Skip to main content

Advertisement

SpringerLink
Log in

Promoting Access Through Complementary eHealth Technologies: Recommendations for VA’s Home Telehealth and Personal Health Record Programs

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

Many healthcare organizations have embraced eHealth technologies in their efforts to promote patient-centered care, increase access to services, and improve outcomes.

OBJECTIVE

Using the Department of Veterans Affairs (VA) as a case study, this paper presents two specific eHealth technologies, the Care Coordination Home Telehealth (CCHT) Program and the My HealtheVet (MHV) personal health record (PHR) portal with integrated secure messaging, and articulates a vision of how they might be implemented as part of a patient-centric healthcare model and used in a complementary manner to enhance access to care and to support patient-centered care.

METHODS

Based on our experience and ongoing work with both programs, we offer a series of recommendations for pursuing and ultimately achieving this vision.

CONCLUSION

VA’s CCHT and MHV programs are examples of an expanding repertoire of eHealth applications available to patients and healthcare teams. VA’s new patient-centric healthcare model represents a significant shift in the way that services are delivered and a profound opportunity to incorporate eHealth technologies like the CCHT and MHV programs into clinical practice to increase access to care, and to ensure the responsiveness of such technologies to the preferences and circumstances of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Eysenbach G. What is e-health? J Med Internet Res. 2001;3(2):e20.

    Article  PubMed  CAS  Google Scholar 

  2. Calabretta N. Consumer-driven, patient-centered health care in the age of electronic information. J Med Libr Assoc. 2002;90(1):32–7.

    PubMed  Google Scholar 

  3. Klein-Fedyshin M. Consumer health informatics—integrating patients, providers, and professionals online. Med Ref Serv Q. 2002;21(3):35–50.

    Article  PubMed  Google Scholar 

  4. Ball MJ, Lillis J. E-health: transforming the physician/patient relationship. Int J Med Inform. 2001;61(1):1–10.

    Article  PubMed  CAS  Google Scholar 

  5. Tang PC, Lansky D. The missing link: bridging the patient-provider health information gap. Health Aff. 2005;24(5):1290–1295.

    Article  Google Scholar 

  6. Ralston JD, Martin DP, Anderson ML, Fishman PA, Conrad DA, Larson EB, Grembowski D. Group health cooperative’s transformation toward patient-centered access. Med Care Res Rev. 2009;66(6):703–24.

    Article  PubMed  Google Scholar 

  7. Liederman EM, Lee JC, Baquero VH, Seites PG. The impact of patient-physician Web messaging on provider productivity. J Healthc Inf Manag. 2005;19(2):81–6.

    PubMed  Google Scholar 

  8. Liederman EM, Lee JC, Baquero VH, Seites PG. Patient-physician web messaging The impact on message volume and satisfaction. J Gen Intern Med. 2005;20(1):52–7.

    Article  PubMed  Google Scholar 

  9. Kaelber DC, Shah S, Vincent A, Pan E, Hook JM, Johnston D, Bates DW, Middleton B. The value of personal health records. Charlestown: Center for Information Technology Leadership; 2008.

    Google Scholar 

  10. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001.

    Google Scholar 

  11. Fortney J. A re-conceptualization of access for 21st century healthcare. Oral presentation given to the VA Health Services Research & Development Service Timely Topics of Interest Cyber Seminar Series; 2010 Aug.

  12. Fortney J. Access to VA health care in the digital age. Health services research and development forum. 2010;5:8.

    Google Scholar 

  13. Ahern DK, Woods SS, Lightowler MC, Finley SW, Houston TK. Promise of and potential for patient-facing technologies to enable meaningful use. Amer J Prev Med. 2011;40(5S2):S162–S172.

    Article  Google Scholar 

  14. Greenhalgh T, Hinder S, Stramer K, Bratan T, Russell J. Adoption, non-adoption, and abandonement of a personal electronic health record: case study of HealthSpace. Brit Med J. 2010;341:c5814.

