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Deployment of Secure Messaging (SM) in primary care and women's clinics throughout the Veteran Health System by 2011 was an implementation priority for the Secretary and Under Secretary for Health for FY11 under the VHA T21 initiative. Secure Messaging is in early phases of implementation, this eHealth tool requires thoughtful evaluation to promote the successful implementation and dissemination of this tool. The primary aim of this project is to describe Veterans' experiences when using the SM feature on MyHealtheVet (MHV). This project has local, VISN, and national impact on the implementation and sustainability of the SM feature on MHV through its qualitative and quantitative examination of users' experiences. Findings from this research explores why Veterans choose to, or not to, use the SM feature on MHV, identify facilitators and barriers, and examine if experiences differ by health literacy or computer literacy. In addition to the interview data, findings from the usability testing and the quantitative survey findings build knowledge about Veterans' experiences using the SM feature on MyHealtheVet. These data will inform systems improvements, educational approaches, and marketing strategies to increase adoption and long-term utilization among Veterans.
Project Background:
Secure Messaging is a VHA implementation priority to improve Veteran access to care. Successful deployment of Secure Messaging will support improved access to care, and improved healthcare outcomes in the Veteran population. To support these initiatives, and the successful implementation of this health informatics tools in the VHA, this project is exploring Veterans' perspectives' about adopting Secure Messaging and their experiences using Secure Messaging to inform systems improvements, educational approaches, and marketing strategies.
Objectives:
The primary aim of this project is to describe Veterans' experiences when using the Secure Messaging feature on My HealtheVet (MHV). This research is designed to explore why Veterans choose to, or not to, use the Secure Messaging feature on MHV, identify facilitators and barriers, and examine if experiences differ by health literacy or computer literacy. In addition to the interview data, findings from the usability testing provide user data about Veterans' skills and patterns when using Secure Messaging. This study was extended to conduct a mail-in quantitative survey evaluation of Veterans experiences, preferences, purposes and perceived facilitators and barriers for using, or not using Secure Messaging.
Methods:
This is a prospective mixed-methods descriptive study.
In Phase One: A purposive sampling was used to identify the sample of Veterans who have been Personally Authenticated for the Secure Messaging feature on My HealtheVet. Participants were recruited from two sites (Tampa n=18, Boston n=15). Phase 1 data collection procedures included: (1) surveys; (2) In-person interviews; (3) usability testing; (4) Secure Messaging secondary data collection; and (5) telephone interviews to complete study objectives.
In Phase Two: Random sampling was used to collect mail-in survey data from up to 1,000 Veteran participants who have been personally authenticated to use secure messaging. Quantitative data will be summarized using descriptive statistics to describe sample characteristics, frequency counts and proportions.
Study Status: The project team has completed data collection and analysis for Phase 1 and 2. Team is currently working on publications for dissemination.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Purposive Sampling | Purposive sampling was used to identify a sample of 33 Veterans who have been Personally Authenticated for the SM feature on MHV. Participants were recruited from each site (Tampa, Boston). Women were purposively recruited to ensure females were represented in data findings. | ||
| Random Sampling | Random sampling was used to conduct a quantitative survey with 819 veterans to explore their experiences using secure messaging. |
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| Measure | Description | Time Frame |
|---|---|---|
| Usability of Secure Messaging | To determine ease of use and usefulness of secure messaging. Purposive sample of 33 participants were assessed for their ability to complete the following tasks: navigate to Secure Messaging, log-in to My HealtheVet and Secure Messaging, Set user preferences, check Secure Message inbox, open and send Secure Message, Open and read Secure Message attachment. Measured as: (1) able to complete task; (2) able to complete task with some difficulty; (3) not able to complete task. | baseline |
| Secure Messaging Use and Content Patterns | Extraction of secure messages over a three-month time frame to examine message content type, including: general, tests, medication, and appointments. | 3 months |
| Frequency of Electronic Resource Use | Mail surveys examine Veterans frequency of electronic resource use. | baseline |
| Reasons for Using Secure Messaging Tool on My HealtheVet | Participants reported reasons for Using Secure Messaging tool on My HealtheVet | baseline |
| Benefits of Using Secure Messaging | Veterans report benefits of using Secure Messaging | baseline |
| Intention to Use Secure Messaging in the Future | Veteran respondent intention to use Secure Messaging in the future | baseline |
| Veterans That Believed Improvements to the Secure Messaging System Would Make the Tool More Useful in the Future Are Presented in the Table. |
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Inclusion Criteria:
Exclusion Criteria:
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Veterans in Tampa and Boston who have been Personally Authenticated for the SM feature on MHV.
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| Name | Affiliation | Role |
|---|---|---|
| Jolie N. Haun, PhD MS BS | James A. Haley Veterans' Hospital, Tampa, FL | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| James A. Haley Veterans' Hospital, Tampa, FL | Tampa | Florida | 33612 | United States | ||
| VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24610454 | Result | Haun JN, Lind JD, Shimada SL, Martin TL, Gosline RM, Antinori N, Stewart M, Simon SR. Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient portal system. J Med Internet Res. 2014 Mar 6;16(3):e75. doi: 10.2196/jmir.2976. | |
| Result | Haun J, Lind JD, Shimada SL, Simon SR. Secure Messaging as a tool to facilitate Veteran-provider communication. Annals of anthropological practice. 2013 Jan 1; 37(2):57-74. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Purposive Sampling | Purposive sampling was used to identify a sample of 33 Veterans who have been Personally Authenticated for the SM feature on MHV. Participants were recruited from each site (Tampa, Boston). Women were purposively recruited to ensure females were represented in data findings. |
| FG001 | Random Sampling | Random sampling was used to conduct a quantitative survey with 819 veterans to explore their experiences using secure messaging. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Participants were Veterans registered for My HealtheVet and opted-in to use Secure Messaging in the Tampa FL and Boston MA areas.
