MyHealtheVet Information System Analysis and Improvement Proposals
Dwayne D. Watson
American Public University System
MyHealtheVet Information System Analysis and Improvement Proposals
Tested on a pilot program in the late 1990’s, and launched in 2003 by the Department of Veterans Affairs the MyHealtheVet (MHV) system has currently undergone several changes. In 2009 appropriations were requested by the Honorable Robert T. Howard for the better development of IT. The request for $2.442 billion dollars was to go toward continued development, operations, and maintenance. The approved request helped to move the Veterans Administration Information Technology (VA IT) management systems toward a centralized system. The MHV Information System (IS) portal has now become a huge web-based public-cloud, hosted by a third party to improve performance and meet the needs of the current veteran populous using the portal. Improvements over the years have been developed to enhance and manage veteran healthcare requirements. The MHV system can now be accessed with practically any type of device as long as an internet connection is available. The Veterans Administration (VA) has even developed apps for use on smartphones so that the patient could access their medical records while away from the home computer system.
With technological advances, happening every day the VA had the responsibility to develop a user-friendly electronic health record system (EHR) that could support both patients and practitioners with health needs. The patient could access the system with only the basics of hardware and software requirements, and a printer if needed. Not only does the MHV portal provide patient access to electronic medical records (EMR), it has now become a Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirement to convert all medical records to a digital format and away from the old paper style. Research and exploration into the client and server sides of MyHealtheVet system will reveal requirements of hardware, software, an analysis of the system and possible improvements with solutions to the MyHealtheVet portal which could prove to be an even more effective healthcare portal.
Server-Side Hardware Requirements
The server-side hardware requirements of the MyHealtheVet information system, include but are not limited to a data warehouse, with several machines complementing the entirety of the system. The system is a “cloud-based” portal system which was upgraded in 2014 from the old storage capable servers and drivers which were costly, provided poor performance, and took up valuable business space. Once the Veterans Administration decided to utilize a cloud-based portal a host was needed to boost the performance and scalability. That host is now provided by Verizon Terremark.
Since I am not privy to specific information about the server-side hardware, I can only assume that there is some type of high-performance rack-mounted servers located somewhere safe to store all the data coming in and out of the system. Standard cloud infrastructure components “include multi-socket, multicore servers, persistent storage and local area network (LAN) equipment, such as switches and routers—but on a much greater scale” (“What is cloud infrastructure? – Definition from WhatIs.com”, 2017). Information and research suggest that MHV cloud servers would most likely use an attached storage setup. These are typically both solid state drives (SSDs) and hard disk drive (HDDs) which are designed for specifically designated scenarios, such as an object, big data or block. Although research shows that a cloud-based system is in place for the MHV system, it is unknown whether it is a public, private or hybrid cloud architecture. Because the MHV system is cloud-based it is likely that some type of backup storage device is used to prevent the loss of veteran’s information. Examples of these backup devices include virtual server backup, disk, disk-to-tape storage, cloud-to-cloud backup, and possibly magnetic tape. It is conceivable that since there are approximately over a three million users on the MHV system that a group of servers are housed in a single location and act as a cluster or server farm for the operation. It is also probable that a Web farm is required to handle user request.
Server-Side Software Requirements
The software being used by the Veterans Administration is unavailable, however, there are many different software services on the market which could be utilized. For example, MediTouch is an EHR software suite of electronic health records and practice management tools designed for the web-based system. ChartLogic EHR and EMR (electronic medical record) are suites that offer the same kind of web-based software that is being used by the Veterans Administration. ChartLogic offers practice management, e-prescribing, patient portal, electronic charting capabilities and medical history and patient notes that are viewable by the practitioner. There are many other brands (“eClinicalWorks, Allscripts, Greenway, Aprima”)(Loria,2017), of suitable software for small to large medical practices. The greater the client and patient numbers will dictate the need for specific software.
Software-as-a-Service (SaaS), has now become very popular among the medical community. SaaS systems provide security dependability and interactive capabilities that were unavailable just years ago. A browser-based system is one that uses the internet to access the information needed by the patient or practitioner. This is probably the type the MHV system uses because it can be accessed from anywhere and always look the same.
Client-Side Hardware Requirements
The client-side hardware requirements of the of the MyHealtheVet information system can be accessed from almost any type of device. Desktop computers, laptop computers, tablets, smartphones, and other handheld computing devices are the common machine used for access to the system. Additionally, several types of data storage can be used such as optical, solid state drives, external drives, and flash drives. Flash drives are a popular storage device because the data can be downloaded, saved, and taken anywhere and then accessed when needed without an internet connection.
There is, however, an additional piece of hardware that is being used and that is the kiosks. Many of the Veterans healthcare facilities have installed theses kiosks for the patient to log in for appointments, update information, and print out future appointments. There really is not any special types of hardware that a user needs to access the MHV portal. However, if medical records, appointments or anything else needed to be printed a printer would be required. Although this system is used by members of the military it does not require a Common Access Card (CAC) reader to access the MHV portal. Since MHV is a cloud-based system one must have internet service to access the system.
