Veterans preferences for exchanging information using VA HIT

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Background: The Veterans Health Administration (VHA) is committed to provide remote and timely health information technology (HIT) services to Veterans to improve patient engagement and their health outcomes. To support the VHA's mission, the eHealth QUERI also set forth a strategic goal to improve Veteran's access and meaningful use of HIT resources. To date, several patient-facing platforms, including mobile applications, tele- health, MyHealtheVet, kiosks, etc. have been implemented. However, with platforms continually expanding, VHA stakeholders recognize the need to develop a holistic Veteran- centered approach to creating useful and user-friendly HIT to ensure that Veterans are able to access and use these services with ease and continuity. Yet, though older Veterans with chronic conditions (e.g. high blood pressure, diabetes, COPD, etc.) represent the large portion of the VHA's HIT users, little is known about their preferences for accessing and using VHA HIT platforms. This study represents a unique opportunity to use participatory research to complement operational and QUERI efforts to support development of a VHA HIT systems that is synchronized, easy to use, and useful for targeted user groups, such as older Veterans with chronic co-morbid conditions. The proposed research aims are: (1) Develop a Digital Health Matrix Decision Model based on an Analytical Hierarchy Process with stakeholder input; (2) Explore older Veterans with chronic co-morbid conditions (n=40) preferences for using VHA HIT resources, at two VA facilities (Tampa & Bedford); (2.1) Develop visual modeling simulation prototypes of VHA HIT platform interfaces based on findings from Aims 1 and 2; and (3) Develop a Veteran-based visual modeling system using participatory methods with the same Veterans from Aim 2. Methods: The study will purposively sample older Veterans (n=40) with chronic co-morbid conditions who report using electronic resources and/or VA HIT to manage personal information. Females and minorities will be over-sampled to ensure representation. Mixed- methods will be used to conduct this prospective descriptive study design. Data collection methods include enhanced focus groups, using participatory methods, in which Veterans inform the development of visual modeling prototypes of patient-facing interfaces using simulation software based on their preferences for exchanging information using HIT. Data analysis will include thematic content analysis and descriptive statistics. Long-term Goals: Currently, operational stakeholders are re-organizing the Office of Informatics and Analytics (OIA) and developing an eHealth group to establish a national governance council to support this VHA HIT transformation. This proposed project is in direct alignment with these emerging operational activities within OIA. This project will lead to a line of implementation research related to enhancing communication through a Veteran-centered synchronized HIT resource system. Products will include Digital Health Matrix Decision Model of VHA HIT platforms, their features, and contexts for use; Veterans' reported preferences for exchanging information using HIT; and visual modeling prototypes of a synchronized HIT system. These products will lay the groundwork for operational efforts to increase Veterans' adoption and sustained meaningful use of VHA HIT.