Deploying e-health to improve veterans’ medical care

UMass/VA team leads national research initiative

	Thomas Houston, MD, MPH

Recognizing the enormous and as-yet untapped potential for information and communication technologies to improve health care access and quality for tens of thousands of veterans, in 2011 the Health Services Research & Development (HSR&D) Service of the VA established the eHealth Quality Enhancement Research Initiative (QUERI). And in a highly competitive process, the VA chose Thomas Houston, MD, MPH, professor of quantitative health sciences and medicine, to direct this national research center. A recognized leader in patient–provider communication and health IT research, Dr. Houston is chief of the Division of Health Informatics and Implementation Science in the Department of Quantitative Health Sciences.

“It’s very exciting that the VA is making a large push into patient-directed technologies as a means to increase patient access, engage patients as active participants in their own care, and help providers make care more patient centered,” he said. Also a primary care physician and faculty member at the Bedford VA Medical Center, Houston uses secure messaging in his own practice. “I’ve set up my clinic as a test site. Patients really appreciate it.”

The newest of 10 VA QUERI Centers, eHealth is the first and only one focused not on a specific health condition, but on an innovative method of delivering care that engages patients and makes it easier for them to participate in their own care. Intended to augment, not replace, traditional services such as telephone calls and clinical visits, eHealth can support patient self-management efforts, more continuous care between office visits, and allow for efficient completion of routine tasks so that patients and caregivers can get the most out of face-to-face visits. “Part of our work is to engage providers and make them more active users of this technology,” said Timothy Hogan, PhD, assistant professor of quantitative health sciences and implementation coordinator for eHealth QUERI.

Coming to field of health care from an information sciences background, Dr. Hogan first became interested in the intersection between the two while working in IT at an academic medical center that treated many patients with HIV. “Hearing from these patients about how difficult it was for them to keep information about medications, appointments and procedures ‘all straight in their heads’ got me excited about supporting information use among people who may have complicated health care needs,” he said. “A project we will soon embark on will teach and give providers the tools and resources they need to use technology for patient outreach and pre-visit planning.”

By way of example, Houston and Hogan related one local eHealth success story, in which a nurse revolutionized the anticoagulation clinic at the VA’s community-based outpatient clinic in Worcester by embracing electronic, asynchronous secure messaging technology. The clinic serves veterans from all over Central and Western Massachusetts, many of whom travel to the facility for various kinds of labs and tests. The day before a scheduled blood draw, Tracey Martin, RN, corresponds with patients through secure messaging to see if they are experiencing any worrisome symptoms. If they report no, they can drive in the next morning, get their blood drawn and drive right home, instead of enduring lengthy waits in the office as was previously practiced. When Martin gets results back later in the day, she returns instructions to the patients, again via secure messaging. “Everybody is happier,” said Houston. “Her job is much easier and the patients love it.”

Since its launch, eHealth QUERI has completed a national survey investigating how VA facilities are promoting adoption of its personal health record portal, and is now shepherding nine VA rapid response grants and one larger grant for a multi-year study of proactive use of secure messaging. QHS investigators at UMMS are conducting a number of other studies focused on eHealth , and how it can best be implemented. “I’ve always had a passion for technology and a focus in my career on behavior and behavior change for both physicians and patients,” Houston reflected. “One of the best parts about being a scientist in the VA is being challenged to demonstrate how what we are doing will improve real care for real people.”

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