Use of My HealtheVet patient web portal among veterans seen for diabetes mellitus at a medical center in the southeastern United States
Original Article

Use of My HealtheVet patient web portal among veterans seen for diabetes mellitus at a medical center in the southeastern United States

Steven S. Coughlin1,2, Laura D. Carbone2,3, Vahé Heboyan1, Lovoria B. Williams4, Christos Hatzigeorgiou5, Pavani Rangachari6, Gianluca De Leo1

1Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, USA;2Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA;3Division of Rheumatology, Medical College of Georgia, 4Department of Biobehavioral Nursing, College of Nursing, 5Division of General Internal Medicine, Medical College of Georgia, 6Office of the Associate Dean for Practice and Community Health, College of Allied Health Sciences, Augusta University, Augusta, GA, USA

Contributions: (I) Conception and design: SS Coughlin; (II) Administrative support: G De Leo; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: SS Coughlin; (V) Data analysis and interpretation: V Heboyan; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Dr. Steven S. Coughlin, PhD, MPH. Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, 1120 15th Street, EC-4324, Augusta, GA 30912, USA. Email: scoughlin@augusta.edu.

Background: An increasing number of studies have examined the use of information technology to improve diabetes care and patient self-management. The goal of the current study was to determine the number of veterans seen for diabetes at a large medical center in the southeastern region of the U.S. and to examine whether they had registered for VA’s My HealtheVet patient web portal according to selected characteristics.

Methods: Existing patient records were reviewed including My HealtheVet web portal registration by veterans treated for diabetes (ICD-10 code for type 2 diabetes) at the Charlie Norwood VAMC. Number of outpatient clinic patients seen for diabetes who had or had not registered for My HealtheVet were examined by age categories, sex, race, Hispanic ethnicity, and era of military service.

Results: A total of 49,341 veterans receive care at the Charlie Norwood VAMC. Of those patients, 10,950 have been seen for diabetes. Of the 49,341 patients, 21,372 patients (43.3%) are using My HealtheVet and 10,465 patients (21.2%) have used secure messages. Of 10,950 diabetic patients, only 1,256 (11.5%) have registered for My HealtheVet. Women with diabetes were more likely to be registered for My HealtheVet than their male counterparts [13.92% vs. 11.24%; odds ratio (OR)=1.28; 95% confidence interval (CI): 1.05–1.55). Veterans with diabetes who served during WW II or the Korean War were less likely to use My HealtheVet than those who served during more recent eras (OR=0.33; 95% CI: 0.24–0.44). Use of the patient portal was highest among diabetic patients ages 51–55 years (15.6%).

Conclusions: A low percentage of Veterans with diabetes are active users of My HealtheVet. Studies are needed to identify My HealtheVet portal design features and veteran characteristics that will increase use of this patient portal which may improve diabetes care.

Keywords: Diabetes; electronic health record; glycemic control; health information technology; patient web portals; veterans

Received: 01 August 2017; Accepted: 12 October 2017; Published: 06 November 2017.

doi: 10.21037/mhealth.2017.10.02

Introduction

The Veterans Health Administration (VHA) estimated that one in four veterans in the U.S. have diabetes. Over 30 million Americans had diabetes in 2015 (1). Potential complications of diabetes include kidney failure, heart attack, lower-limb amputations, and blindness (2). Good glycemic control is associated with better patient outcomes, but almost half of patients with type 2 diabetes do not achieve glycemic control, or cholesterol or blood pressure control (3-5).

In type 2 diabetes, effective patient-provider communication and patient self-management is associated with the improved management of side effects, monitoring of blood test results, and screening for potential complications (6). Patients’ who are more knowledgeable about their risk factor levels have been shown to have improved clinical outcomes (7,8). When a collaborative relationship exists between patients and their health care providers, clinical outcomes tend to be improved (9,10).

Patient portals, personal health records and electronic medical records provide opportunities to leverage information technology to improve chronic disease management and outcomes (11,12). In 2003, VHA introduced My HealtheVet, an internet-based patient portal containing a personal health record. My HealtheVet is connected to their VHA electronic medical record and allows several functions such as online prescription refills or self-entry in food or physical activity journals. The VHA deployed the Blue Button feature in 2010 as part of its online combined personal health record and patient portal, My HealtheVet. The Blue Button allows patients to access components of their electronic health record such as medications, laboratory results, procedures, vitals, and past and future appointments. The introduction of patient web portals and personal health records constitute an important development in diabetes care. Patients with diabetes and other chronic illnesses can now view health information such as medications, laboratory results, and patient education.

The goal of the current feasibility study was to determine the number of veterans seen for type 2 diabetes at a large medical center in the southeastern region of the U.S. and to examine whether they had registered for the My HealtheVet patient web portal according to age, sex, race, Hispanic ethnicity, and era of military service.

