Portland VA center pilots personal health portal

Regenstrief Institute

Making an appointment with a doctor or refilling prescriptions might not seem like big deals. And they certainly don't seem to be the kind of actions for which a computer and online connection would make a major difference. But Vietnam War veteran Roger Sample begs to differ.

A recent enrollee in a Department of Veterans Affairs My HealtheVet pilot program at the Portland VA Medical Center (PVMC) in Oregon, Sample said online access to medical professionals and health records can make a phenomenal difference in the daily life of a patient.

Before the online access, Sample said, you'd have to start the process with a phone call, which often meant going through an answering machine and then waiting for someone to get back to you. And if you wanted to see your health records, you'd have to request paper copies, which could take weeks. "The only ones who did that were the people who really needed them," he said.

"The difference now is like night and day," Sample said. "You can see all of your appointments on the screen, both past and active. And if you can't remember what your prescriptions are, it doesn't matter because you can get to see all of them with just a mouse click or two."

Personal portal

The VA announced the creation of My HealtheVet in November 2003 as a one-stop Web portal through which veterans could get current information about health benefits, use online tools to assess their health status, request prescription refills, make appointments and build personal health logs.

The national release of My HealtheVet is currently under way. Portland is one of nine sites nationwide where the VA is demonstrating the system to show that it can provide veterans with safe, secure and private electronic health records along with the other functions. Portland is conducting two tests, one to provide veterans with Internet access to their medical records and another to provide an online prescription refill service.

Health providers at the medical center were initially fearful that My HealtheVet would open a Pandora's box.

"They thought if veterans had easy access to their records, they could misinterpret the information and panic, where in fact, it might be just a minor lab result abnormality," said David Douglas, PVMC's chief information officer. "They also thought patients would read what doctors had written about them and be offended in some way. So there was a lot of fear on the part of quite a few of the staff."

More is better

Despite the concerns, only a few veterans have complained about minor discrepancies in their records, Douglas said. And the success of the test programs has confirmed his belief that making veterans more informed helps them and their health providers.

For example, if a veteran with diabetes comes to PVMC and receives treatment instructions from a doctor, the veteran must remember everything the doctor said. The veteran must keep track of his blood sugar levels and know where for additional information.

Now veterans with diabetes can simply log on to the My HealtheVet Web site and see what a doctor said about treatments, and they can keep track of blood sugar levels with online logs, said Rod Langer, an information technology project manager at PVMC.

"In Portland, our diabetes clinic staff can also go online to track what the vet's blood sugar is, and if they see something that looks wrong, they can make an appointment to bring the vet in to take a look at him," he said.

The simplicity of My HealtheVet's prescription refill service belies the complexity of the information available, said Sample, who works in PVMC's IT department. If you have only one or two prescriptions, refills are easy. But many patients at PVMC take a dozen or more medications.

"Having all of the prescriptions they need to remember right up there on the screen and also knowing when each of them needs to be refilled is huge for those patients," he said.

Sample said he considers the Portland test programs to be indicative of health care's future. "Historically, Americans have been trained to accept that what their physician says is gospel," he said. "These information sources people can access through My HealtheVet enable patients to be more aware and to be much more involved in their own care."

Studies show that when patients are involved in their own health care, they take a more proactive approach to treatment plans, Langer said.

Registration drive

PVMC has been successful in recruiting veterans to use the program. By early July, it had enrolled more than 1,000 veterans for the pilot program, compared with about 3,200 at the other eight HealtheVet sites combined. The center uses its Web site to inform veterans about the program, has posted signs in its lobby and is mailing thousands of letters to veterans about how to enroll.

PVMC expects 5,000 veterans, or about 10 percent of its total patient population, to enroll by the end of December.

The enrollment process shows how computer savvy and ready veterans are for this kind of program. In the beginning, the center expected a slow response and set up training programs using a classroom with 16 computers.

But every class sold out. Center officials also found that many patients were so proficient they didn't need basic training, so PVMC instead expanded the online help section to assist people with the enrollment process.

"We decided it was in our best business interests to do all of this," Douglas said. "Not only does it mean veterans are more informed consumers of health care if they have access to their records, it also means there will be fewer veterans coming to the office over time."