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My HealtheVet (MHV) is the personal health record and patient portal developed by the United States Veterans Health Administration (VA). While millions of American veterans have registered for MHV, little is known about how a patient's health status may affect adoption and use of the personal health record.
Our aim was to characterize the reach of...
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Context 1
... varied significantly by condition. Table 2 shows the unadjusted breakdown of PHR adoption and use by specific clinical conditions, reflecting actual adoption and use across the VA. Unadjusted adoption was generally higher among patients with trauma-related diagnoses, mood disorders, and posttraumatic stress disorder (PTSD). ...
Citations
... Users of VHA's patient portal are often more educated, younger, and have higher income than the general Veteran population. 37,38 In addition, as is typical with the overall Veteran population, our sample was mostly male, and therefore may not be representative of non-Veterans within the general US population. Finally, we are unable to assess the temporal impact of surveying Veterans among this cohort during the COVID-19 pandemic. ...
Digital health devices (DHDs), technologies designed to gather, monitor, and sometimes share data about health-related behaviors or symptoms, can support the prevention or management of chronic conditions. DHDs range in complexity and utility, from tracking lifestyle behaviors (e.g., pedometer) to more sophisticated biometric data collection for disease self-management (e.g., glucometers). Despite these positive health benefits, supporting adoption and sustained use of DHDs remains a challenge.
This analysis examined the prevalence of, and factors associated with, DHD use within the Veterans Health Administration (VHA).
National survey.
Veterans who receive VHA care and are active secure messaging users.
Demographics, access to technology, perceptions of using health technologies, and use of lifestyle monitoring and self-management DHDs.
Among respondents, 87% were current or past users of at least one DHD, and 58% were provided a DHD by VHA. Respondents 65 + years were less likely to use a lifestyle monitoring device (AOR 0.57, 95% CI [0.39, 0.81], P = .002), but more likely to use a self-management device (AOR 1.69, 95% [1.10, 2.59], P = .016). Smartphone owners were more likely to use a lifestyle monitoring device (AOR 2.60, 95% CI [1.42, 4.75], P = .002) and a self-management device (AOR 1.83, 95% CI [1.04, 3.23], P = .037).
The current analysis describes the types of DHDs that are being adopted by Veterans and factors associated with their adoption. Results suggest that various factors influence adoption, including age, access to technology, and health status, and that these relationships may differ based on the functionalities of the device. VHA provision of devices was frequent among device users. Providing Veterans with DHDs and the training needed to use them may be important factors in facilitating device adoption. Taken together, this knowledge can inform future implementation efforts, and next steps to support patient-team decision making about DHD use.
... 8,13 The functionality of MHV has expanded over time, enhancing the usability and adding tools that promote self-management. 14 Patients engaged in VA care who are living with HIV have shown some of the highest rates of MHV adoption, 15 and recent research shows that 49% of these patients have registered for MHV. 16 Given the primary aim of this study was to examine the relationships between specific portal tool use and healthrelated outcomes in PLWH, we opted not to extend the observed cohort into the COVID-19 pandemic time-period. ...
Patient portals play an increasingly critical role in engaging patients in their health care. They have the potential to significantly impact the health of those living with chronic diseases, such as HIV, for whom consistent care engagement is both critical and complex.
The primary aim was to examine the longitudinal relationships between individual portal tool use and health-related outcomes in patients living with HIV.
Retrospective cohort study using electronic health record data to examine the relationship between patient portal tool use and key HIV-specific, health-related outcomes in patients engaged in care in the Veterans Health Administration (VA) through the application of marginal structural models.
A national sample of patients living with HIV (PLWH) active in VA care who were registered to use the VA’s patient portal, My HealtheVet (MHV; n = 18,390) between 10/1/2012 and 4/1/2017.
The MHV tools examined were prescription refill (including prescription refill of an antiretroviral (ART) medication and any medication), secure messaging, view appointments, and view labs. Primary outcomes were viral load test receipt, viral load suppression, and ART medication adherence (measured as proportion of days covered).