Methods

The current study was conducted as “preparatory to research” in support of a grant application for a larger and more detailed proposed study. Prior to a review of computerized patient records (CPRs), a determination was made by the director of the institutional review board (IRB) office and the Associate Chief of Staff for Research that the study was exempt from IRB review. One of the authors (SS Coughlin) met with key informants including the coordinator of the My HealtheVet office at the Charlie Norwood VAMC and the nurse diabetes educator. Existing patient records were reviewed including My HealtheVet web portal registration by veterans treated for type 2 diabetes (ICD-10 code E-11) at the Charlie Norwood VAMC. De-identified number of outpatient clinic patients seen for diabetes were examined by age categories, sex, race, Hispanic ethnicity, and era. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using EpiInfo version 7.2.0.1.

Results

A total of 49,341 veterans receive care at the Charlie Norwood VAMC. Of those patients, 10,951 have been seen for type 2 diabetes (mean age 65.47 years). Of the 49,341 patients, 21,372 patients (43.3%, mean age 63.89 years) are using My HealtheVet and 10,465 patients (21.2%) use secure messages. Of 10,950 diabetic patients, only 1,256 (11.5%) have registered for My HealtheVet (Table 1). Women with diabetes were more likely to be registered for My HealtheVet than their male counterparts (13.92% vs. 11.24%; OR=1.28; 95% CI: 1.05–1.55), as shown in Table 2. Veterans with diabetes who served during WW II or the Korean War were less likely to use My HealtheVet than those who served during more recent eras (OR=0.33; 95% CI: 0.24–0.44). Use of the patient portal was highest among diabetic patients ages 51–55 years (15.59%).

Table 1
Table 1 Characteristics of veterans seen for type 2 diabetes at the Charlie Norwood VA medical center in Augusta, Georgia according to whether or not they had registered for My HealtheVet
Full table
Table 2
Table 2 OR and 95% CI for associations between selected characteristics of veterans seen for type 2 diabetes at the Charlie Norwood VA Medical Center in Augusta, Georgia and Registration for My HealtheVet
Full table

Discussion

The current study indicates that use of the My HealtheVet web portal among veterans seen for diabetes at a large medical center in the southeastern U.S. is very low. Although My HealtheVet includes a feature that allows diabetic patients to type in their blood glucose results, graph it, and forward this information to their provider at the VAMC, few patients take advantage of this resource. Veterans who meet with the My HealtheVet coordinator are provided with a copy of the VA My HealtheVet Handbook and are asked to sign a form authorizing their electronic medical record to be linked to their My HealtheVet account. The coordinator does not screen veterans for computer literacy. When patients are seen at outpatient clinics, a clinical reminder in the CPRs prompts the nurse, physician, or clinic clerk to remind the veteran to register for My HealtheVet if they have not already registered. Veterans receive prompts to register for My HealtheVet on patient letters and from the VAMC pharmacy and Facebook account.

A limited number of studies have examined the use of patient web portals for diabetes health care (13). Few of these studies have been conducted at VA healthcare facilities. Although results-to-date have been mixed, results from prior studies suggest that secure messaging between diabetes patients and their clinician is associated with improved disease management (13). Improvements in low density lipoprotein (LDL) cholesterol and blood pressure have also been observed in some studies of web portals for patients with diabetes (6). The patient web portal features that may improve diabetes care (e.g., secure messaging or patient education) have not been clearly identified by published studies. Previous studies show that diabetic patients often do not use web portals, when offered, perhaps because of computer illiteracy or a lack of internet access (14).

With respect to limitations, the current study did not examine the specific reasons that diabetes patients had registered for My HealtheVet or whether they used it over time. Future studies should examine whether veterans who use My HealtheVet for secure messaging are active secure message users or whether they send secure messages to their provider only rarely. A further limitation is that the current study was cross-sectional in nature and lacked information about the temporal relationship between treatment for diabetes and My HealtheVet registration. The current study examined prevalent cases of diabetes which could have been diagnosed recently or in the past. In addition, no information was available about computer literacy and health literacy. Health illiteracy is frequent among diabetes patients and can impair diabetes management (15-18). Patients with lower computer literacy may have difficulty learning how to use a web portal (12,15) suggesting the need for educational programs.

Previous studies of the use of My HealtheVet or Blue Button by veterans with diabetes (6,19), or veterans with diabetes or other chronic health conditions have been cross-sectional surveys (19-21) or a retrospective cohort (observational) study design (5) and have not employed a prospective randomized controlled trial design. A low percentage of Veterans with diabetes are active users of My HealtheVet. Additional studies are needed to identify My HealtheVet portal design features and veteran characteristics that will increase use of this patient portal which may improve diabetes care.

