MyMy Health Healtheevet for vet for Communication & Social Communication & Social

Marketing Marketing

Keith McInnes & Allen GiffordKeith McInnes & Allen Gifford

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CollaborationCollaborationQUERI HIV / HepatitisQUERI HIV / HepatitisSteve AschSteve AschBarbara BokhourBarbara BokhourJane BurgessJane BurgessLinda McCoyLinda McCoyJeff SolomonJeff Solomon

Public Health Strategic Healthcare Group (PHSHG)Public Health Strategic Healthcare Group (PHSHG)Jane BurgessJane BurgessDavid RossDavid Ross

Consumers Health Informatics Office / MHVConsumers Health Informatics Office / MHVKim NaziKim Nazi

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MHV

QUERI

PHSHG

Working in Area of OverlapWorking in Area of Overlap

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OverviewOverview

ObjectivesObjectives BackgroundBackground MethodsMethods Patient focus group resultsPatient focus group results Provider focus group resultsProvider focus group results SummarySummary Future directionsFuture directions

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ObjectivesObjectives

Assess veteran & provider attitudes about use Assess veteran & provider attitudes about use of MHV to broadcast emails with public health of MHV to broadcast emails with public health messages; special interest in HIV screeningmessages; special interest in HIV screening

Evaluate patient and provider reactions to Evaluate patient and provider reactions to messages contentmessages content

Refine message in preparation for broadcasting Refine message in preparation for broadcasting

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BackgroundBackground

MyMy Health Healtheevet allows registrant to enter vet allows registrant to enter personal email addresspersonal email address

Checkbox indicating interest in receiving Checkbox indicating interest in receiving health messages via emailhealth messages via email

Approximately 300,000 vets both Approximately 300,000 vets both provided email and indicated interest in provided email and indicated interest in email health messagesemail health messages

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MethodsMethods

QUERI RRP fundingQUERI RRP funding 4 total focus groups (2 with pts; 4 total focus groups (2 with pts;

2 with providers)2 with providers)– First round focus groups (2)First round focus groups (2)– Analysis & develop message contentAnalysis & develop message content– Second round focus groups (2)Second round focus groups (2)– Analysis & refine message contentAnalysis & refine message content

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Patient ThemesPatient Themes

Lack of Clarity about MHVLack of Clarity about MHV – about what about what MyMy Health Healthevevet iset is– type of registration gives which functionstype of registration gives which functions

““I know about the [I know about the [MyMy Healthevet site], but I Healthevet site], but I haven't done it. Are you telling me, in other haven't done it. Are you telling me, in other words, if I sign up for this password and all words, if I sign up for this password and all that stuff, I can get my medical records via that stuff, I can get my medical records via the Internet?”the Internet?”

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Patient ThemesPatient ThemesDiffusion of Innovation?Diffusion of Innovation?

A:A: Oh, yeah, I use the Internet. But I also use the Oh, yeah, I use the Internet. But I also use the VA site, primarily for prescription refills. VA site, primarily for prescription refills. It's so It's so convenient.convenient.

B:B: Prescription refills are terriblePrescription refills are terrible, because you , because you only get the prescription number. They don’t give only get the prescription number. They don’t give you what it is. So you have to have a separate you what it is. So you have to have a separate list to cross-reference.list to cross-reference.

A:A: They’ve changed that now. They’ve got the They’ve changed that now. They’ve got the name of the medication.name of the medication.

B:B: No, they haven't. Not on mine, they don’t! No, they haven't. Not on mine, they don’t!

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Patient ThemesPatient ThemesTrust: Provider instructions carry special weightTrust: Provider instructions carry special weight

““I would say if it came from the VA, just the VA site, I I would say if it came from the VA, just the VA site, I would have the tendency more than likely to delete would have the tendency more than likely to delete that sort of thing, unless I was interested. But if it that sort of thing, unless I was interested. But if it came from my healthcare provider saying came from my healthcare provider saying ‘Your ‘Your healthcare provider, your doctor has suggested that healthcare provider, your doctor has suggested that you be tested for X, Y, and Z,’you be tested for X, Y, and Z,’ then that's a different then that's a different story. But just to have a blanket email from the VA story. But just to have a blanket email from the VA saying everybody should get tested -- I don’t think it saying everybody should get tested -- I don’t think it will sit as well as a personal note saying, ‘Look, your will sit as well as a personal note saying, ‘Look, your doctor suggests you have this test.’"doctor suggests you have this test.’"

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Patient ThemesPatient Themes

NuisanceNuisance

“…“…if you just send me to my open mail, I'll if you just send me to my open mail, I'll probably delete it, without opening it. probably delete it, without opening it. Because I'm not looking for it. I'm going on Because I'm not looking for it. I'm going on line for something else. I'm doing other line for something else. I'm doing other things. I don’t want to read about that. things. I don’t want to read about that. Don’t bother me. It's more of the same Don’t bother me. It's more of the same coming in that I probably delete a chunk, coming in that I probably delete a chunk, probably 20, 30 messages a day.”probably 20, 30 messages a day.”

