You are a Vital Member of the My HealtheVet MHV Team

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You are a Vital Member of the My HealtheVet (MHV)
Team

• My HealtheVet Class 122

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MHV Class 122 Faculty

• Southern Arizona VA Healthcare System
• Karen Hebda, EEO Manager, VISN Facility MHV POC
• Michelle Levack, Asst. Chief HIMS Privacy
  Officer
• Tom Vagedes, Clinical Applications Coordinator
• Fayetteville, North Carolina VA Medical Center
• Terri Admire, Patient Education Coordinator MHV
  POC

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What is My HealtheVet (MHV)?
My HealtheVet is a transforming eHealth portal
that provides a new, online environment where
veterans, family, and clinicians work
collaboratively to optimize each veterans
health care.
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Class Objectives

• Identify essential team members, their roles and
  responsibilities
• Understand the team concept, effectiveness, and
  endless possibilities
• Learn successful implementation strategies for
  current and future My HealtheVet functionality

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Main Objective

• Sell the Team Approach

• Share the work
• Tap into talent pool
• Make it fun!!!

None of us is as smart as all of us! Phil
Condit, Former CEO of Boeing
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VISN 18 Team

• Includes facilities in
• Albuquerque, NM
• Amarillo, TX
• Big Spring, TX
• El Paso, TX
• Phoenix, AZ
• Prescott, AZ
• Tucson, AZ
• VISN 18 1st place nationally for percentage of
  veteran population enrolled in MHV and for number
  of authenticated users

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VISN 18 Team

• Attribute Successes To
• Monthly Phone Conference
• Setting Goals
• Tracking Goals
• Sharing Best Practices
• Brainstorming
• Combining Our Efforts

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VISN 18 Goals
2006 2007
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VISN 18 Team

• Graph showing progress toward Rx Refill in 2006

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VISN 18 Team

• Graph showing progress toward Rx Refill in 2007

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SAVAHCS
Description of Facility

• 283-Bed Tertiary-Care Facility
• Affiliations with 85 academic institutions
  including University of Arizona Colleges of
  Medicine, Nursing Pharmacy
• Includes
• Blind Rehab Center
• Geriatrics Rehab Center
• Research Facility
• Spinal Cord Injury Clinic

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SAVAHCS
Same Challenges as with VISN

• Largely rural
• Includes the Tohono Oodom Indian Reservation
  (Comparable in size to the state of Connecticut)
• Few densely populated cities

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SAVAHCS
My HealtheVet Action Committee 2007
19 Active Members (Not all pictured)
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SAVAHCS
Successes Attributed to Our Actively Functioning
Team

• Within Our VISN
• Highest of employees enrolled
• Highest of employees trained
• Highest number of authenticated users
• Highest of Rx Refills
• Largest, most active team
• Nationally (As of June 2007)
• 2nd highest number of employees enrolled
• 2nd highest number of authenticated users

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MHV Team Roles, Responsibilities and Best
Practices

• MHV POC
• Keep current on all MHV info
• Recruit train volunteers
• Gather statistical data
• Plan chair monthly meetings
• Prepare distribute meeting minutes
• Keep management informed
• Provide help to veterans as needed

My HealtheVet Account Info Keep this
information secure and private!

User ID____________________
Password__________________
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MHV Team Roles, Responsibilities and Best
Practices

• IT POC
• Technical and subject matter expert for hardware
  software needs
• MHV kiosk readiness and lockdown solution
• Installs updates
• Liason to IT Department for all MHV computer
  needs
• Role Administrator for MHV Admin Portal
  (originally assigned user roles)

Copies of Training DVD
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MHV Team Roles, Responsibilities and Best
Practices

• Patient Nurse Educator
• Includes MHV training in all health classes
• Covers MHV in New Employee Orientation (NEO)
• Includes MHV topics in facility-wide education
  committee
• Participates in outreach to staff, volunteer and
  veteran organizations
• Arranged to get MHV In-Person Authentication
  (IPA) training video on the Instant Health Line,
  making it easily accessible throughout the
  facility

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MHV Team Roles, Responsibilities and Best
Practices

• PERC Librarian
• Monitors both MHV kiosks and printers
• Assists veterans with registration,
  authentication, and troubleshooting
• Shows IPA video on Instant Health Line as needed
• Duplicates materials as needed
• Acts as MHV helpline for phone inquiries in
  absence of MHV POC

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MHV Team Roles, Responsibilities and Best
Practices

