Innovating for our Veterans online at Portland VA Medical Center

Portland VA Medical Center

As I mentioned in my handy-dandy guide to walking meetings, it’s always useful to choose a direction to walk in ( east, west, north, south ); and “up” is also an option. With that in mind, I gladly accepted the invitation from Sue Woods, MD ( @SueWoods ) to ride the Portland Aerial Tram up to to the Portland VA Medical Center to see what’s new with the My HealtheVet patient portal.

Sue and I have known each other for some time, and she’s started a great blog called Shared Health Data which I regularly read and enjoy. More patient-centered informatics physicians online is a good thing.

The first thing Sue showed me is the way this medical center is working to bring patients online. At the current time, My HealtheVet requires that users obtain in person authentication to get access. With that in mind, there’s an office that’s well-placed right in the pharmacy, which allows patients to complete this process. I was also shown how the staff here is tracking in person appointments of patients who have registered but not yet authenticated; this allows them to reach out while they are on site.

Next I got to see the check-in kiosk, which is in use in a lower-fidelity format as it is being developed. You can see in the screens in the photos below that this allows patients to interact with their electronic health record while they are checking in, to review their medication list and reconcile prior to their practitioner visit.

Several things are interesting here. First, they’ve learned that the answer to “Are you taking this medication?” is not a binary “yes” or “no,” because patients may be taking a medication but not as originally prescribed, so there are really four different possible answers to this question. Second, they have learned that older patients take slightly longer to complete the process, usually about 60 seconds longer, with good acceptability. In our conversation about this tool, it was clear that the real breakthrough is maybe not the medication reconciliation activity but the involvement that comes from interacting with one’s health record. Whether it be at the medical center or at home (and they are looking at doing this at home in the future), I think this is very significant. Imagine what we can learn about how to design electronic health records when we study patients using them. A lot.

Speaking of design, Sue then showed me the My HealtheVet portal (with test information throughout) and new secure messaging system. Patients can now communicate with care teams via the portal, with some nice touches, such as the ability to attach documents in responses back to patients.

Sharing Health Data – the one question I get to ask

Sue reminded me of something that I don’t know if a lot of people know; the very first version of My HealtheVet allowed patients to see everything in their medical record – test results, physician progress notes, everything. There are about 9,000 patients in the group that had this kind of access, including patients in the Washington, DC area. The few clinicians who I have asked about this and its impact on their work / care delivery did not mention that this was a problem in their experience. The newer version has less access to patients’ complete medical record.

My question is a simple one : “Why?”

I asked it because the data that shows that patients want all of their health record information, it’s safer for them to have it, there’s no evidence that there’s harm from them getting it. Luckily, Sue and colleagues are studying this experiment, and as the title of her blog shows, they are interested in promoting sharing. This is great and I had a great time at Portland VA Medical Center. With great thanks to all of the dedicated people at the top of the aerial tram brining innovation to the rest of the nation!


I look forward to hearing more about why the VA decided to restrict access to certain parts of a patient's medical records. I hope Sue and colleagues can propose guidelines. In this era of WikiLeaks, we all have a new appreciation for the pros and cons of transparency.

Ted Eytan, MD