Career Objectives: Stephanie Shimada, PhD received her doctorate from Harvard University in 2005, subsequently came to the Bedford VAMC for a HSR&D postdoctoral health services research fellowship, and was hired at Bedford as a Research Health Scientist. Within VA, her research has focused on quality, patient safety, disparities, and informatics. Her career goal is to become a nationally-recognized, independent VA researcher with expertise in evaluating, improving, and implementing patient-facing eHealth technologies and assessing their impact on patients and on the VA healthcare system. A secondary goal is to ensure that these new technologies do not increase disparities or cause unintended quality or safety problems. Her career will initially focus on My HealtheVet. Through this CDA, she will acquire the skills needed in informatics, systems engineering, implementation science, and disparities to allow her to evaluate the impacts of eHealth technologies on patients, providers, and the VA healthcare system. Research Objectives:
AIM 1. Analyze VA administrative and clinical datasets for FY2007-2010 to describe which veterans are currently in-person authenticated (IPA) for MHV (NH192,000 as of 4/2010), and which are not, and examine whether there is a significant association between IPA status and patients'sociodemographic characteristics or burden of comorbidities. Explore whether IPA status has any impact on intermediate health outcomes among IPA'd diabetic veterans. Hypotheses will include whether IPA MHV adopters differ from non-IPA patients in disease burden, health outcomes or demographics;whether intermediate outcomes improve over time with the use of MHV;and whether intermediate outcomes are better for IPA'd users than for non-users after enrollment in MHV.
AIM 2. Conduct usability testing of MHV with a small sample (N=20) of minority veterans who are non- users of MHV. We will measure the time on task, error rates, and satisfaction of these patients as they attempt to use the MHV site to perform tasks important for self-management of health. We will conduct cognitive interviewing to gain insight as to how users think, and understand how the user interface might be improved. We will also interview these patients about their access to the internet and communication preferences to find out what other modes of communication would be most preferable.
AIM 3. We will interview patients (N=40) and providers (N=30) currently piloting secure messaging within the VA Boston Healthcare System, Bedford VAMC, or Togus VAMC about their current experiences, preferences, and assumptions about secure messaging. We will observe secure messaging teams and conduct workflow analyses. Results will help ascertain which veterans are less likely to have IPA MHV access, and provide insight into alternative ways for VA to reach populations who do not have access to or choose not to take advantage of MHV. They will increase our understanding of the effect of IPA'd access on intermediate outcomes. Usability testing will allow us to understand where the challenges lie, if any, in patients accessing MHV so that VA can improve the MHV interface, target training efforts more appropriately, or better market MHV. Finally, focus on secure messaging will provide an in-depth look at the potential promises and pitfalls of a key feature of MHV currently being implemented around the country.

Public Health Relevance

The VA is committed to transforming primary care by providing more efficient access through non-face- to-face mediums. eHealth technologies, such as VA's patient portal and personal health record system MyHealtheVet (MHV), can be used to increase access and engage veterans as partners in their own medical care. Patient-directed strategies, such as preventive care reminders, have been shown to be more effective than provider reminders at increasing adherence to evidence-based guidelines. However, VA does not yet know whether access to MHV results in improved healthcare outcomes, or whether differences in access to MHV might widen disparities for vulnerable patient subgroups, or create unanticipated consequences for patients, providers, or the healthcare system. This project, and Dr. Shimada's career, will focus on understanding how eHealth technologies designed to increase patient engagement and patient-centered care impact patients, providers, and the healthcare system so that their implementation can be optimized.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IK2)
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HSR&D Career Development Award (CDA0)
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Ern Memorial Veterans Hospital
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Shimada, Stephanie L; Allison, Jeroan J; Rosen, Amy K et al. (2016) Sustained Use of Patient Portal Features and Improvements in Diabetes Physiological Measures. J Med Internet Res 18:e179
Shimada, Stephanie L; Hogan, Timothy P; Rao, Sowmya R et al. (2013) Patient-provider secure messaging in VA: variations in adoption and association with urgent care utilization. Med Care 51:S21-8