• Pharmacist
• Acts as liaison to Pharmacy staff for all MHV
  related issues
• Placed MHV information in New Patient Handbook
• Encourages Online Refill as preferred method for
  refilling prescriptions (brochure, voice mail,
  window pick up, etc.)
• Instrumental in getting MHV kiosk near OP
  Pharmacy
• Conducts MHV training updates as needed during
  Pharmacy staff meetings
• Brings Pharmacy concerns to monthly MHV team
  meetings

Brochures with Instructions for Online Rx Refill
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MHV Team Roles, Responsibilities and Best
Practices

• TLC Pharmacy Tech
• Acts as liaison to TLC Pharmacy staff for all MHV
  related issues
• Troubleshoots website problems with patients who
  call the TLC line
• Works directly with MHV POC to assist patients
  with refill issues and questions
• Includes MHV printed updates to Pharmacy staff
  folders to keep everyone informed

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MHV Team Roles, Responsibilities and Best
Practices

• Dietician
• Worked with MHV design team to test the food
  activity journals
• Provides MHV updates to nutritional staff
• Provides training on MHV functionality for
  dieticians
• Encourages use of MHV with patients to track
  their diets
• Nutrition Week Activities

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MHV Team Roles, Responsibilities and Best
Practices

• LPN, Geriatrics
• Worked with subcommittee to draft first
  implementation plan that was used as a national
  model
• Provides MHV updates to Geriatric Clinic staff
• Promotes MHV with all Geriatric Clinic patients
  family members
• Had several articles published in the Retiree
  Newsletter at the local Air Force Base
• Provided MHV brochures for out-briefings on base

MHV IPA Sign Greets Patients Entering the Facility
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MHV Team Roles, Responsibilities and Best
Practices

• Physician Champion
• Encourages all providers to incorporate MHV in
  their practice
• Conducts outreach during Medical Staff Meetings
• Instrumental in getting MHV website info on Next
  Step of Care Form
• Has recruited patients to act as MHV volunteers
• Included MHV website info on Advanced Clinical
  Access Brochure

Rx Pads Used to Promote MHV with Patients
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MHV Team Roles, Responsibilities and Best
Practices
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MHV Team Roles, Responsibilities and Best
Practices

• Secretary to Associate Director

• Liaison for VISN MHV Committee
• Maintains statistics and creates minutes for
  VISN MHV Committee
• Keeps MHV POC informed of any and all facility
  activities as potential outreach opportunities
• Places MHV updates into Weekly Bulletin that goes
  out to all employees
• Places MHV ads on welcoming marquis light up sign

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MHV Team Roles, Responsibilities and Best
Practices

• Administrative Officer
• Community Based Outreach Clinics (CBOC)
• Acts as liaison to all CBOC staff for MHV updates
  and issues
• Represents CBOC concerns during committee
  meetings
• Requests signage and other promotional materials
  as needed
• Identifies locations for MHV kiosks as new CBOC
  sites are activated
• Helped to workout the IPA procedure that was
  developed and ready for use as soon as the IPA
  process was implemented

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MHV Team Roles, Responsibilities and Best
Practices

• Volunteers
• Work directly with veterans and families in the
  registration process (assisted over 200
  w/registration in FY07)
• Help to troubleshoot problems brought to them by
  MHV users
• Call in overhead announcements when they are
  posted at the kiosk
• Outreach to patients in waiting areas to provide
  MHV brochures and information
• Donated used computer equipment for use in the
  MHV kiosk
• Developed ideas and methods for outreach to
  inpatients

SAVAHCS volunteer assisting a veteran with MHV
registration In FY07 MHV volunteers have
interacted with approximately 2000 veterans
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MHV Team Roles, Responsibilities and Best
Practices

• The List Goes On-
• Consider
• Telephone Operators
• Eligibility/Enrollment Staff
• ROI/HIMS
• CPRS/Clinical Applications Coordinator (CAC)
• Medical Media
• Voluntary Service Staff
• Public Affairs Officer
• Never turn anyone away
• Invite anyone with an interest to
• join your team

Encourage Continuous Growth
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SAVAHCS MHV Team Most Recent Additions

• Assistant Chief HIMS/ROI-Michelle Levack
• CPRS Team/CAC-Tom Vagedes

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Release of Information (ROI) Involvement

• Michelle Levack, Assistant Chief of HIMS
• Privacy Officer
• Training ROI Staff to Prepare for IPA
• National MHV Online Training
• Satellite Conferences
• Local Hands On Training
• All Involved ROI Staff Registered on MHV

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ROI Involvement

• Workload Planning
• Contingency Plan
• Use of other HIM staff members
• Transcription
• Program Support Assistant
• Coding Staff
• CBOC clerks
• Authentication capabilities
• Enrollment/Eligibility