    Article  PubMed  Google Scholar 

  15. Department of Veterans Affairs [Internet]. Strategic Plan FY 2010–2014; 2010 [cited 2011 June 6]. Available from: http://www1.va.gov/op3/Docs/StrategicPlanning/VA_2010_2014_Strategic_Plan.pdf

  16. Primary Care Program Office [Internet]. Patient Aligned Care Team (PACT); 2010 [cited 2011 June 6]. Available from: http://www1.va.gov/PrimaryCare/pcmh/

  17. Rosenthal TC. The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med. 2008;21:427–40.

    Article  PubMed  Google Scholar 

  18. Rogers JC. The patient-centered medical home movement—promise and peril for family medicine. J Am Board Fam Med. 2008;21(5):370–374.

    Article  PubMed  Google Scholar 

  19. Hynes DM, Koelling K, Stroupe K, Arnold N, Mallin K, Sohn MW, Weaver FM, Manheim L, Kok L. Veterans’ access to and use of Medicare and VA healthcare. Med Care. 2007;45(3):214–23.

    Article  PubMed  Google Scholar 

  20. Lee TA, Shields AE, Yogeli C, Gibson TB, Woong-Sohn M, Marder WD, Blumenthal D, Weiss KB. Mortality rate in Veterans with multiple chronic conditions. J Gen Intern Med. 2007;22(supp 3):403–7.

    Article  PubMed  Google Scholar 

  21. Office of Rural Health. Veterans rural health: perspectives and opportunities. Washington, D.C.: Veterans Health Administration, Department of Veterans Affairs; 2008.

  22. Weeks WB, Bott DM, Lamkin RP, Wright SM. Veterans health administration and Medicare outpatient health care utilization by older rural and urban New England Veterans. J Rural Health. 2005;167–171.

  23. Darkins AW, Cary MA. Telemedicine and telehealth: principles, policies, performance, and pitfalls. New York: Springer; 2000.

    Google Scholar 

  24. Chumbler NR, Chuang HC, Wu SS, Wang X, Kobb R, Haggstrom D, Jia H. Mortality risk for diabetes patients in a care coordination, home-telehealth programme. J Telemed Telecare. 2009;15(2):98–101.

    Article  PubMed  Google Scholar 

  25. Noel HC, Vogel DC, Erdos JJ, Cornwall D, Levin F. Home telehealth reduces healthcare costs. Telemed J E Health. 2004;10(2):170–83.

    Article  PubMed  Google Scholar 

  26. Chumbler NR, Neugaard B, Kobb R, Ryan P, Qin H, Joo Y. Evaluation of a care coordination/home-telehealth program for veterans with diabetes: health services utilization and health-related quality of life. Eval Health Prof. 2005;28(4):464–78.

    Article  PubMed  Google Scholar 

  27. Darkins A, Ryan R, Kobb R, Foster L, Edmonson E, Wakefield B, Lancaster AE. Care coordination/home telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of Veteran patients with chronic conditions. Telemed J E Health. 2008;14(10):1118–26.

    Article  PubMed  Google Scholar 

  28. Chumbler NR, Vogel WB, Garel M, Qin H, Kobb R, Ryan P. Health services utilization of a care coordination/home-telehealth program for veterans with diabetes: a matched-cohort study. J Ambul Care Manage. 2005;28(3):230–40.

    PubMed  Google Scholar 

  29. Wakefield BJ, Ward MM, Holman JE, Ray A, Scherubel M, Burns TL, Kienzie MG, Rosenthal GE. Evaluation of home telehealth following hospitalization for heart failure: a randomized trial. Telemed J E Health. 2008;14(8):753–61.

    Article  PubMed  Google Scholar 

  30. Chumbler NR, Neugaard B, Ryan P, Qin H, Joo Y. An observational study of veterans with diabetes receiving weekly or daily home telehealth monitoring. J Telemed Telecare. 2005;11(3):150–156.

    Article  PubMed  Google Scholar 

  31. Wakefield BJ, Holman JE, Ray A, Scherubel M, Adams MR, Hillis SL, Rosenthal GE. Effectiveness of home telehealth in co-Morbid diabetes and hypertension: A randomized controlled trial. Telemed J E Health. 2011;17(4):254–261.

    Article  PubMed  Google Scholar 

  32. Young LB, Foster L, Silander A, Wakefield B. Home telehealth: patient satisfaction, program functions, and challenges for the care coordinator. J Gerontol Nurs. Forthcoming 2011.

  33. Markle Foundation. Connecting for health: A public-private collaborative. Final Report of the Personal Health Working Group. New York: Markle Foundation; 2003.

