Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences
Epidemiology | Health Information Technology | Health Services Administration | Health Services Research | Military and Veterans Studies
BACKGROUND: Health care systems have entered a new era focused on patient engagement. Patient portals linked to electronic health records are recognized as a promising multifaceted tool to help achieve patient engagement goals. Achieving significant growth in adoption and use requires agile evaluation methods to complement periodic formal research efforts.
OBJECTIVE: This paper describes one of the implementation strategies that the Department of Veterans Affairs (VA) has used to foster the adoption and sustained use of its patient portal, My HealtheVet, over the last decade: an ongoing focus on user-centered design (UCD). This strategy entails understanding the users and their tasks and goals and optimizing portal design and functionality accordingly. Using a case study approach, we present a comparison of early user demographics and preferences with more recent data and several examples to illustrate how a UCD can serve as an effective implementation strategy for a patient portal within a large integrated health care system.
METHODS: VA has employed a customer experience analytics (CXA) survey on its patient portal since 2007 to enable ongoing direct user feedback. In a continuous cycle, a random sample of site visitors is invited to participate in the Web-based survey. CXA model questions are used to track and trend satisfaction, while custom questions collect data about users' characteristics, needs, and preferences. In this case study, we performed analyses of descriptive statistics comparing user characteristics and preferences from FY2008 (wherein "FY" means "fiscal year") to FY2017 and user trends regarding satisfaction with and utilization of specific portal functions over the last decade, as well as qualitative content analysis of user's open-ended survey comments.
RESULTS: User feedback has guided the development of enhancements to core components of the My HealtheVet portal including available features, content, interface design, prospective functional design, and related policies. Ten-year data regarding user characteristics and portal utilization demonstrate trends toward greater patient engagement and satisfaction. Administration of a continuous voluntary Web-based survey is an efficient and effective way to capture veterans' voices about who they are, how they use the patient portal, needed system improvements, and desired additional services.
CONCLUSIONS: Leveraging "voice-of-the-customer" techniques as part of patient portal implementation can ensure that such systems meet users' needs in ways that are agile and most effective. Through this strategy, VA has fostered significant adoption and use of My HealtheVet to engage patients in managing their health.
eHealth, patient portal, user-centered design, veteran
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© Kim M Nazi, Carolyn L Turvey, Dawn M Klein, Timothy P Hogan. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.07.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
DOI of Published Version
J Med Internet Res. 2018 Jul 10;20(7):e10413. doi: 10.2196/10413. Link to article on publisher's site
Journal of medical Internet research
Nazi KM, Turvey CL, Klein DM, Hogan TP. (2018). A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design. Population and Quantitative Health Sciences Publications. https://doi.org/10.2196/10413. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1202
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.