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Tools Developed

• MHV Form 10-5345a
• Colored to differentiate between ROI and MHV
• Guidance through Email
• Locating users on portal
• Admin Portal issues
• Helpful hints from ROI staff

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Tools Developed

• Face to Face VISN Meeting
• Networking
• Delegation of subject matter experts
• Instant Health Line
• MHV video My HealtheVet Building Your Personal
  Health Record

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IPA Implementation

• Test Patient
• Employee volunteer
• Slow Going
• Issues with the MHV administrative portal
• Slow, steady stream of veterans
• Troubleshooting via phone and email with VISN
  team members

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Outreach Efforts
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Current IPA Stats
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Outreach Efforts

• MHV Posters
• MHV website
• Located on patient records
• Mailings
• Pharmacy
• First party ROI requests

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Outreach Efforts

• Partnership with MOVE!
• Posters and Literature
• Patient Carnival
• Veterans Benefits Fair
• CBOC Benefits Fair

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Outreach Efforts to CBOCs
Attention MyHealtheVet Users At Community Based
Outreach Clinics Those who have been using
MyHealtheVet for refilling prescriptions online
and tracking their personal health information
have been awaiting the capability of seeing the
name of their prescription as well as the
prescription number when they order refills
online. You will also be able to view key
portions of your Personal Health Record as they
are released throughout 2007.
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Distance of CBOCs

• Casa Grande (70 miles)
• Green Valley (30 miles)
• Safford (130 miles)
• Sierra Vista (75 miles)
• Yuma (241 miles)

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CBOC Implementation
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CBOC Implementation

• Teleconference to prepare for IPA
• Staff from all five CBOCs
• MHV POC
• ROI Supervisor
• CBOC Supervisor
• CBOC Administrative Officer
• Kiosk Placement

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CBOC Implementation

• Is it working?
• Forms received inter-office mail
• Forms received through fax

• Verifying Identity
• Copy of picture ID attached
• ID verified by CBOC staff (RNs, NPs, MDs, and
  Clinic Clerks)

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Employee Outreach

• New Employee Orientation
• Staff given a walk through of the portal
• Staff enrolled
• Mandatory Training
• VISN 18 Requirement
• SAVAHCS Requirement

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Employee Outreach

• Encourage Staff MHV Enrollment
• New Employee Orientation
• Prizes include Gym Membership, Restaurant Gift
  Certificate, Select Parking Spot for One Month,
  Gift Certificate to the Canteen Store, Bowling
  Passes, Free Oil Change
• Obstacles Overcome
• Results of Efforts
• Significant increase in number of employees
  enrolled

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Employee Outreach

• Top 5 Facilities for Employee MHV Enrollment

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Employee Outreach

• VISN 18 Employee MHV Enrollment

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MHV Team Plans for the Future
Tom Vagedes, Clinical Applications Coordinator
(CAC)

• Clinical Applications Coordinator members can
  bring added value to the MHV Team as you prepare
  for the electronic personal health record

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Opportunities for CACs

• Education and Training of new staff
• Re -educating and -training current staff
• CPRS Orders and MHV
• Creation of templates with links to MHV
• Coordinate mobile computers for MHV
• Vista routines to track MHV data
• Support for new MHV features
• e.g. Blended View of Medications
• Align MHV goals and VHA goals
• e.g. Patient knowledge of their medications and
  reconciliation to document changes

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New Staff Education Training

• CPRS is the current health care record
• Clinical and Administrative staff training
• Expand awareness of busy staff
• Concept of a unified health record
• CPRS and MHV comprise the future record
• Many opportunities to educate and train
• Promote the goals of MHV
• Assist MHV enrollment
• Train-the-trainer model
• Staff learn and then train others

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New Staff Education Training

• Current Opportunities
• Staff are trained to use the Computerized Patient
  Record System (CPRS)
• Training includes veterans access to the health
  record through My HealtheVet
• My HealtheVet as a personal health record
• Computer link to a portal of valuable information
• The Veteran as Active Participant in their care

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Staff Education Training

• Future Opportunities
• Staff education as MHV advances
• Veteran access expands with new functions and
  information, e.g.
• Blended View of Medications
• Immunizations
• Progress Notes
• Vital Signs

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CPRS Orders MHV

• Patients are thinking about their health when
  discharged
• Discharge Instructions are given to every patient
  when discharged
• Discharge Orders were modified to include a MHV
  reminder to the patient
• Nurses are also encouraged to promote MHV with
  these patients

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Discharge Order Reminder
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Templates and MHV

• Add the MHV link to templates
• Providers
• Use templates in progress notes
• Can easily review the MHV page
• Can promote MHV
• Can describe MHV in the visit
• Can demonstrate ease of access