The use of prescription refill for any medication or for ART was positively associated with ART adherence. Secure messaging was positively associated with ART adherence but not with viral load test receipt or viral load suppression. The use of view appointments was positively associated with ART adherence and viral load test receipt but not viral load suppression. The use of view labs was positively associated with viral load suppression but not ART adherence or viral load test receipt.
These findings highlight the valuable role patient portals may play in improving health-related outcomes among PLWH and have implications for patients living with other types of chronic disease.
... Since the expansive use of digital health has impacted healthcare overall, the utilization of digital health is limited in minority populations due to a variety of reasons that include limited internet access, poor digital literacy, and myths spread about electronic medical records amongst these communities. MiVIA, MyChart-MyHealth, myHERO and MyHealtheVet are some examples of software HIT applications that have been implemented to support the needs of the underserved communities [8][9][10]. ...
The rapid development of digital health technology has transformed the current medical practice. However, lack of consideration for underserved groups during design process can exacerbate the existing health disparities, lead to unequal access to health care information and potentially worsen the health outcome. Our study aims to address these issues by providing insights of digital health design to improve health outcome among underserved communities.
This review paper studies the primary literature of health applications/tools that designed for underserved communities. Following PRISMA guideline, we performed a scoping review by searching published articles in five databases between January 1990 to October 2023.
Eighteen articles were included in final review. Six main themes were identified by evaluating the functionalities of reviewed health applications/tools. These themes are feature categorization, user-centered design, iteration, messaging service, behavior change technique, and interactivity.
Our review suggests that designing health applications that are inclusive and accessible for diverse populations can better address health disparities issues. It is important that government, research institutions and industry should work together to advance application design and close the gap for health disparities.
... Qualitative methods were used to identify determinants of the acceptance and use of the Veteran Health Administration's (VA) tethered PHR, My HealtheVet, among providers of HIV care, veterans living with HIV, and relevant PHR coordinating and support staff. Veterans living with HIV are a proportionally large group of VA PHR users compared with veterans living with other chronic conditions [25], and thus are well positioned to provide insight into patients and their providers' experiences engaging with the PHR. ...
Use of tethered personal health records (PHRs) can streamline care, reduce unnecessary care utilization, and improve health outcomes for people living with human immunodeficiency virus (HIV). Providers play a role in influencing patients' decision to adopt and use PHRs. To explore patient and provider acceptance and use of PHRs in an HIV care setting. We used a qualitative study design guided by the Unified Theory of Acceptance and Use of Technology. Participants included providers of HIV care, patients living with HIV, and PHR coordinating and support staff in the Veterans Health Administration (VA). Interviews were analyzed using directed content analysis. We interviewed providers (n = 41), patients living with HIV (n = 60), and PHR coordinating and support staff (n = 16) at six VA Medical Centers between June and December 2019. Providers perceived PHR use could enhance care continuity, appointment efficiency, and patient engagement. Yet, some expressed concerns that patient PHR use would increase provider workload and detract from clinical care. Concerns about poor PHR interoperability with existing clinical tools further eroded acceptance and use of PHRs. PHR use can enhance care for patients with HIV and other complex, chronic conditions. Negative provider attitudes toward PHRs may impact providers' encouragement of use among patients, consequently limiting patient uptake. Multipronged interventions at the individual, institutional, and system level are needed to enhance PHR engagement among both providers and patients.
... The veterans who compose the VET-C cohort were also intentionally sampled because they were users of another VHA patient-facing technology, the health care system's patient portal. In addition to potentially being more likely to use technology, previous research has indicated that veterans who use the VHA's portal are more educated, younger, and have higher income than the overall veteran population [39,40], which could limit the generalizability of our findings to the overall veteran population. It is important to note, however, that to ensure the privacy and security of user's health data, many of the VHA's mobile apps require veterans to sign in through a secure sign-in partner, the options for which include a DS Logon Level 2 (Premium), ID.me, or My HealtheVet Premium account. ...
Background
Despite their prevalence and reported patient interest in their use, uptake of health-related apps is limited. The Veterans Health Administration (VHA) has developed a variety of apps to support veterans; however, uptake remains low nationally.
Objective
We examined the prevalence of VHA health-related app use and how veterans learned about these apps in order to identify factors associated with their use.
