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Evaluation and Research for My Healthevet Personal Health Record in Veterans Health Administration

This article discusses the current evaluation efforts and opportunities for research in My Healthevet Personal Health Record (PHR) in the Veterans Health Administration. It explores strategies to promote research collaboration, addresses barriers, gaps, infrastructure, challenges, and needs, and offers potential solutions.

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Evaluation and Research for My Healthevet Personal Health Record in Veterans Health Administration

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  1. My Healthevet Personal Health Record Kim M. Nazi, FACHE Veterans Health Administration Office of Information kim.nazi@va.gov December 2008

  2. Topics • Current My Healthevet Evaluation Efforts • Opportunities for Research • Strategies to Promote Research Collaboration • Focus on Barriers, Gaps, Infrastructure, Challenges, Needs, …and Solutions

  3. Performance Evaluation Goals • Optimize program to improve veterans health care • Evidence-based knowledge to support clinical adoption • New collaborative relationships with VA Research • Agency requirements (OMB 300 Program) • Inform external partnerships (e.g., AHIC, Markle Foundation) • Contribute to field of health care informatics Inform Engage Activate

  4. Research Paradigms: EHR & PHR My Healthevet Personal Health Record (PHR) VA Electronic Health Record (EHR) • Well established policies, processes, and procedures • Accessible data infrastructure • Proven successes • Rich history • New frontier • Veteran “owns” information • Veteran controls access • Paucity of PHR research evidence • Different data sources • Lack of established policies, processes, and procedures

  5. My Healthevet www.myhealth.va.gov Website? Portal? Education Tool? E-service Gateway? Personal Health Record? VHA Program? Intervention? yes

  6. Performance Evaluation Framework *An extension of the RE-AIM Framework www.re-aim.org

  7. Performance Evaluation Framework RE-AIM • Number of registrations & visits over time • Demographic profiles of registered users • Target populations who can most benefit from use Reach Effectiveness/Efficacy Adoption Implementation Maintenance

  8. Performance Evaluation Framework RE-AIM Identify and assess key targeted outcomes: Quality (clinical outcomes) Access (utilization management) Value (cost) Satisfaction (perceptions) Reach Effectiveness/Efficacy Adoption Implementation Maintenance

  9. Performance Evaluation Framework RE-AIM • Track PHR adoption by patients & providers • Compare adoption across sites & settings • Identify how PHR tools offer clinical utility in practice Reach Effectiveness/Efficacy Adoption Implementation Maintenance

  10. Performance Evaluation Framework RE-AIM Reach Effectiveness/Efficacy Adoption Implementation Maintenance • System Availability • Cost Analysis • Component Utilization • Implementation Benchmarks • Best Practices

  11. Performance Evaluation Framework RE-AIM • Longer term impacts of targeted outcomes • (> 6 months) • Program milestones • Clinical adoption patterns • Sustainability Reach Effectiveness/Efficacy Adoption Implementation Maintenance

  12. Performance Evaluation Strategies • Web analytic tools to monitor usage patterns • Customized indicators for relevant dimensions of RE-AIM • Satisfaction surveys to measure/track satisfaction and enable direct feedback (e.g., ACSI, VHA SHEP, Pilot Surveys) • Research collaborations to address research agenda questions in scientifically rigorous studies • Dissemination of results • Program optimization based on evaluation results 12

  13. Performance Evaluation Roadmap Purpose: provide a comprehensive guide to potential evaluation strategies that are appropriate for each phase in the development of a new feature, service, or content area. It is intended that the roadmap should be used as a tool to support a customized approach for designing a strategic evaluation of new features and services leading to a consistent, comprehensive, and effective approach to evaluation.

  14. Performance Evaluation Strategies

  15. Performance Evaluation Strategies • Solicit direct stakeholder input on needs and preferences • Solicit input from technical, clinical, and organizational subject matter experts to inform requirements • Conduct environmental scan • Define requirements for metrics and reports • Define web analytics • Define success criteria • Conduct Table Top Exercises • Conduct usability testing with task driven scenarios

  16. Performance Evaluation Strategies • Track initial usage using web analytics • Validate metrics and reports • Solicit stakeholder feedback through surveys, focus groups, personal interviews • Evaluate education, training, and communication support products • Continue usability testing • Clinical adoption • Evaluation feedback repository • Testing issues repository

  17. Performance Evaluation Strategies • Apply RE-AIM Framework • Track usage using web analytics • Measure stakeholder satisfaction with standardized tools • Develop a prioritized research agenda • Feature specific metrics and reports • Utilize custom surveys for feature-specific assessments

  18. Performance Evaluation Strategies • Support research collaboration to generate evidence-based findings • Monitor feedback channels to identify product enhancements • Monitor satisfaction using standardized methods and tools • Evaluate success criteria • Indentify new requirements • Develop effective channels for knowledge sharing and innovation

  19. Connecting Operations & Research • Effective collaboration to produce evidence-based knowledge to inform program optimization: • Focus on research agenda priorities • Create effective processes for collaboration • Align with existing methods for solicitation, approval, monitoring, compliance, and support • Ensure operational program office support for studies • Identify and address relevant policy needs • Define and implement technical infrastructure to support appropriate data access strategies

  20. Research Opportunities How are veterans are using MHV and how does use enhance “access”? (Reach/Adoption) What are the reasons for non-adoption and barriers to use? (Adoption) Does use of MHV translate into outcomes? (Efficacy) How can the program keep users engaged and connected? (Maintenance) What is the impact of e-services on bricks and mortar operations (e.g., does secure messaging decrease telephone workload?) (Implementation)

  21. Strategies to Promote Collaboration Multidisciplinary Performance Evaluation Workgroup Strong collaboration for current studies Development of a RE-AIM based research agenda Development of an Evaluation Roadmap My Healthevet Research SharePoint Site My Healthevet Research Interest Teleconferences Consultation with Health Data and Informatics and Privacy Office subject matter experts Environmental scan of PHR research policy Workshops (HSR&D 2/08, QUERI 12/08)

  22. You Are Here!

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