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Templates and MHV
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Assist With Computer Availability

• Volunteer with a mobile computer
  workstation presenting MHV to a patient

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VistA Routines and MHV Data

• VistA Reports can be used to track MHV progress
• Tracking Rx Refill Progress
• Support for VISN Goals

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Tracking Rx Refill Progress

• Select Refill Request Source Local Menu Option ?
• 1 My HealtheVet Refill Requests by
  Month/Day
• 2 Refill Requests via Pharmacy
• Enter ?? for more options, ??? for brief
  descriptions, ?OPTION for help text.
• Select Refill Request Source Local Menu Option 1
  My HealtheVet Refill Requests
• by Month/Day
• Previous selection DATE PROCESSED from Jun
  1,2006 to Jun 22,2006_at_2400
• START WITH DATE PROCESSED Jun 1,2006// (JUN
  01, 2006)
• GO TO DATE PROCESSED Jun 22,2006// (JUN 22,
  2006)
• DEVICE

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Tracking Rx Refill Progress Supporting VISN Goal
Results of File Man Sort/Print Template (File
52.43)My HealtheVet Refill Requests by Month/Day
OUTPUT FROM WHAT FILE PRESCRIPTION REFILL
REQUEST// SORT BY 'DATE PROCESSED//   START
WITH DATE PROCESSED Jun 1,2006//   (JUN 01,
2006)GO TO DATE PROCESSED Jun 22,2006//   (JUN
22, 2006)  WITHIN DATE PROCESSED, SORT BY
MONTH(DATE PROCESSED)""SC11  Replace  
START WITH MONTH(DATE PROCESSED) FIRST//    
WITHIN MONTH(DATE PROCESSED), SORT BY
NUMDATE(DATE PROCESSED)""C5  Replace    
START WITH NUMDATE(DATE PROCESSED) FIRST//
      WITHIN NUMDATE(DATE PROCESSED), SORT
BYFIRST PRINT FIELD !DATE PROCESSED"REFILLS"
C11   THEN PRINT FIELD

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Tracking Rx Refill Progress Supporting VISN Goal
Results of File Man Sort/Print Template (File
52)Refill Requests via Pharmacy

• OUTPUT FROM WHAT FILE PRESCRIPTION//
• SORT BY REFILL//     (multiple)
• REFILL SUB-FIELD 'RELEASED DATE/TIME//  
• START WITH RELEASED DATE/TIME Jun 1,2006//  
  (JUN 01, 2006)
• GO TO RELEASED DATE/TIME Jun 22,2006//   (JUN
  22, 2006)
•   WITHIN RELEASED DATE/TIME, SORT BY
  REFILL//     (multiple)
•   REFILL SUB-FIELD MONTH(RELEASED
  DATE/TIME)""C1S
•   Replace
•    By 'RELEASED DATE', do you mean REFILL
  'RELEASED DATE/TIME'? Yes//   (Yes)
•   START WITH MONTH(RELEASED DATE/TIME) FIRST//
•     WITHIN MONTH(RELEASED DATE/TIME), SORT BY
  REFILL//     (multiple)
•     REFILL SUB-FIELD NUMDATE(RELEASED
  DATE/TIME)""C11
•   Replace
•    By 'RELEASED DATE', do you mean REFILL
  'RELEASED DATE/TIME'? Yes//   (Yes)
•     START WITH NUMDATE(RELEASED DATE/TIME)
  FIRST//
•       WITHIN NUMDATE(RELEASED DATE/TIME), SORT
  BY
• FIRST PRINT FIELD REFILL//     (multiple)
•   FIRST PRINT REFILL SUB-FIELD !RELEASED
  DATE/TIME REFILLS"

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Tracking Rx Refill Progress

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Support for New MHV Features

• E.g. Blended View of Medications
• Active medications and Current prescriptions
• Supplements both VA and self entered

Summary view of all medications including your
self-entered medications and VA prescriptions.
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Align MHV Goals and VHA Goals

• E.g. Patient knowledge of their medications
• Medication Reconciliation to document changes

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Team Concept Works
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Fayetteville VA Medical CenterFayetteville,
North Carolina
Terri Admire, MHV POC Patient Education
Coordinator
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Fayetteville VA Medical Center Part of VISN 6
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Veterans Served by the Fayetteville VAMC

• Clinical Core Level III Facility
• 90 general medical, surgical and mental health
  beds
• 69 beds in long-term care unit
• 21 counties served including 2 counties in South
  Carolina
• 2 community-based outpatient clinics

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Additional Resources

• Veterans requiring specialized services are
  referred to the Durham VAMC, or other VISN 6 VA
  facilities.
• VA/DoD agreement between Womack Army Hospital,
  Pope Air Force Base and Fayetteville VAMC to
  augment health care delivery.
• Affiliations with Campbell University School of
  Pharmacy, University of North Carolina Schools of
  Medicine, Dentistry and Pharmacy.

