VAs PHR and Portal Not Reaching High-Priority Vets
Though millions of U.S. veterans have registered for the My HealtheVet personal health record and patient portal developed by the Veterans Health Administration, opportunities are being missed for those with specific medical conditions that require intensive treatment and self-management.
That is the conclusion of a study just published online by the Journal of Medical Internet Research, which states that little is known about how a patients health status may affect adoption and use of the personal health record. The aim of the study was to characterize the reach of the VA personal health record by clinical condition.
Researchers compared adoption (registration, authentication, opt-in to use secure messaging) and use (prescription refill and secure messaging) of My HealtheVet in April 2012 across 18 specific clinical conditions prevalent in and of high priority to the VA. Nationwide, 18.64 percent had registered for MHV, 11.06 percent refilled prescriptions via MHV, and 1.91 percent used secure messaging with their clinical providers.
Results from the multivariable regression suggest that patients with HIV, hyperlipidemia, and spinal cord injury had the highest predicted probabilities of adoption, whereas those with schizophrenia/schizoaffective disorder, alcohol or drug abuse, and stroke had the lowest, states the study. Variation was observed across diagnoses in actual (unadjusted) adoption and use, with registration rates ranging from 29.19 percent of patients with traumatic brain injury to 14.18 percent of those with schizophrenia/schizoaffective disorder. Some of the variation in actual reach can be explained by facility-level differences in MHV adoption and by differences in patients socio-demographic characteristics (e.g., age, race, income) by diagnosis.
Among more than 6 million VA patients nationwide, 81.38 percent had one or more of the 18 target conditions and 18.62 percent had none of the 18 conditions. The most prevalent specific clinical conditions were hypertension (56.63 percent), hyperlipidemia (55.69 percent), diabetes (24.71 percent), and depression (24.68 percent). The least prevalent conditions were spinal cord injury (0.43 percent), HIV (0.45 percent), and TBI (1.40 percent).
Although adoption remained low (less than 30 percent registered and 17 percent authenticated in April 2012) for each specific clinical condition, certain groups, such as younger patients with mental illness, may be more ready for and receptive to targeted interventions delivered through a PHR, according to researchers. Understanding the level of adoption and the types of use among patients with the most prevalent clinical conditions can help with prioritizing the development of eHealth tools with the potential to improve self-management and further engage a given patient subgroup.
Results of a similar study released earlier this year revealed that veterans perceive secure messaging in the My HealtheVet patient portal as a useful tool for communicating with healthcare teams. However, to maximize sustained utilization of secure messaging, the study concluded that marketing, education, skill building, and system modifications are needed.