Methods
As part of a VHA quality improvement initiative, we recruited a national cohort of veterans to obtain feedback on their use of technology for health and collected data from them via a cross-sectional survey. The survey data were supplemented with VHA administrative data. We used descriptive statistics to examine demographic and health characteristics, health-related technology use, and how veterans learned about apps. We assessed factors associated with app use using bivariate analyses and multiple logistic regression models.
Results
We had complete data on 1259 veterans. A majority of the sample was male (1069/1259, 84.9%), aged older than 65 years (740/1259, 58.8%), White (1086/1259, 86.3%), and non-Hispanic (1218/1259, 96.7%). Most respondents (1125/1259, 89.4%) reported being very comfortable and confident using computers, over half (675/1259, 53.6%) reported being an early adopter of technology, and almost half (595/1259, 47.3%) reported having used a VHA health-related app. Just over one-third (435/1259, 34.6%) reported that their VHA care team members encouraged them to use health-related apps. Respondents reported learning about available VHA health-related apps by reading about them on the VHA’s patient portal (468/1259, 37.2%), being told about them by their VHA health care team (316/1259, 25.1%), and reading about them on the VHA’s website (139/1259, 11%). Veterans who self-reported having used VHA health-related apps were more likely to receive care at the VHA (OR [odds ratio] 1.3, 95% CI 1.0-1.7), be in worse health (as assessed by Hierarchical Condition Community score; OR 1.1, 95% CI 1.0-1.2), report owning a desktop or laptop computer (OR 1.8, 95% CI 1.1-3.1), have posttraumatic stress disorder (OR 1.4, 95% CI 1.1-1.9), and report having VHA health care team members encourage them to use the apps (OR 2.7, 95% CI 2.1-3.4).
Conclusions
We found strong associations between self-reported use by veterans of VHA health-related apps and multiple variables in our survey. The strongest association was observed between a veteran self-reporting app use and having received encouragement from their VHA health care team to use the apps. Veterans who reported receiving encouragement from their VHA care team members had nearly 3 times higher odds of using VHA apps than veterans who did not report receiving such encouragement. Our results add to growing evidence suggesting that endorsement of apps by a health care system or health care team can positively impact patient uptake and use.
... Additionally, our participants comprised a purposefully selected sample of Veterans who were users of VA's patient portal, whom research indicates are more educated, who are younger, and who have higher income than the overall Veteran population. 25,26 These Veterans may be a more "activated" and engaged group, and thus, the rate of discussing goals with providers and setting goals may be lower in the overall population, as compared to this sample. Although reflective of the overall Veteran population, our sample was comprised of more men than women, which may impact external validity of the results. ...
Background
There is increasing recognition of the importance of supporting patients in their health-related goals. Patient-provider discussions and health-related mobile applications (apps) can support patients to pursue health goals; however, their impact on patient goal setting and achievement is not well understood.Objective
To examine the relationships between the following: (1) patient demographics, patient-provider discussions, and health-related goal setting and achievement, and (2) patient mobile health app use and goal achievement.DesignCross-sectional survey.ParticipantsVeterans who receive Veterans Health Administration (VA) healthcare and are users of VA patient-facing technology.Main MeasuresVeteran demographics, goal-related behaviors, and goal achievement.Methods
Veterans were invited to participate in a telephone survey. VA administrative data were linked to survey data for additional health and demographic information. Logistic regression models were run to identify factors that predict health-related goal setting and achievement.Key ResultsAmong respondents (n=2552), 75% of patients indicated having set health goals in the preceding 6 months and approximately 42% reported achieving their goal. Men (vs. women) had lower odds of setting goals (OR: 0.71; CI95: 0.53–0.97), as did individuals with worse (vs. better) health (OR: 0.18; CI95: 0.04–0.88). Individuals with advanced education—some college/college degrees, and post-college degrees (vs. no college education)—demonstrated higher odds of setting goals (OR: 1.35; CI95: 1.01–1.79; OR: 1.71; CI95: 1.28–2.28, respectively). Those who reported having discussed their goals with their providers were more likely to set goals (OR: 3.60; CI95: 2.97–4.35). Patient mobile health app use was not statistically associated with goal achievement.Conclusions
Efforts to further promote patient-led goal setting should leverage the influence of patient-provider conversations. Use of patient-facing technologies, specifically mobile health apps, may facilitate goal-oriented care, but further work is needed to examine the potential benefits of apps to support patient goals, particularly if providers discuss and endorse use of those apps with patients.
