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Personal health record adoption and variations in healthcare facility characteristics: A national Veterans Health Administration evaluation.

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.

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online patient portal and personal health record (PHR), "My HealtheVet" (MHV). MHV provides veterans trusted health information, functions for self-entered health information, access to lab results, appointment views, and ability to refill medications and secure message with their healthcare provider. We sought to understand whether structural and cultural characteristics of clinical facilities were associated with patient adoption. Study Design: Cross-sectional analysis, linking survey responses with data on MHV adoption. Population Studied: Patient adoption begins with an online registration. Veterans then complete a one-time in-person authentication for full access to features. Each VA healthcare facility has a full-time funded internal facilitator, a MHV Coordinator, to support adoption. These MHV coordinators work directly with patients at the point of care and train other clinical staff to facilitate the MHV adoption process. In June 2011, we fielded a 12-page survey to MHV coordinators at in-person national training sessions, with follow-up mailings to all coordinators unable to attend. The survey included information about the MHV Coordinator and their facility. We asked questions regarding the facility resources (access to computers for MHV coordinators and veterans), and culture (support of staff and facility leadership). We linked this survey dataset to facility-level data on local MHV adoption rates, calculated as the ratio of number of veterans fully adopting (in-person authenticated) MHV to the number of unique outpatients seen at the facility between October 2010 - September 2011. Principal Findings: All 145 coordinators were asked to participate; 104 (72%) both completed the survey and identified their facility. Forty-four percent of coordinators have a B.A., R.N. or N.P. degree, 80% have held previous positions at the VA, and 73% have been coordinators less than one year. All MHV coordinators reported access to a computer for themselves. Computers in multiple locations improved the median adoption rate; 2.6% for 1 or 2 locations, 3.6% for 3 or more locations (P = 0.07 for Kruskal-Wallis). The median adoption rates varied by placement of computers: 2.6% for library, 2.9% for lobby or waiting area, 3.1% for computer room or other location, and 3.2% for a dedicated MHV room. Perceived level of support by staff was not associated with rates of adoption. Perceived lack of support by facility senior management is negatively associated with adoption rates. For the 4 items regarding senior management's understanding and support of the coordinator's job responsibilities, we counted the number of items where the respondent rated leadership support as poor. Facilities with two to four poor ratings had a median authentication rate of 1.8%, those with one or no poor ratings, 2.7% (P = 0.08 for Kruskal-Wallis). Conclusions: The number and types of locations in the healthcare facility with veteran-accessible computers were associated with adoption rates. Negative perceptions of senior management's understanding and support of the MHV program and the coordinator's responsibilities were a barrier. Implications for Policy, Delivery or Practice: Patient portals are an important component of 21st Century patient-centered healthcare. When promoting portals,healthcare institutions need to assure leadership support, and understand that in-facility computer access may support adoption. Funding Source(s): VA

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