136-MHV_ My HealtheVet Secure Messaging Electronic Patient by wuxiangyu


									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

               Class Objectives

• Provide an overview of the VA Personal
  Health Record – My HealtheVet
• Characterize the electronic patient-doctor
• Describe use of "secure messaging” in
  clinical practice
• Show the required steps for using secure
  messaging for patient care
• Understand the characteristics of clinical

                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
  – If we run out of time, your questions and
    answers will be posted on the VeHU website

         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
       My HealtheVet Services today

• Online Prescription Refills
• Complete Medications View
• Condition Centers
• Health Education Information
• Self-assessment Tools
• Health Journals & e-Logs

        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
  – Manage their own health using IT based tools

          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)
          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)
Patient – Health care Team Relationships


   • Face-to-face
   • Written
   • Telephone
   • Internet
   • Secure Messaging

    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!

Electronic Communication

         My HealtheVet - Secure Messaging

               MHV Secure Messaging

• Electronic bi-directional,
  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.
  My HealtheVet - Secure Messaging

How is Secure Messaging Different from e-mail?

      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
 Self-Management and Secure Messaging


• Renew meds
• Request appointments
• Contact health care team for non-urgent
• Message their provider with non-urgent

                  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%
                                                  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
    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
 – Clinical and non-clinical staff trained to assist
   with message triage

All Participants Must Be MHV Registrants and Completed the
              In-Person Authentication Process
 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

Patient Opt In

                         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.
My HealtheVet - Secure Messaging

Viewing a Message

Reading the Message

    Read message

Sending a Message

Triage Staff Assigns a Message

Save Messages as a TIU Progress Note

           Possible Advantages

• Patient/provider relationships
• Reduce non urgent telephone calls and
  pages for providers
• Quality of care
• Communication

           Possible Advantages

• Provider and patient satisfaction
• Care efficiency
• Written record
• Messages
  – Customized
  – Guided messages

 Secure Messaging

Secure Messaging

                 Success Factors

             MHV Clinical Adoption

   Veterans and Consumers Health Informatics Office
is committed to providing you the clinical adoption tools
     to assist in the adoption of Secure Messaging
                     in your facility.

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

..provides the health care team an opportunity to
prepare for the change instead of reacting to the
    Secure Messaging Clinical Adoption
• Leadership

• Strong project management

• Clear decision-making

• Organizational expertise

• Strategy for adoption

    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

     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

            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

                  Introduction, socialization
•   Identifying stakeholders
•   Establishing clear goals/outcomes
•   Educating
•   Discussing
•   Listening
•   Brainstorming
•   Listening
•   Trying/testing
•   Listening
•   Evaluating
•   Repeat
•   Clinical adoption

        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

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.

     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
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.
   My HealtheVet Personal Health Record
Participants Role and Responsibilities during Table Top
    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
               Record Keeper
               Capture modifications to work flow and meeting minutes
     My HealtheVet Personal Health Record

                   Table Top Exercise Process

NOTE: Document current communications work flow prior to the Table Top
 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
 5. Document any improvement/modification work flow
             opportunities or technical challenges.

   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

            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

Potential Business Models

Potential Business Models

       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

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.

       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

    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
   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)


• 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.”

       Successes identified by team

• Delicate communication with patient more
• 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
              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

             My HealtheVet

VA's personal health record, anywhere, anytime
        internet access to health care!
           Celebrating 5 years


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