Client-Side Software Requirements
Competitive Analysis of the System
The MyHealtheVet (MHV) information system does provide a competitive advantage over face-to-face medical care. MHV is a web-based cloud system that allows for access by the patient and practitioner to have interaction with one another between appointments, order prescription refills and much more. Personal health records (PHR) and the internet have now become a vital role in healthcare. The MHV portal provides an advantage over other healthcare systems by reducing the cost of hardware, software, and IT support. MHV is a comprehensive web-based information system required by current HIPAA regulations. MHV IS retains a competitive edge because of its ease of use, secure messaging, and online prescription refills. Also, with this system comes the “Blue Button”(Bailey, 2010) which allows the patient to download PHRs to a hard drive, flash drive or print them out with a printer. MHV IS is protected with software to prevent the theft of its information and with a user log-in and password start page or Department of Defense self-service log on.
Research has shown that 80-90% of individuals that were surveyed about the importance of access to PHRs responded positively showing concern to track their own health, reduce redundancy, and checking for mistakes. “Overall, 96% of respondents indicated that they think it is important for individuals to be able to access all of their own medical records to manage their own health” (Nazi, 2010). This availability to access personal medical history has become even more prevalent in the current years. This is due to the increased use of the internet by veterans and the desire to manage one’s own medical history and health.
The MHV IS is constantly collecting data and formulating an analysis of that data to better improve the system for its users. In addition to collecting data for analysis, the system is continuously monitored and recording activity on the “system to protect the system and its information and may use that monitoring information for official administrative or legal purposes”(“User Login – My HealtheVet”, 2018). Ongoing analysis of the data entered to the MHV IS by either the patient or practitioner is used to provide a positive productive IS so that the server side of the system can continuously be updated without too much interruption to the service.
The analysis findings for a competitive advantage of the MyHealtheVet IS is founded on information gathered and research conducted to hypothesize that the system is of great worth to the Veterans Health Administration and to the patients who use it as well.
Recommendations for Improving the System
To begin, one possible improvement to the MHV system is to redevelop the prescription tracking section. A common problem is the current tracking of medications through the United States Postal Service (USPS). This problem includes how the delivery tracking of prescriptions remain in the MHV system far beyond its arrival to the patient. There is no way to delete the delivery status once the patient takes possession of the prescription. This small detail could inherently have a catastrophic effect if the patient had to refill the same prescription. The prescription refill tab will not allow the patient to refill a prescription that is currently out for delivery or that has not been removed from the system and noted as received. VHA recommends that the patient refill medications at least two weeks before the prescription runs out and in most cases submit a refill request once the prescription is delivered, to prevent any break in the taking of prescribed medications.
One proposal to remedy the problem of delayed deletion of delivered prescriptions is simply to add a received or delete button to the refill section of MHV. By placing a click button next to the tracking information the patient has the ability to make an annotation that delivery has been made to them. However, if the patient fails to click the received button the system will automatically revert back to a default deletion time frame as indicated by the VA. This new addition to the system would benefit both the Administration and the patient. This data would enable the VA pharmacy to effectively track medications traveling via the USPS and would verify that the veteran that ordered the refill actually received the refill. In addition, this data can be used to determine if the patient is abusing the use of medications or selling them.
Secondly, the information under the “Track Health” section is only information input by the patient. This patient information includes blood pressure, heart rate, body weight, body temperature, pain levels, blood sugar, cholesterol, and pulse. This information is also accessible elsewhere within the MHV system, however, it is not convenient for the patient to bounce back and forth from the Blue Button medical reports to input the information from the visit to the provider when the information is already established elsewhere in the system. This is redundant and should be simplified. The information should have the capability to be input from both medical provider and patient.
Since the information is already entered into the PHRs by the medical provider, it should be able to sync and populate with patient-entered data automatically as it is entered. This data should indicate who entered the data with an acronym or another method so when it is viewed the viewer will know who input the data. Another advantage of this proposal is that it creates a system of checks and balances with information being entered into the database. Humans are not invulnerable to mistakes, so this would allow for a more user-friendly way for the patient to monitor their information entered by the medical provider.
Thirdly, add a virtual nurse to the system without redirection to an outside website. Include the virtual nurse button to the home page for easy access. This virtual nurse would be able to answer common medical questions and concerns immediately providing the most up to date remedies and possible analyses in both written text and recorded voice implementation. Technology is advancing every day in the direction of virtual, phone, email, chat and video conferencing. “Kaiser Permanente has a service called KP OnCall that provides “24/7 integrated programs in remote care management or ‘telehealth’ to providers, payers, and employers”(Burman, 2018). Although this virtual nurse cannot currently “diagnose” a patient they can triage them based on the information provided by the patient and make suggestions to the patient on what actions to take next.