... As of 2017, 49% of veterans with HIV have registered for MHV, and previous research of MHV reach in the VHA has found that veterans living with HIV have the highest levels of adoption (along with veterans with hyperlipidemia and spinal cord injury). 8,9 However, there is some evidence that some subgroups of patients are not reached by PHRs. A previous study among veterans living with HIV has described disparities in PHR adoption by race/ethnicity, with Black and Hispanic/Latinx veterans having lower rates of registration and utilization than White veterans. ...
... This is consistent with previous findings that depression and bipolar disorder were associated with increased PHR adoption. 8,[29][30][31] In contrast, veterans with SUD and AUD had lower rates of PHR use, especially Rx Refill. These conditions are known barriers to HIV care, ART adherence, and viral suppression. ...
Objective
We examined correlates of registration and utilization of the Veteran Health Administration’s (VHA) personal health record (PHR), My HealtheVet (MHV), among a national cohort of veterans living with HIV.
Materials and Methods
Using VHA administrative data, we matched veterans with HIV who registered for MHV in fiscal year 2012–2018 (n = 8589) to 8589 veterans with HIV who did not register for MHV. We compared demographic and geographic characteristics, housing status, comorbidities, and non-VHA care between MHV registrants and nonregistrants to identify correlates of MHV registration. Among registrants, we examined the association between these characteristics and MHV tool use (prescription refill, record download, secure messaging, view labs, and view appointments).
Results
MHV registrants were more likely to be younger, women, White, and to have bipolar disorder, depression, or post-traumatic stress disorder diagnosis than nonregistrants. Having a substance use disorder (SUD) diagnosis or a higher Elixhauser score was associated with lower odds of MHV registration. Among registrants, women were less likely to use prescription refill. Patients who were at risk of homelessness in the past year were less likely to use secure messaging and, along with those who were homeless, were less likely to use view labs and prescription refill. Bipolar disorder and depression were associated with increased secure messaging use. Diagnoses of SUD and alcohol use disorder were both associated with lower rates of prescription refill.
Discussion
Among veterans living with HIV, we identified significant differences in PHR registration and utilization by race, sex, age, housing status, and diagnosis.
... We found those who accessed their notes differed sociodemographically from those who did not. While recent OpenNotes literature suggests racial minority and less educated patients are more likely to value and benefit from access to clinical notes online, 26,27 white patients are more likely to access portals 24,34,35 and to view their notes online. 25 Older patients, men, and those socioeconomically disadvantaged are less likely to use portals. ...
... 25 Older patients, men, and those socioeconomically disadvantaged are less likely to use portals. 35,34 Although the digital divide has narrowed in recent years for the elderly and lower income patients, who are among the fastest growing subset of Internet users, 36,37 our work has further confirmed a digital divide even among portal-using patients. ...
Background
In an effort to foster patient engagement, some healthcare systems provide their patients with open notes, enabling them to access their clinical notes online. In January 2013, the Veterans Health Administration (VA) implemented online access to clinical notes (“VA Notes”) through the Blue Button feature of its patient portal.Objective
To measure the association of online patient access to clinical notes with changes in healthcare utilization and clinician documentation behaviors.DesignA retrospective cohort study.PatientsPatients accessing My HealtheVet (MHV), the VA’s online patient portal, between July 2011 and January 2015.Main MeasuresUse of healthcare services (primary care clinic visits and online electronic secure messaging), and characteristics of physician clinical documentation (readability of notes).Key ResultsAmong 882,575 unique portal users, those who accessed clinical notes (16.2%; N = 122,972) were younger, more racially homogenous (white), and less likely to be financially vulnerable. Compared with non-users, Notes users more frequently used the secure messaging feature on the portal (mean of 2.6 messages (SD 7.0) v. 0.87 messages (SD 3.3) in January–July 2013), but their higher use of secure messaging began prior to VA Notes implementation, and thus was not temporally related to the implementation. When comparing clinic visit rates pre- and post-implementation, Notes users had a small but significant increase in rate of 0.36 primary care clinic visits (2012 v. 2013) compared to portal users who did not view their Notes (p = 0.01). At baseline, the mean reading ease of primary care clinical notes was 53.8 (SD 10.1) and did not improve after implementation of VA Notes.ConclusionsVA Notes users were different than patients with portal access who did not view their notes online, and they had higher rates of healthcare service use prior to and after VA Notes implementation. Opportunities exist to improve clinical note access and readability.