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Patient ThemesPatient ThemesSecurity / Confidentiality around HIV ContentSecurity / Confidentiality around HIV Content

““I've given away computers …to people who I've given away computers …to people who never had one. [The new owner ] can get never had one. [The new owner ] can get into your mainframe, as you folks may into your mainframe, as you folks may know. They can find stuff that you left in know. They can find stuff that you left in there. I'm not taking that chance, HIV. I'm there. I'm not taking that chance, HIV. I'm very careful about what goes in my very careful about what goes in my computer. I have a disk that I put everything computer. I have a disk that I put everything on. I don’t let it go on my mainframe. But on. I don’t let it go on my mainframe. But some stuff goes in there. You think I want to some stuff goes in there. You think I want to take a chance and let HIV go in there? And take a chance and let HIV go in there? And they accidentally find it? Hell, no!” they accidentally find it? Hell, no!”

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Patient ThemesPatient Themes

Alternatives to EmailAlternatives to Email Email: “Important message at MHV”Email: “Important message at MHV”

– ““Just tell me to go to Just tell me to go to MyMy Health Healtheevet website, vet website, log in and I get messages there. I'd rather see log in and I get messages there. I'd rather see a message there than coming into [my a message there than coming into [my personal email]”personal email]”

Use of posters in clinicsUse of posters in clinics Inserts with appointment reminder lettersInserts with appointment reminder letters

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Patient ThemesPatient Themes

Message Content SuggestionsMessage Content Suggestions Factual information about HIVFactual information about HIV Story of Magic JohnsonStory of Magic Johnson Emphasize that all be testedEmphasize that all be tested Appeal to altruism – help other vetsAppeal to altruism – help other vets Cite authorities, such as CDCCite authorities, such as CDC

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Provider ThemesProvider Themes

Email about HIV would worry patientsEmail about HIV would worry patients

“… “… there is a small subset … who might there is a small subset … who might think, "What happens in the military that think, "What happens in the military that puts us at higher risk for being exposed to puts us at higher risk for being exposed to HIV more than the rest of the population? HIV more than the rest of the population? Is it something the military performed Is it something the military performed experiments on us, unknown to us?"experiments on us, unknown to us?"

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Provider ThemesProvider Themes

Flood of Patient Inquiries to Message about HIVFlood of Patient Inquiries to Message about HIV

““I'm concerned …if they read something like this, I'm concerned …if they read something like this, they're going to be on the phone calling up. they're going to be on the phone calling up. We can only handle so much.”We can only handle so much.”

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Provider ThemesProvider Themes

Workflow – Need to Address Demand for Workflow – Need to Address Demand for HIV TestsHIV Tests

Stand alone clinicStand alone clinic Designated staff person for education, Designated staff person for education,

pre- and post-test counselingpre- and post-test counseling

““So up until now, in fact at this time, there is So up until now, in fact at this time, there is a disconnect with increasing numbers of a disconnect with increasing numbers of performance measures… but without performance measures… but without increasing support staff, infrastructure and increasing support staff, infrastructure and time for providers, that makes us all feel time for providers, that makes us all feel very frustrated.”very frustrated.”

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Provider ThemesProvider Themes

Use Link to MHVUse Link to MHV Similar to patient viewSimilar to patient view

““Make it a newsletter as opposed to [a Make it a newsletter as opposed to [a personal email], …because you can do it personal email], …because you can do it with these things called ‘push pages’. [You with these things called ‘push pages’. [You get an email and it says] ‘Hi, your VA is get an email and it says] ‘Hi, your VA is sending you a weekly newsletter.’ sending you a weekly newsletter.’

Hyperlink takes you to MHV newsletter Hyperlink takes you to MHV newsletter

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Provider ThemesProvider Themes

Content of MessageContent of Message

– Treatable, chronic diseaseTreatable, chronic disease

– Spread messages over several weeks Spread messages over several weeks starting with less sensitive conditionsstarting with less sensitive conditions

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SummarySummary

Similarities between patients & providersSimilarities between patients & providers– Email indicating mail at MHV; posters, fliers, Email indicating mail at MHV; posters, fliers,

US mailUS mail– Privacy / confidentiality concernsPrivacy / confidentiality concerns

Need to explain MHV to subjects Need to explain MHV to subjects Wariness of electronic systems – happen Wariness of electronic systems – happen

fast & less controlfast & less control Range of comfort / ability with computersRange of comfort / ability with computers

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Future Directions?Future Directions?

Value of qualitative researchValue of qualitative research Diffusion of innovationDiffusion of innovation Social networksSocial networks

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THANK YOUTHANK YOU