BACKGROUND/RATIONALE:
VA has made a considerable investment in My HealtheVet (MHV), its personal health record and patient portal, and is relying on the promise it holds to improve patient access to health information and patient engagement with their care. MHV is a cornerstone of the Patient Aligned Care Team (PACT) initiative that is part of VA's primary care transformation. Despite the fact that MHV has been available for over a decade, and that new features continue to be added, the majority of Veterans have not gone through the in-person authentication process to access the key features of MHV. It is of the utmost importance that we understand who is and is not currently being reached by MHV, and how better to reach those Veterans who are not currently using MHV, so that VA can plan appropriate outreach and ensure health disparities are not widened by disparities in access.

OBJECTIVE(S):
1. Conduct an extensive database study to:
a. Assess the relationship between patient sociodemographic characteristics, clinical characteristics, enabling resources, and adoption and use of MHV;
b. Assess the relationship between a patient's comorbidity burden and in-person authentication for MHV, and the mediating effect of healthcare utilization;
c. Assess whether in-person authentication for MHV, and use of specific features of MHV, are associated with improved health outcomes among diabetic patients in VA.
2. Assess Veterans' user experience with MHV via usability testing.
3. Explore patient and provider experiences with MHV secure messaging via a mixed-methods approach.

METHODS:
1. Conducted an analysis of CDW data on MHV adoption and use of specific features of MHV.
2. Conducted usability testing of MHV and semi-structured interviews with patients to gain an understanding of the barriers to use of MHV, both in terms of patient preferences surrounding eHealth, and in terms of the human-computer interface.
3. Conducted semi-structured qualitative interviews with providers and patients using secure messaging. Surveyed providers using secure messaging. Analyzed message content, the intended and unintended consequences of secure messaging, and the impact on workload, workflow and patient-provider communication.



FINDINGS/RESULTS:
None to date

IMPACT:
This CDA has helped improve the VA's understanding of how to leverage its personal health record/patient portal and other patient-facing technologies to improve Veterans' and their caregivers' engagement in their healthcare and improve health outcomes. Findings have been presented at national conferences and shared with the Office of Connected Care and Veteran/Consumer Health Informatics Office.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX000759-01
Link: https://reporter.nih.gov/project-details/8201850

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PUBLICATIONS:

