United States Patient portal

At the US Department of Veterans Affairs, the initial PHR prototype offered military veterans a “virtual window” into their health record. The My HealtheVet Pilot afforded a unique opportunity for patients to access their complete health records, including primary care and specialty notes, discharge summaries, and laboratory and imaging results.

The Centers for Medicare & Medicaid Services and the Department of Veterans Affairs are carrying out major new pilots to test various aspects of personal health records with their constituencies. In June 2007, CMS announced a new project (Registration Summary/Medication History PHR) http://www.cms.hhs.gov/perheal threcords/ expanding its efforts to encourage Medicare beneficiaries to take advantage of Internet-based tools to track their health care services and to provide them with resources to better communicate with their providers. This pilot program is intended to enable certain beneficiaries to use a PHR provided through participating health plans, accessible through http://www.mymedicare.gov. The Centers for Medicare & Medicaid Services launched the program in conjunction with four health plans to test the use of their PHRs. The plans are HIP USA, Humana, Kaiser Permanente, and the University of Pittsburgh Medical Center. Each plan has a unique PHR tool that will be accessible to beneficiaries. The availability of different tools is expected to provide valuable information to The Centers for Medicare & Medicaid Services on the various features offered, including which are most popular and useful to the individual.

The Department of Veterans Affairs is testing My HealtheVet Pilot, http://www.healthevet.va.gov/ a prototype developed to demonstrate that the agency can provide veterans with a safe, secure, and private electronic copy of their own the Department of Veterans Affairs health information through a web environment.

Pilot registrants can obtain copies of key portions of their electronic health records; add structured medical data in the “self-entered” section of the record; track personal health metrics (blood pressure, weight, etc.); access health education materials; and grant access to their health information to family members and Veterans Affairs and non- Veterans Affairs health providers.

Between 2000 and 2010, nine VA facilities in Oregon, Florida, New York, and Washington, DC, recruited 7464 patients to enroll in the My HealtheVet Pilot. An enrolled patient completing in-person identity proofing could access clinic notes, hospital discharge notes, problem lists, vital signs, medications, allergies, appointments, and laboratory and imaging test results. Users could also manually enter personal data (eg, blood pressure, blood sugar, weight), access educational content, and authorize others to use the PHR on their behalf. Secure email with providers was not yet available through the PHR prototype.

The Veterans Health Administration has been addressing these challenges through technological innovations including the implementation of Clinical Video Telehealth, two-way interactive and synchronous videoconferencing between a provider and a patient, and an electronic patient portal and personal health record, My HealtheVet.

The US Department of Veterans Affairs Health Administration has been a leader nationally through its deployment of several health information technologies, including an integrated electronic medical record, Home Telehealth (in-home, messaging, and peripheral devices such as blood pressure and heart rate monitors), mobile health apps, Clinical Video Telehealth, and an integrated Web-based personal health record and patient portal, My HealtheVet. These patient-facing technologies are consistent with recommendations by the Institute of Medicine to support continuous healing relationships through use of the internet and technologies that provide patients with access to care outside of face-to-face visits, and access to their medical information, when and where they need it most. They also offer unique ways for patients and providers to communicate in addition to or in lieu of traditional face-to-face encounters.

 The concept of complementary use of health care technology (the use of features and functionality of two different technologies in conjunction with one another) is a way of enhancing access to care and supporting patient-centered care by supporting communication, information sharing, and increasing patient involvement in their care.

The integration of technologies in a complementary way has the potential to increase veterans’ access to care and improve the quality of delivered care. Dual use of technologies (veteran adoption and use of more than one technology at any point) may be a precursor to complementary use. For example, veterans who have adopted the My HealtheVet portal and have engaged in Clinical Video Telehealth might be willing or inclined to use both tools in a complementary way.

My HealtheVet and Clinical Video Telehealth

My HealtheVet and Clinical Video Telehealth are two established virtual care technologies in the Veterans Affairs Health Administration. Over a decade ago, the Veterans Affairs Health Administration launched its Web-based personal health record and patient portal, My HealtheVet, to complement traditional health care services, to improve comanaged care, and to promote active engagement of patients and their families in the patient’s health care.

The My HealtheVet portal allows users to create and maintain a comprehensive personal health record by using a range of My HealtheVet features, including secure messaging, Web-based prescription refills, access to information in their Veterans Affairs Health Administration health record (laboratory results, clinical progress notes, discharge summaries, and medication lists), and tracking of personal and self-reported health information using a variety of tools (food, activity and allergy journals, family health history, and other data).

Access to features depends on the type of My HealtheVet enrollment and account type. My HealtheVet registration creates a basic account that provides access to the My HealtheVet self-report features (ie, self-entered information or journals). An advanced account is limited to veterans and/or Veterans Affairs Health patients and gives these users the ability to refill prescriptions and to view some of their information in their health records.

A premium account, also only for veterans or Veterans Affairs Health patients, is the highest level of My HealtheVet access and requires users to verify their identity either in-person or on the Web, a process known as authentication. In addition to using My HealtheVet to view many parts of their Veterans Affairs Health health record and Department of Defense Military Service Information, premium users can send secure messages to communicate with their health care providers and health care teams.

As of July 2018, of the 4.45 million who registered (since November2004), about 3.9 million indicated they were veterans. Of the 4.45 million registrants, about 2.74 million have authenticated since January 1, 2007.

The Veterans Affairs Health has also expanded access to health care through a range of telehealth services, including Clinical Video Telehealth which is two-way interactive and synchronous videoconferencing between a provider and a patient at a distance in settings such as a Veterans Affairs Health medical center and a community clinic or home. Clinical Video Telehealth is available across a range of medical and mental health specialties.

Unlike My HealtheVet, a Web app, access to Clinical Video Telehealth is less ubiquitous for two primary reasons:

1. clinicians refer patients and place consults to Clinical Video Telehealth programs (patients may not be able to self-refer)
2. Clinical Video Telehealth programs that do exist are not available to every veteran, everywhere. Some programs are regional—they emanate from a regional medical center or hub and provide remote specialty services to clinics that are closer to a veteran’s home, thus reducing travel time and time away from work or family. A few programs provide services across state lines, although to specific sites (the provider and veteran must be located in a federal facility), and some programs provide Clinical Video Telehealth into the home.