... Some participants pointed out that the system will be useful when it allows them to book walk-in appointments, communicate with their doctors, and select the required doctor. As Patient Online currently enables patients to choose the required doctor, developers should consider adding these services, which are provided by many ePHRs (eg, MyChart, MyHealtheVet, Patient Gateway) [46,66,77]. Furthermore, users of such systems should be informed and reassured about the different security measures that are in place (eg, strong firewalls, encouragement to use complex and long passwords), and it should be made clear that the provision of GP online services is strictly controlled by legislation to safeguard personal data. ...
Background
General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients’ adoption and implementation success of the system, it is important to understand the factors affecting their use of the system.
Objective
The aim of this study is to explore patients’ perspectives of factors affecting their use of ePHRs in England.
Methods
A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis.
Results
Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants’ responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online.
Conclusions
The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.
... The Centers for Medicare and Medicaid Service Meaningful Use requirement has made SM a common feature of patient portals and tethered personal health records across many health care systems [4,[14][15][16]. In 2004, the Veterans Health Administration (VHA) implemented My HealtheVet (MHV), an online patient portal and personal health record that has an SM feature to support communication between patients and their VHA clinical team members [17,18]. ...
BACKGROUND
Although secure messaging (SM) between patients and clinical team members is a recommended component of continuous care, uptake by patients remains relatively low. We designed a multicomponent supported adoption program (SAP) to increase SM adoption among patients using the Veterans Health Administration (VHA) for primary care.
OBJECTIVE
Our goals were to 1) conduct a multi-site randomized encouragement design trial to test the effectiveness of a SAP designed to increase patient engagement with SM through VHA’s online patient portal (My HealtheVet, MHV), and 2) evaluate the impact of the SAP and patient-level SM adoption on perceived provider autonomy support and communication. Patient-reported barriers to SM adoption were also assessed.
METHODS
We randomized 1,196 patients at three VHA facilities who had MHV portal accounts but had never used SM. Half were randomized to receive the SAP and half served as controls receiving usual care. The SAP consisted of encouragement to adopt SM via mailed educational materials, proactive SM sent to patients, and telephone-based motivational interviews (MIs). We examined differences in SM adoption rates between SAP recipients and controls at 9 and 21 months. Follow-up telephone surveys were conducted to assess perceived provider autonomy support and self-report of telephone communication with clinical teams.
RESULTS
Patients randomized to the SAP had significantly higher rates of SM adoption than the control group (101/595, 17% vs 40/601, 7% respectively). Most adopters in the SAP sent their first message without a motivational interview (71/101, 70%). The 10-percentage point difference in adoption persisted a full year after the encouragement ended (24% vs. 14% in the control group). We obtained follow-up survey data from 49% (592/1,196) of the participants. SAP participants reported higher perceived provider autonomy support (5.7 vs 5.4) and less telephone use to communicate with their provider (69% vs 76%), compared to patients in the control group. Patient-reported barriers to SM adoption included self-efficacy (e.g. not comfortable using a computer) (24%), no perceived need for SM (22%), and difficulties with portal password/login (17%).
CONCLUSIONS
The multicomponent SAP was successful in increasing use of SM ten percentage points above standard care; new SM adopters reported improved perceptions of provider autonomy support and less use of the telephone to communicate with their providers. Still, despite the encouragement and technical assistance provided through the SAP, adoption rates were lower than anticipated, reaching only 24% at 21 months (10% above controls). Common barriers to adoption such as limited perceived need for SM may be more challenging to address and require different interventions than barriers related to patient self-efficacy or technical difficulties.
CLINICALTRIAL
ClinicalTrials.gov Identifier: NCT02665468