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MHV Promotion Strategy
Get Help!
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Organize A Task Force

• Form a multidisciplinary team.
• Involve administration.

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Implementing My HealtheVet

• Take a critical look at your facility and the
  resources available.

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Location, Location, Location

• Where are your MHV computers located?
• Do you have an appropriate space with equipment
  to view MHV instructional DVDs?

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Challenges

• Space
• Staffing
• Time Management
• Budget

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Getting the Word Out With Limited Funds

• Signs
• Handouts
• Newsletters
• Emails
• Bulk mailings
• Telephone Trees
• Health Fairs
• VSO Events

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The Most Effective Approach for Implementing
IPA/PHR

• Fayettevilles IPA/PHR Plan is MHV Contest 6
  Winner of the Above and Beyond the Call of Duty
  Award from My HealtheVet (November 14, 2006)

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Registration Process

• Veteran presents to HAS desk in Basement
  Outpatient Area and requests IPA for My
  HealtheVet
• Veteran is registered as MHV user and has viewed
  the IPA orientation video on the website
• Veteran will be given registration slip and will
  be directed to the ROI Window on the first floor
  from 8am-12noon and 1pm-4pm, Monday thru Friday

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Registration Process

• Veteran is not registered as MHV user
• Veteran will be escorted by a trained volunteer
  to the MHV computer in the Eagle Clinic waiting
  area to register for MHV and view the IPA
  orientation video on the website
• Veteran will then be given registration slip and
  will be directed to the ROI Window on the first
  floor

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Registration Process

• More than one veteran presenting for IPA at the
  same time will be escorted by a trained volunteer
  to room 119 in the Bravo Clinic to view the IPA
  orientation video as a group from 8am-12noon
• Any veterans in the group who have not registered
  for MHV will have to register for MHV on the
  computer in the Eagle Clinic waiting area
• Veterans will then be directed to the ROI window
  on the first floor

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Registration Process

• Veterans who present to the HAS desk for IPA
  after 12 noon and have either not registered for
  MHV or who need to view the IPA video, will be
  sent to Voluntary Service for assistance

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Final Registration Step

• Veteran who has completed prerequisites will
  present to the ROI window for IPA
• Veteran will provide one form of
  government-issued photo ID such as VIC card or
  drivers license
• Veteran will sign participation form
• ROI staff will validate the veteran and match the
  veterans information with the Master Patient
  Index (MPI)
• ROI staff will initiate a record review

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Training

• Create dialog sheets for HAS staff to use so that
  they will know where to direct the veterans
• Create registration slips to give to veterans so
  that when they present to the ROI window the
  staff will know that they have completed the
  prerequisites for IPA

• Train volunteers to use MHV and the process for
  IPA
• Designate a Champion in each clinic and on each
  ward who has been trained to use MHV and knows
  the IPA process

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Communications

• Increase awareness of My HealtheVet
• 1. Continue to give MHV pamphlet to all
  veterans
• attending classes
• 2. Continue to present MHV as part of the
  New
• Patient Orientation Clinic
• 3. Continue to include MHV pamphlet in
  the
• admission packet
• 4. Veterans presenting in ambulatory
  care,
• pharmacy and lab areas will receive
  MHV
• materials
• 5. Veterans visiting the veterans
  benefits
• coordinator will receive MHV materials

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Uh, Oh! Problems With The Plan

• Retreat, take a second look, modify, be flexible.
• Turn around, renew, revitalize, go forward!

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SUCCESS!!!

• Dont you love it when a good plan comes together?

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Its Easy To Get Harried

• Computer problems
• Equipment failures
• Staffing issues
• Veterans questions
• Lack of time
• And on, and on

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Slow and Steady Wins the Race

• Stay focused
• Follow your plan
• Be flexible
• Keep your eyes on the goal
• Were rooting for you!!!

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Contact Information

• At Southern AZ VA Health Care System (VISN18)
• Karen Hebda, MHV POC, EEO Manager
• karen.hebda_at_va.gov
• Michelle Levack, Asst. Chief HIMS
• michelle.levack_at_va.gov
• Tom Vagedes, Clinical Apps Coordinator
• ronald.vagedes_at_va.gov
• At Fayetteville VA Medical Center (VISN 6)
• Terri Admire, MHV POC, Pt. Education Coordinator
• terri.admire_at_va.gov