Acknowledgements

None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Disclaimer: The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government.

References

  1. CDC. National Diabetes Statistics Report, 2017. Estimates of Diabetes and Its Burden in the United States. Available online: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
  2. CDC. Diabetes. Available online: https://www.cdc.gov/chronicdisease/resources/publications/aag/diabetes.htm
  3. Ali MK, Bullard KM, Saaddine JB, et al. Achievements of goals in U.S. diabetes care, 1999-2010. N Engl J Med 2013;368:1613-24. [Crossref] [PubMed]
  4. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adjults with previously diagnosed diabetes. JAMA 2004;291:335-42. [Crossref] [PubMed]
  5. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003;348:383-93. [Crossref] [PubMed]
  6. Shimada SL, Allison JJ, Rosen AK, et al. Sustained use of patient portal features and improvements in diabetes physiological measures. J Med Internet Res 2016;18:e179. [Crossref] [PubMed]
  7. Heisler M, Piette JD, Spencer M, et al. The relationship between knowledge of recent HbA1c values and diabetes care understanding and self-management. Diabetes Care 2005;28:816-22. [Crossref] [PubMed]
  8. Berikai P, Meyer PM, Kazlauskaite R, et al. Gain in patients’ knowledge of diabetes management targets is associated with better glycemic control. Diabetes Care 2007;30:1587-9. [Crossref] [PubMed]
  9. Anderson RM, Funnell MM, Butler PM, et al. Patient empowerment. Results of a randomized controlled trial. Diabetes Care 1995;18:943-9. [Crossref] [PubMed]
  10. Rachmani R, Levi Z, Slavachevski I, et al. Teaching patients to monitor their risk factors retards the progression of vascular complications in high-risk patients with type 2 diabetes mellitus: a randomized prospective study. Diabet Med 2002;19:385-92. [Crossref] [PubMed]
  11. Ricciardi L, Mostashari F, Murphy J, et al. A national action plan to support consumer engagement via e-health. Health Aff (Millwood) 2013;32:376-84. [Crossref] [PubMed]
  12. Coughlin SS, Prochaska JJ, Williams LB, et al. Patient web portals, disease management, and primary prevention. Risk Manag Healthc Policy 2017;10:33-40. [Crossref] [PubMed]
  13. Coughlin SS, Williams LB, Hatzigeorgiou C. A review of studies of web portals for patients with diabetes mellitus. mHealth 2017;3:23. [Crossref] [PubMed]
  14. Wade-Vuturo A. mayberry LS, Osborn CY. Secure messaging and diabetes management: experiences and perspectives of patient portal users. J Am Med Inform Assoc 2013;20:519-25. [Crossref] [PubMed]
  15. Sarkar U, Karter AJ, Liu JY. The literacy divide: health literacy and the use of an Internet-baed patient portal in an integrated health system—results from the Diabetes Study of Northern California (DISTANCE). J Health Commun 2010;15 Suppl 2:183-96. [Crossref] [PubMed]
  16. Tutino GE, Yang WY, Li WH, et al. A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with Type 2 diabetes. Diabet Med 2017;34:440-50. [Crossref] [PubMed]
  17. Morris NS, MacLean CD, Littenberg B. Literacy and health outcomes: a cross-sectional study in 1002 adults with diabetes. BMC Fam Pract 2006;7:49. [Crossref] [PubMed]
  18. Cavanaugh K, Huizinga MM, Wallston KA, et al. Association of numeracy and diabetes control. Ann Int Med 2008;148:737-46. [Crossref] [PubMed]
  19. Cho AH, Arar NH, Edelman DE, et al. Do diabetic veterans use the Internet? Self-reported usage, skills, and interest in using My HealtheVet Web portal. Telemed J E Health 2010;16:595-602. [Crossref] [PubMed]
  20. Turvey CL, Zulman DM, Nazi KM, et al. Transfer of information from personal health records: a survey of veterans using My HealtheVet. Telemed J E Health 2012;18:109-14. [Crossref] [PubMed]
  21. Turvey C, Klein D, Fix G, et al. Blue Button use by patients to access and share health record information using the Department of Veterans Affairs online patient portal. J Am Med Inform Assoc 2014;21:657-63. [Crossref] [PubMed]
doi: 10.21037/mhealth.2017.10.02
Cite this article as: Coughlin SS, Carbone LD, Heboyan V, Williams LB, Hatzigeorgiou C, Rangachari P, De Leo G. Use of My HealtheVet patient web portal among veterans seen for diabetes mellitus at a medical center in the southeastern United States. mHealth 2017;3:50.

Article Options

Download Citation

Share