The virtual nurse is one possible solution, but a virtual nurse avatar is another. This is a nurse that takes information and analysis it through programmed algorithms and other software tools to assist in “facilitating check-ins for patients and coaching patients as they make lifestyle changes”…” can perform some nursing tasks in an acceptable manner, they are limited in their ability to make complex judgments and engage in collaboration” (Abbott & Shaw, 2016). The virtual nurse avatar is not a new concept, it has been around for several years. The introduction to virtual nursing or a virtual nurse avatar embedded in the MHV system would bring the veteran patient into a comfort zone not associated with an actual person. Studies show that subjects who interact with nurse avatars, (44%), would rather have interaction with the avatar than with the person.
Technology is headed toward the science fiction realm such as in the movies where a hologram and robot will diagnose and treat medical issues. This would be a step closer for the VA and the MyHealtheVet system bring veteran patients into the future.
The MyHealtheVet system has become a prodigious asset to both the client/ patient and the Veterans Health Administration. It has allowed for the patient and practitioner to communicate without physically being present. With its ease of access and user-friendliness, the system can be navigated with only a few clicks of a mouse. Although the internet is required to access the MHV, a simple machine or device such as a smartphone can be used with the most basic of software and apps.
As technology advances so will the MHV IS. This, however, can be examined by taking what the system already is and adding additional tabs, software, data analysis programs and the availability of a virtual nurse or avatar nurse. Though the MHV IS is a well-developed system, there is always room for improvement within the operating processes. The proposal of data amalgamation from provider and patient would provide a more accommodating web site. The advancement to a received or / delete button to the prescription refill tracking information would postulate the correct information flow between patient and provider.
Finally, the introduction of a virtual nurse on the home page of MHV would bring the VA into the cutting edge of the virtual world of technology, thus reducing patient return visits, aiding the human nurse staff, and providing a friendly and compassionate virtual entity in which to discuss medical issues.
The overall final analysis of the MyHealtheVet IS is one that has become vital to the operation of the VA and its patients with simplicity and useful information and data storage. Other than providing the three previously proposed options, there really is no other better IS that could be used in the way that it is currently being applied.
Abbott, M., & Shaw, P. (2016). Virtual Nursing Avatars: Nurse Roles and Evolving Concepts of Care. OJIN: The Online Journal of Issues In Nursing, 21(3). http://dx.doi.org/DOI: 10.3912/OJIN.Vol21No03PPT39,05
Bailey, L. (2010). Shedding Some Light on VA’s Blue Button. VAntage Point. Retrieved from http://www.blogs.va.gov/VAntage/666/shedding-some-light-on-vas-blue-button/
Burman, S. (2018). Virtual Nursing – Nursing Field of the Future?. NursingLink. Retrieved 13 January 2018, from http://nursinglink.monster.com/education/articles/3032-virtual-nursing-nursing-field-of-the-future
Houston, T., Volkman, J., Feng, H., Nazi, K., Shimada, S., & Fox, S. (2013). Veteran Internet Use and Engagement With Health Information Online. Military Medicine, 178(4), 394-400. http://dx.doi.org/10.7205/milmed-d-12-00377
Howard, R. (2008). VA Testimony of Robert Howard before Congress on April 3, 2008 – Congressional and Legislative Affairs. Va.gov. Retrieved 12 January 2018, from https://www.va.gov/OCA/testimony/hac/smqlva/080403IT.asp
Jensen, J. (2017). VA My HealtheVet | KRM Associates Inc. KRM Associates Inc. Retrieved 12 January 2018, from https://www.krminc.com/portfolio/va-my-healthevet/
Loria, G. (2017). Best Cloud-Based EMR Software – 2018 Reviews & Pricing. Softwareadvice.com. Retrieved 12 January 2018, from https://www.softwareadvice.com/medical/web-based-emr-software-comparison/#buyers-guide
Nazi, K. (2010). Veterans’ voices: use of the American Customer Satisfaction Index (ACSI) Survey to identify My HealtheVet personal health record users’ characteristics, needs, and preferences. Journal Of The American Medical Informatics Association, 17(2), 203-211. http://dx.doi.org/10.1136/jamia.2009.000240
User Login – My HealtheVet. (2018). Myhealth.va.gov. Retrieved 13 January 2018, from https://www.myhealth.va.gov/mhv-portal-web/user-login
What is cloud infrastructure? – Definition from WhatIs.com. (2017). SearchCloudComputing. Retrieved 12 January 2018, from http://searchcloudcomputing.techtarget.com/definition/cloud-infrastructure
Yasin, R. (2015). MyHealtheVet cloud-based portal redesign underway. Federal Times. Retrieved 12 January 2018, from https://www.federaltimes.com/it-networks/cloud/2015/06/29/myhealthevet-cloud-based-portal-redesign-underway/