Journal Articles

1. Houston TK, Fix GM, Shimada SL, Long JA, Gordon HS, Pope C, Volkman J, Allison JJ, DeLaughter K, Orner M, Bokhour BG. African American Veterans Storytelling: A Multisite Randomized Trial to Improve Hypertension. Medical care. 2017 Sep 1; 55 Suppl 9 Suppl 2:S50-S58. [view]
2. Shimada SL, Petrakis BA, Rothendler JA, Zirkle M, Zhao S, Feng H, Fix GM, Ozkaynak M, Martin T, Johnson SA, Tulu B, Gordon HS, Simon SR, Woods SS. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging. Journal of the American Medical Informatics Association : JAMIA. 2017 Sep 1; 24(5):942-949. [view]
3. Mull HJ, Rosen AK, Shimada SL, Rivard PE, Nordberg B, Long B, Hoffman JM, Leecaster M, Savitz LA, Shanahan CW, Helwig A, Nebeker JR. Assessing the potential adoption and usefulness of concurrent, action-oriented, electronic adverse drug event triggers designed for the outpatient setting. EGEMS (Washington, DC). 2015 Apr 30; 3(1):1116. [view]
4. McInnes DK, Solomon JL, Shimada SL, Petrakis BA, Bokhour BG, Asch SM, Nazi KM, Houston TK, Gifford AL. Development and evaluation of an internet and personal health record training program for low-income patients with HIV or hepatitis C. Medical care. 2013 Mar 1; 51(3 Suppl 1):S62-6. [view]
5. Abel EA, Shimada SL, Wang K, Ramsey C, Skanderson M, Erdos J, Godleski L, Houston TK, Brandt CA. Dual Use of a Patient Portal and Clinical Video Telehealth by Veterans with Mental Health Diagnoses: Retrospective, Cross-Sectional Analysis. Journal of medical Internet research. 2018 Nov 7; 20(11):e11350. [view]
6. Haun JN, Lind JD, Shimada SL, Martin TL, Gosline RM, Antinori N, Stewart M, Simon SR. Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient portal system. Journal of medical Internet research. 2014 Mar 6; 16(3):e75. [view]
7. Ozkaynak M, Johnson S, Shimada S, Petrakis BA, Tulu B, Archambeault C, Fix G, Schwartz E, Woods S. Examining the Multi-level Fit between Work and Technology in a Secure Messaging Implementation. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2014 Nov 14; 2014:954-62. [view]
8. Shin MH, Sullivan JL, Rosen AK, Solomon JL, Dunn EJ, Shimada SL, Hayes J, Rivard PE. Examining the validity of AHRQ's patient safety indicators (PSIs): is variation in PSI composite score related to hospital organizational factors? Medical care research and review : MCRR. 2014 Dec 1; 71(6):599-618. [view]
9. Blok AC, Amante DJ, Hogan TP, Sadasivam RS, Shimada SL, Woods S, Nazi KM, Houston TK. Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study. Journal of general internal medicine. 2021 Mar 1; 36(3):592-599. [view]
10. Sadasivam RS, Kinney RL, Lemon SC, Shimada SL, Allison JJ, Houston TK. Internet health information seeking is a team sport: analysis of the Pew Internet Survey. International journal of medical informatics. 2013 Mar 1; 82(3):193-200. [view]
11. McInnes DK, Shimada SL, Midboe AM, Nazi KM, Zhao S, Wu J, Garvey CM, Houston TK. Patient Use of Electronic Prescription Refill and Secure Messaging and Its Association With Undetectable HIV Viral Load: A Retrospective Cohort Study. Journal of medical Internet research. 2017 Feb 15; 19(2):e34. [view]
12. Shimada SL, Hogan TP, Rao SR, Allison JJ, Quill AL, Feng H, Phillips BD, Nazi KM, Haidary ST, Houston TK. Patient-provider secure messaging in VA: variations in adoption and association with urgent care utilization. Medical care. 2013 Mar 1; 51(3 Suppl 1):S21-8. [view]
13. Shimada SL, Brandt CA, Feng H, McInnes DK, Rao SR, Rothendler JA, Haggstrom DA, Abel EA, Cioffari LS, Houston TK. Personal health record reach in the Veterans Health Administration: a cross-sectional analysis. Journal of medical Internet research. 2014 Dec 12; 16(12):e272. [view]
14. Keith McInnes D, Shimada SL, Rao SR, Quill A, Duggal M, Gifford AL, Brandt CA, Houston TK, Ohl ME, Gordon KS, Mattocks KM, Kazis LE, Justice AC. Personal health record use and its association with antiretroviral adherence: survey and medical record data from 1871 US veterans infected with HIV. AIDS and behavior. 2013 Nov 1; 17(9):3091-100. [view]
15. Wakefield BJ, Turvey CL, Nazi KM, Holman JE, Hogan TP, Shimada SL, Kennedy DR. Psychometric Properties of Patient-Facing eHealth Evaluation Measures: Systematic Review and Analysis. Journal of medical Internet research. 2017 Oct 11; 19(10):e346. [view]
16. Rodriguez HP, Glenn BA, Olmos TT, Krist AH, Shimada SL, Kessler R, Heurtin-Roberts S, Bastani R. Real-world implementation and outcomes of health behavior and mental health assessment. Journal of the American Board of Family Medicine : JABFM. 2014 May 1; 27(3):356-66. [view]
17. Haun J, Lind JD, Shimada SL, Simon SR. Secure Messaging as a tool to facilitate Veteran-provider communication. Annals of anthropological practice. 2013 Jan 1; 37(2):57-74. [view]
18. Shimada SL, Allison JJ, Rosen AK, Feng H, Houston TK. Sustained Use of Patient Portal Features and Improvements in Diabetes Physiological Measures. Journal of medical Internet research. 2016 Jul 1; 18(7):e179. [view]
19. Hogan TP, Nazi KM, Luger TM, Amante DJ, Smith BM, Barker A, Shimada SL, Volkman JE, Garvin L, Simon SR, Houston TK. Technology-assisted patient access to clinical information: an evaluation framework for blue button. JMIR research protocols. 2014 Mar 27; 3(1):e18. [view]
20. Volkman JE, Luger TM, Harvey KL, Hogan TP, Shimada SL, Amante D, McInnes DK, Feng H, Houston TK. The National Cancer Institute's Health Information National Trends Survey [HINTS]: a national cross-sectional analysis of talking to your doctor and other healthcare providers for health information. BMC family practice. 2014 Jun 6; 15(1):111. [view]
21. McInnes DK, Sawh L, Petrakis BA, Rao S, Shimada SL, Eyrich-Garg KM, Gifford AL, Anaya HD, Smelson DA. The potential for health-related uses of mobile phones and internet with homeless veterans: results from a multisite survey. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2014 Sep 1; 20(9):801-9. [view]
22. Houston TK, Volkman JE, Feng H, Nazi KM, Shimada SL, Fox S. Veteran internet use and engagement with health information online. Military medicine. 2013 Apr 1; 178(4):394-400. [view]

