechanism
2.Practice/Provider Recruitment
Provide briefing to Primary Care
Identify Primary Care providers and Staff who will participate
Identify associated Customer Service Specialists, Nurse
Care Managers, Schedules, and any other staff who may be
involved.
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Introduction, socialization
• Identifying stakeholders
• Establishing clear goals/outcomes
• Educating
• Discussing
• Listening
• Brainstorming
• Listening
• Trying/testing
• Listening
• Evaluating
• Repeat
• Clinical adoption
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Secure Messaging Clinical Adoption
Education and Training….
the cornerstone to all successful clinical adoption endeavors
• Video
• On line tutorial “Our implementation was
• Web pages with resources so successful because
• CD/DVD training was provided by
• Face-to-face training the clinician.”
Health Care Providers
• Quick Reference Guides Loma Linda SMS Pilot
• Web-based modules
• National training calls 37
Secure Messaging Clinical Adoption
Secure Messaging Toolkit
• Key Implementation Steps
• Checklist and Time Line The objective of the
• Generic clinical work flow SM Toolkit is to
• Table Top Exercise ensure your success by
• Communications planning tools providing How-To key
• Education and training guidelines steps and tools.
• Outreach campaign guidelines
• Reference to other pertinent
resources and toolkits
38
Secure Messaging Clinical Adoption Update
Secure Messaging Table Top Exercise
The Secure Messaging Table Top Exercise is a
paper-based simulation of anticipated messaging
scenarios and clinical work flow.
Simulate the most common types of messages so the
Team understands how to respond to the messages.
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My HealtheVet Personal Health Record
Secure Messaging Table Top Exercise
I. Purpose
Allow implementation team/test team to evaluate the
integration of secure messaging services in their clinical
communications/processes before implementing the
application.
II. Desired outcomes
Identify clinical process improvement/modification
opportunities prior to implementing Secure Messaging.
Provides the health care team an opportunity to prepare
for the change instead of reacting to the change.
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My HealtheVet Personal Health Record
Participants Role and Responsibilities during Table Top
Exercise
Implementation Team
Talk through the processing of each type of secure
message identified in the communication work flow.
Identify and document work flow improvement opportunities,
modifications, and challenges
Select Facilitator
Maintain ground rules
Identify when the implementation team appears confused and
encourage forward progression
CANNOT PARTICIPATE IN DECISION MANAGEMENT
Record Keeper
Capture modifications to work flow and meeting minutes
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My HealtheVet Personal Health Record
Table Top Exercise Process
NOTE: Document current communications work flow prior to the Table Top
Exercise.
1. Facilitator forwards message to initial reviewer.
2. Initial reviewer explains his/her action(s).
3. Initial reviewer forwards message to the next receiver in
the work flow.
4. Continue forwarding the message until the message is
completed.
5. Document any improvement/modification work flow
opportunities or technical challenges.
42
MHV Personal Health Record Clinical Adoption
Secure Messaging Clinical Work flow
Secure Messaging Clinical Telecommunication Work flow
• Model current clinical business processes
• Incorporate processes/systems that have worked well for your site
or other sites
• Evaluate integration of Secure Messaging into current clinical
business processes
• Portland modeled the work flow after the telehealth program
• Identify significant contact points
• Modify clinical business processes
• Test modified clinical business processes
Provides the health care team an opportunity to prepare
for the change instead of reacting to the change. 43
Past implementation
1. The Portland VA:
implemented the use/application of various technology, work flow
processes, models of care, types of visits...etc.
2. Look back through all of the iterations:
– not start early
– stakeholders not represented
– no champion's)
– infrastructure not in place
– Did not benchmark or too late in process. 44
Nurses role
45
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Potential Business Models
Modelled current work flow Processes
Telecommunication and “walk-in” processes
Map out VA Telephone Care information flow
Identify all communication processes of participating providers
and staff that fall outside Telephone Care (Pharmacy, laboratory)
Nurse’s role (Nurse Care Manager)
How will RN role be same
How will RN role be different
Already taking care of these patients in less efficient manner
Chronic care model
Advice nurse
Delegation
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Potential Business Models
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Potential Business Models
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Secure Messaging Clinical Adoption Update
Integrated Clinical Adoption Testing
SM Application Functionality Testing
• Six sites
• Testing period spring-summer 2008
• Test functionality of application
• Exchange of actual information
• Participants: PCPs and associated health
care team members, 4 patients/PCP
• Second round of clinical adoption testing
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Development for pre-alpha and alpha phase
– Solidify team members
– Address questions concerns
– Enroll veterans for Alpha Phase
– Incorporate what was learned from table
top exercise.
– Solidify business rules.
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Secure Messaging Clinical Adoption Update
Integrated Clinical Adoption Testing
SM Administrative Functionality Testing
• Additional sites
• Start date Summer 2008
• Increased participants
• Exchange of actual information
• Additional SM features
• Facility establish triage teams
• Run performance reports
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Secure Messaging Clinical Adoption
Communication Strategies
• Approved product messaging
and language
• Communication brochures
• Frequently Asked Questions
• Approved press releases
Communicating information about the new product—
internally and externally—is vital to the success of your
implementation.
53
Secure Messaging Clinical Adoption
Continuous performance evaluation is key to the long
term success of MHV.
Performance Metrics
• Workload Effort—number of messages
responded to by specific classification
(providers, clinicians, triage team)
• Clinical processes--number of escalated
messages (messages not completed within 3
business day)
54
Struggles/concerns
• Finding time to meet with all team members
• Delays in implementation
• Why does SM notification have to come
through outlook
• How are we going to take on this additional
work load?
• “It is all going to fall on the RN.”
55
Successes identified by team
• Delicate communication with patient more
comfortable
• Confidentiality/HIPPA
• Concise and abbreviated
• Improve prioritization and organization
• Manage the work load rather than the work
load managing us
• Optimizes space needs
• Proactive communication
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Lessons Learned
• Need to enculturate the belief with patients
that communicating with the health care
team is the same as communicating with
the provider
• Partner in health care.
• Perceived benefits: savings (time and
money), decreased frustrations by staff and
patients; maximize resources (meets ACA
principles)
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My HealtheVet
VA's personal health record, anywhere, anytime
internet access to health care!
Celebrating 5 years
www.myhealth.va.gov
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