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Feature Article

Researchers aim to promote Veterans' use of MyHealtheVet

My HealtheVet (www.myhealth.va.gov) is VA's personal health record. Designed for Veterans, active duty Servicemembers, and their dependents and caregivers, the online record allows users to get a better understanding of their health status and explore ways to monitor and improve their health and to connect with health care providers.

The system, available 24 hours a day, seven days a week, allows Servicemembers and Veterans to become active partners in their own health care. In an article appearing online in the Journal of the American Medical Informatics Association, two VA researchers looked at the use of My HealtheVet, and the Internet in general, among Veterans—especially those who use VA mental health services. i

The authors found that, while in their opinion adoption of My HealtheVet has been slow, the majority of Veterans do use the Internet and are willing to receive information from and interact with health information services online.

According to Jack Tsai, PhD, who co-authored the study with Robert A. Rosenheck, MD, "no previous study has examined Internet use among mental health users of a large nationwide healthcare system, although a range of internet-based programs for medical and mental health problems have been shown to be effective in randomized controlled trials."

Continued Tsai, "My HealtheVet holds great potential for mental health services, if people use it. There are opportunities for telemental health, computerized therapies, online peer support groups, and other successful therapies, that have yet to be realized."

Tsai and Rosenheck are associated with VA's New England Mental Illness Research, Education, and Clinical Center at the West Haven VA Medical Center and the Department of Psychiatry at Yale University School of Medicine. They used data from the 2010 National Survey of Veterans, a comprehensive national survey designed by VA to help the Department plan future programs and services for Veterans. The 2010 survey, the sixth in a series, was the first to ask detailed questions about Internet use.

The researchers focused on 7215 Veterans who provided information within the survey about enrollment for VA health care and use of mental health services. In particular, they looked at responses to two yes or no questions asked in the survey: 'do you use the Internet, at least occasionally?' and 'have you ever used the My HealtheVet website to obtain information related to your personal VA healthcare?'

Other questions asked by the survey included asking Veterans to rate, on a scale of one to five, how willing they are to use the Internet to obtain news and information; carry out research on services; purchase goods or services: respond to polls or surveys; obtain information about VA benefits; and apply for VA benefits. Veterans were also asked to rate their general health from one (poor) to five (excellent).

In analyzing the data, the researchers divided respondents into three groups; those not enrolled with VA for their health care; those enrolled with VA but not reporting that they had used mental health services; and VA mental health service users. The majority of Veterans in the survey group were white, male, in their early 60s, had at least some college education, were employed, had a household income of more than $30,000 per year, were married or in a civil union. About 71 percent of the Veterans in the group reported that they used the Internet, and 7.2 percent had served in Iraq or Afghanistan.

"We found that Veterans who did not enroll for VA services were more likely to use the Internet than those who were enrolled with VA but did not use mental health services," says Tsai. "There was no significant difference in Internet use between VA mental health users and other Veterans who received their care from VA."

Not surprisingly, Veterans enrolled for VA care indicated a greater willingness to obtain information about VA benefits, apply for VA benefits through the Internet, and use My HealtheVet for their personal health care. There were, again, no significant differences between mental health service users and other VA service users on this issue, although those who used mental health services were less likely to use their Internet in their own homes. Instead, many used public locations or someone else's home for service.

Almost all Veterans who used the Internet also reported they used email, and were receptive to receiving information about VA and their health care online. Despite this, only about a quarter of VA mental health service users and a fifth of other VA service users reported using the My HealtheVet website. Use of the site was not significantly associated with demographic characteristics or the use of mental health services, suggesting, according to the authors, that "these factors are no different from other barriers to general Internet access."

Other factors possibly contributing to the lack of usage of My HealtheVet included chronic illness, concerns about privacy and confidentiality, and issues related to sharing information both on the part of patients and their health care providers. Some patients are concerned about receiving bad news electronically instead of in person. And some clinicians are concerned about sharing clinical notes, lab tests, and even diagnoses that patients may not be able to fully understand and from which they may draw incorrect conclusions. Additional education and research, Tsai and Rosenheck suggest, may be the key to increased usage.

According to the My HealtheVet program office, as of June 30, 2012 nearly 1.8 million Veterans, Servicemembers and their caregivers have registered to use the website. The site has received nearly 71 million visits since it began operating on Veterans Day, 2003. Its most popular feature, the ability to refill VA prescriptions online, has processed nearly 31 million refill requests since 2005. More than 350,000 users are able to conduct secure messaging with their health care providers, and more than 550,000 users have submitted requests to download their health records electronically.

My HealtheVet's Blue Button feature enables patients to assemble and download personal health information into a single, portable file that can be used inside a growing number of private health care electronic records, including VA's. Because it is web-based, the information is available anywhere, anytime. Its security measures are identical to those employed by retail websites that accept credit cards. In August, 2012, VA announced that one million Veterans have registered for this feature.

To get the most out of My HealtheVet, Veterans should visit the nearest VA health care facility to get an upgraded account. This simple process will allow them to view their VA appointments; access wellness reminders; communicate with their health care providers online through secure messaging; view VA lab results; review their personal health information; and take advantage of future features My HealtheVet will provide. Most VA medical centers have a designated My HealtheVet coordinator to help Veterans navigate the s



i J Tsai, RA Rosenheck, "Use of the internet and an online personal health record System by US veterans; comparison of Veterans Affairs mental health service users and other veterans nationally," J Am Med Inform Assoc (2012). Doi:10.1136/amiajnl-2012-000971.

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