J. Med. Internet Res. - Personal health record reach in the Veterans Health Administration: a cross-sectional analysis.


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CKGROUND: My HealtheVet (MHV) is the personal health record and patient portal developed by the United States Veterans Health Administration (VA). While millions of American veterans have registered for MHV, little is known about how a patient's health status may affect adoption and use of the personal health record.OBJECTIVE: Our aim was to characterize the reach of the VA personal health record by clinical condition.METHODS: This was a cross-sectional analysis of all veterans nationwide with at least one inpatient admission or two outpatient visits between April 2010 and March 2012. We compared adoption (registration, authentication, opt-in to use secure messaging) and use (prescription refill and secure messaging) of MHV in April 2012 across 18 specific clinical conditions prevalent in and of high priority to the VA. We calculated predicted probabilities of adoption by condition using multivariable logistic regression models adjusting for sociodemographics, comorbidities, and clustering of patients within facilities.RESULTS: Among 6,012,875 veterans, 6.20% were women, 61.45% were Caucasian, and 26.31% resided in rural areas. The mean age was 63.3 years. Nationwide, 18.64% had registered for MHV, 11.06% refilled prescriptions via MHV, and 1.91% used secure messaging with their clinical providers. Results from the multivariable regression suggest that patients with HIV, hyperlipidemia, and spinal cord injury had the highest predicted probabilities of adoption, whereas those with schizophrenia/schizoaffective disorder, alcohol or drug abuse, and stroke had the lowest. Variation was observed across diagnoses in actual (unadjusted) adoption and use, with registration rates ranging from 29.19% of patients with traumatic brain injury to 14.18% of those with schizophrenia/schizoaffective disorder. Some of the variation in actual reach can be explained by facility-level differences in MHV adoption and by differences in patients' sociodemographic characteristics (eg, age, race, income) by diagnosis.CONCLUSIONS: In this phase of early adoption, opportunities are being missed for those with specific medical conditions that require intensive treatment and self-management, which could be greatly supported by functions of a tethered personal health record.

Resumo Limpo

ckground healthevet mhv person health record patient portal develop unit state veteran health administr va million american veteran regist mhv littl known patient health status may affect adopt use person health recordobject aim character reach va person health record clinic conditionmethod crosssect analysi veteran nationwid least one inpati admiss two outpati visit april march compar adopt registr authent optin use secur messag use prescript refil secur messag mhv april across specif clinic condit preval high prioriti va calcul predict probabl adopt condit use multivari logist regress model adjust sociodemograph comorbid cluster patient within facilitiesresult among veteran women caucasian resid rural area mean age year nationwid regist mhv refil prescript via mhv use secur messag clinic provid result multivari regress suggest patient hiv hyperlipidemia spinal cord injuri highest predict probabl adopt wherea schizophreniaschizoaffect disord alcohol drug abus stroke lowest variat observ across diagnos actual unadjust adopt use registr rate rang patient traumat brain injuri schizophreniaschizoaffect disord variat actual reach can explain facilitylevel differ mhv adopt differ patient sociodemograph characterist eg age race incom diagnosisconclus phase earli adopt opportun miss specif medic condit requir intens treatment selfmanag great support function tether person health record

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