Conference Presentations

1. Abel EA, Shimada SL, Feng H, Skanderson M, Erdos JJ, Godleski L, Houston TK, Brandt CA. Complementary eHealth: Veterans Use of MyHealtheVet and Clinical Video Telehealth. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2014 Apr 24; Philadelphia, PA. [view]
2. Shimada SL, Petrakis BA, Zirkle BA, Rothendler JA, Ozkaynak M, Johnson S, Tulu B, Fix GM, Simon S, Gordon HS, Zhao S, Woods S. Content of Patient-Provider Secure Messages at Two Veterans Affairs Medical Centers. Paper presented at: Communication in Healthcare International Annual Conference; 2015 Oct 5; New Orleans, LA. [view]
3. McInnes DK, Fix GM, Solomon J, Shimada SL, Gifford AL, Houston TK. Feasibility of Mobile Phone Technologies to Engage Homeless Persons in Outpatient Care. Poster session presented at: American Medical Informatics Association Annual Symposium; 2013 Nov 16; Washington, DC. [view]
4. Turvey CL, Shimada S, McInnes K, Woods SS, Simon SR, Nazi K. Increasing Veteran Adoption of My HealtheVet: Collaboration between the eHealth QUERI and Operational, Clinical, and Community-based Partners. Presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; National Harbor, MD. [view]
5. Shimada SL, Feng H, Rosen AK, Allison JJ, Houston TK. Is Use of a Patient Portal Good for Your Diabetes? Paper presented at: AcademyHealth Annual Research Meeting; 2014 Jun 10; San Diego, CA. [view]
6. Shimada SL, Petrakis B, Zirkle M, Rothendler J, Zhao S, Ozkaynak M, Johnson S, Tulu B, Feng H, Fix G, Simon SR, Gordon HS, Woods S. Patient Aligned Care Team (PACT) Experiences with Secure Messaging at Two Early Adopter Facilities. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 10; Philadelphia, PA. [view]
7. Shimada SL, Volkman JE, Houston TK, Rodriguez H, Krist A, Glasgow R. Patient Responses to a Brief Patient Health Assessment: Is Non-Response a Clinical Concern? Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 4; Baltimore, MD. [view]
8. Shimada SL, McInnes DK, Petrakis BA, Quill A, Rao S, Hogan TP, Houston TK. Personal health record adoption and variations in healthcare facility characteristics: A national Veterans Health Administration evaluation. Paper presented at: AcademyHealth Annual Research Meeting; 2012 Jun 20; Orlando, FL. [view]
9. Shimada SL, Brandt CA, McInnes DK, Houston TK. Personal Health Record Adoption Varies by Diagnosis: The VA Experience. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2013 Mar 1; San Francisco, CA. [view]
10. Shimada SL, Allison JJ, Brandt CA, Rosen AK, Feng H, Rao S, Houston TK. Sociodemographic Differences in Patient Portal Adoption and Use among Veterans with Diabetes. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA. [view]
11. Atkins D, Ho M, Hogan TP, Kirsh S, Shimada SL. Technology-assisted new models of care: Implementation challenges and evaluation in the VA. Presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA. [view]

DRA: Health Systems
DRE: Technology Development and Assessment
Keywords: none
MeSH Terms: none