  34. Nazi KM. My HealtheVet personal health record. Testimony to AHIC CE Workgroup; 2007 September.

  35. Nazi KM. My HealtheVet personal health record, part II. Testimony to AHIC CE Workgroup; 2007 October.

  36. Schneider J. My HealtheVet: fighting for health with information. J Consum Health Internet. 2008;12(1):13–21.

    Article  Google Scholar 

  37. Nazi KM, Hogan TP, Wagner T, McInnes DK, Smith BM, Haggstrom D, Chumbler NR, Gifford AL, Charters KG, Saleem JJ, Weingardt KR, Fischetti LF, Weaver FM. A research vision for personal health records: experiences with the VA My HealtheVet system. J Gen Intern Med. 2010;25(1):62–67.

    Article  PubMed  Google Scholar 

  38. American Customer Satisfaction Index [Internet]. ACSI methodology [cited 2011 June 6]. Available from: http://www.theacsi.org/index.php?option=com_content&view=article&id=48&Itemid=122

  39. MHV Program Office. My HealtheVet product intranet website: statistics. 2011.

  40. Nazi KM. Veterans’ voices: use of the American Customer Satisfaction Index (ACSI) survey to identify My HealtheVet personal health record users’ characteristics, needs, and preferences. J Am Med Inform Assoc. 2010;17:203–211.

    Article  PubMed  Google Scholar 

  41. Woods S, Nazi KM, Weaver FM. My HealtheVet users: preliminary evidence on rural reach and usage. Paper presented at VA Health Services Research & Development Rural Health Meeting / VA Office of Rural Health Field-Based Meeting; 2010 May 5; Portland, ME.

  42. Chumbler NR, Haggstrom DA, Saleem J. Implementation of health information technology in Veterans health administration to support transformational change. Telehealth and personal health records. Med Care. 2010;48:12.

    Google Scholar 

  43. Darkins A. Changing the location of care: management of patients with chronic conditions in Veterans health administration using care coordination/home telehealth. J Rehabil Res Dev. 2006;43:vii-xii.

  44. Strauss AL, Corbin JM. Shaping a new healthcare system: the explosion of chronic illness as a catalyst for change. San Francisco: Jossey-Bass Publishers; 1988.

    Google Scholar 

  45. Houston TK. Department of Veterans Affairs Quality Enhancement Research Initiative for eHealth: strategic plan [Internet]. [cited 2011 June 6]. Available from: http://www.queri.research.va.gov/ehealth/default.cfm.

  46. Walker JM, Carayon P. From task to processes: the case for changing health information technology to improve health care. Health Aff. 2009;28(2):467–77.

    Article  Google Scholar 

  47. Kaelber DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for personal health records (PHRs). J Am Med Inform Assoc. 2008;15(6):729–36.

    Article  PubMed  Google Scholar 

  48. Fuji KT, Galt KA, Serocca AB. Personal health record use by patients as perceived by ambulatory care physicians in Nebraska and South Dakota: a cross-sectional study. Perspect Health Inf Manag. 2008;5:15.

    PubMed  Google Scholar 

  49. Greer C, Buck SL. PHRs and physician practices. J AHIMA. 2007;78(4):71–5.

    Google Scholar 

  50. Siteman E, Businger A, Gandhi T, Grant R, Poon E, Schnipper J, Volk LA, Wald JS, Middleton B. Clinicians recognize value of patient review of their electronic health record data. AMIA Annu Symp Proc 2006; 1101.

  51. Katz SJ, Moyer CA. The emerging role of online communication between patients and their providers. J Gen Intern Med. 2004;19:978–983.

    Article  PubMed  Google Scholar 

  52. Kittler AF, Carlson GL, Harris C, Lippincott M, Pizziferri L, Volk LA, Jagannath Y, Wald JS, Bates DW. Primary care physician attitudes towards using a secure Web-based portal designed to facilitate electronic communication with patients. Inform Prim Care. 2004;12(3):129–38.

    PubMed  Google Scholar 

  53. Wakefield BJ, Holman JE, Ray A, Morse J, Kienzie MG. Nurse and patient communication via low- and high-bandwidth home telecare systems. J Telemed Telecare. 2004;10(3):156–9.

    Article  PubMed  Google Scholar 

  54. Wakefield BJ, Orris LJ, Holman JE, Russell CL. User perceptions of in-home medication dispensing devices. J Gerontol Nurs. 2008;34(7):15–25.