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| ID | Title | Description |
|---|---|---|
| BG000 | Purposive Sampling | Veterans registered for My HealtheVet and opted-in to use Secure Messaging from the Tampa, FL and Boston, MA areas. |
| BG001 | Random Sampling | Veterans registered for My HealtheVet and opted-in to use Secure Messaging from the Tampa, FL and Boston, MA areas. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Usability of Secure Messaging | To determine ease of use and usefulness of secure messaging. Purposive sample of 33 participants were assessed for their ability to complete the following tasks: navigate to Secure Messaging, log-in to My HealtheVet and Secure Messaging, Set user preferences, check Secure Message inbox, open and send Secure Message, Open and read Secure Message attachment. Measured as: (1) able to complete task; (2) able to complete task with some difficulty; (3) not able to complete task. | This user-testing method was conducted with the first purposive sample of 33 participants in phase 1 of the study. The random sample of 819 participants in phase 2 were not a part of the user-testing study method. | Posted | Number | participants | baseline |
|
2 years
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Purposive Sampling | Serious and other [non-serious] adverse events were not collected/assessed. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Jolie Haun | Center of Innovation on Disability and Rehabilitation Research | 813-558-7622 | jolie.haun@va.gov |
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Veterans were asked to report if improvements to the secure messaging system would make the tool more useful for use in the future. |
| baseline |
| Veteran Need for Education Support for My HealtheVet and Secure Messaging Use. | Veterans were asked to report if they would like to have education and support using My HealtheVet and the Secure Messaging tool. | baseline |
| Boston |
| Massachusetts |
| 02130 |
| United States |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Number of particpants with greater than or equal to high school education | Number | participants |
|
| Number of participants with annual income of $35,001 or more | Number | participants |
|
| OG001 | Purposive Sampling: Able to Complete Task With Difficulty | Veterans in this arm were able to complete task with some difficulty. |
| OG002 | Purposive Sampling: Not Able to Complete Task | Veterans in this arm were not able to complete the task. |
|
|
| Primary | Secure Messaging Use and Content Patterns | Extraction of secure messages over a three-month time frame to examine message content type, including: general, tests, medication, and appointments. | This method of secondary data collection was conducted with the purposive sample of 33 Veterans in phase 1 of the study. The random sample of 819 Veteran survey respondents in phase 2 were not included in this method of data collection. | Posted | Number | secure messages | 3 months | number messages | Participants |
|
|
|
| Primary | Frequency of Electronic Resource Use | Mail surveys examine Veterans frequency of electronic resource use. | This is a primary outcome for phase 2 of the study which was measured in random sample of 819 Veterans. The purposive sample of 33 Veterans from phase 1 was not included in this method of the study. | Posted | Number | participants | baseline |
|
|
|
| Primary | Reasons for Using Secure Messaging Tool on My HealtheVet | Participants reported reasons for Using Secure Messaging tool on My HealtheVet | This is a primary outcome for phase 2 of the study which was measured in random sample of 819 Veterans registered for My HealtheVet and opted in to use Secure Messaging. The sample of 33 Veterans from phase 1 was not included in this method of the study. | Posted | Number | participant | baseline |
|
|
|
| Primary | Benefits of Using Secure Messaging | Veterans report benefits of using Secure Messaging | This is a primary outcome for phase 2 of the study which was measured in random sample of 819 Veterans registered for My HealtheVet and opted in to use Secure Messaging. The sample of 33 Veterans from phase 1 was not included in this method of the study. | Posted | Number | participant | baseline |
|
|
|
| Primary | Intention to Use Secure Messaging in the Future | Veteran respondent intention to use Secure Messaging in the future | This is a primary outcome for phase 2 of the study which was measured in random sample of 819 Veterans registered for My HealtheVet and opted in to use Secure Messaging. The sample of 33 Veterans from phase 1 was not included in this method of the study. | Posted | Number | participant | baseline |
|
|
|
| Primary | Veterans That Believed Improvements to the Secure Messaging System Would Make the Tool More Useful in the Future Are Presented in the Table. | Veterans were asked to report if improvements to the secure messaging system would make the tool more useful for use in the future. | This is a primary outcome for phase 2 of the study which was measured in random sample of 819 Veterans registered for My HealtheVet and opted in to use Secure Messaging. The sample of 33 Veterans from phase 1 was not included in this method of the study. | Posted | Number | participant | baseline |
|
|
|
| Primary | Veteran Need for Education Support for My HealtheVet and Secure Messaging Use. | Veterans were asked to report if they would like to have education and support using My HealtheVet and the Secure Messaging tool. | This is a primary outcome for phase 2 of the study which was measured in random sample of 819 Veterans registered for My HealtheVet and opted in to use Secure Messaging. The sample of 33 Veterans from phase 1 was not included in this method of the study. | Posted | Number | participant | baseline |
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | Random Sampling | Serious and other [non-serious] adverse events were not collected/assessed. | 0 | 0 | 0 | 0 |
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| Title | Measurements |
|---|
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| Medication |
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| Other: System Related not Content Related |
|
| Title | Measurements |
|---|---|
|
| Using secure messaging 6 months or longer |
|
| Use secure messaging at least once a year |
|
| Use secure messaging at least once a month |
|
| Title | Measurements |
|---|---|
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| Test results |
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| Health related questions |
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| Sensitive health topics |
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| Title | Measurements |
|---|---|
|