    Article  PubMed  Google Scholar 

  55. Lober WB, Zierler B, Herbaugh A, Shinstrom SE, Stolyar A, Kim EH, Kim Y. Barriers to the use of a personal health record by an elderly population. AMIA Annu Symp Proc. 2006;2006:514–518.

    Google Scholar 

  56. Roblin DW, Houston TK, Allison JJ, Joski PJ, Becker ER. Disparities in use of a personal health record in a managed care organization. J Am Med Inform Assoc. 2009;16(5):683–689.

    Article  PubMed  Google Scholar 

  57. Hogan TP. Multi-morbidity as a complicating factor for existing models of health information seeking. Panel presentation at the American Society for Information Science and Technology Annual Meeting 2010 Oct 26; Pittsburgh, PA.

  58. Hogan TP, Brashers DE. The theory of communication and uncertainty management: implications from the wider realm of information behavior. In: Afifi TD, Afifi WA, eds. Uncertainty, information management, and disclosure decisions: theories and applications. New York: Routledge; 2009:45–66.

    Google Scholar 

  59. Brashers DE, Goldsmith DJ, Hsieh E. Information seeking and avoiding in health contexts. Human Comm Res. 2002;28:258–71.

    Article  Google Scholar 

  60. Fox S. Online health search 2006 [Internet]. Washington, D.C.: Pew Internet and American Life Project; 2006 [cited 2011 June 6]. Available from: http://www.pewinternet.org/Reports/2006/Online-Health-Search-2006.aspx?r=1

  61. Gordon KS, Goulet JL, Brandt CA, Duggal M, Justice AC. Variation in Veterans’ access to internet and email: potential impact on VHA electronic health communication. VA Information Resource Center (VIReC) clinical informatics seminar [Internet]; 2009 Jul [cited 2011 June 6]. Available from: http://vaww.virec.research.va.gov/EducationResources/Seminars/Clinical-Informatics_Arch_2009.htm

  62. McInnes DK, Gifford AL, Kazis LE, Wagner TH. Disparities in health-related internet use by US veterans: results from a national survey. Inform Prim Care. 2010;18(1):59–68.

    PubMed  Google Scholar 

  63. Bates DW, Bitton A. The future of health information technology in the patient-centered medical home. Health Aff. 2010;29(4):614–621.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the organizers of the "Improving Access to VA Care" State of the Art (SOTA) conference held in Arlington, VA, September 21–22, 2010, for the original opportunity to develop this manuscript.

Conflicts of Interest

None disclosed

Author information

Authors and Affiliations

  1. Center for Management of Complex Chronic Care & Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines, Jr. VA Hospital, 5000 S. 5th Avenue, Hines, IL, 60141, USA

    Timothy P. Hogan PhD & Frances M. Weaver PhD

  2. eHealth Quality Enhancement Research Initiative, National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA

    Timothy P. Hogan PhD, Bonnie Wakefield PhD, RN, Thomas K. Houston MD, MPH & Frances M. Weaver PhD

  3. Program in Health Services Research, Stritch School of Medicine, Loyola University Health System, Loyola University Chicago, Maywood, IL, USA

    Timothy P. Hogan PhD & Frances M. Weaver PhD

  4. VA Health Services Research and Development Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, IA, USA

    Bonnie Wakefield PhD, RN

  5. Veterans and Consumers Health Informatics Office, Office of Health Information, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA

    Kim M. Nazi MA

  6. Center for Health Quality, Outcomes & Economic Research (CHQOER), Bedford VAMC, Bedford, MA, USA

    Thomas K. Houston MD, MPH

  7. Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA

    Thomas K. Houston MD, MPH

Authors
  1. Timothy P. Hogan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bonnie Wakefield PhD, RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kim M. Nazi MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas K. Houston MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frances M. Weaver PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy P. Hogan PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hogan, T.P., Wakefield, B., Nazi, K.M. et al. Promoting Access Through Complementary eHealth Technologies: Recommendations for VA’s Home Telehealth and Personal Health Record Programs. J GEN INTERN MED 26 (Suppl 2), 628 (2011). https://doi.org/10.1007/s11606-011-1765-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11606-011-1765-y

KEY WORDS

Search

Navigation