Steve Samer was a helicopter door gunner with the 101st Airborne Division in Vietnam. He is grateful to the other veterans who helped him adjust after the war.“It was difficult for me to talk to people and explain to them what had happened to me and what I had gone through. Some World War II vets understood. Since then, I’ve just wanted to do some payback for all those who helped me along the way,” Samer said.For the past four years, Samer, 68 and a retired publisher, has been paying it back as a volunteer at the Capt. James A. Lovell Federal Health Care Center in North Chicago. He teaches other veterans as well as active-duty service members how to use “a very productive, highly useful software application” called My HealtheVet. It’s the VA’s online personal health record for VA patients and providers—and anyone else.My HealtheVet, available at www.myhealth.va.gov, was launched in 2003. Today, even amid a crowded market of third-party software and applications that do some of the same things, the program remains ahead of the curve. And the VA is working on a next-generation version, due out in 2017.The continuing development of My HealtheVet is fueled by feedback and test data from veterans and their caregivers as well as VA and non-VA clinicians. Some of the input comes from formal research studies by VA investigators.“We’ve been able to provide our redesign contractor with everything we know from the perspective of patients and caregivers and providers, everything we know from research, everything we’ve been wanting to change,” said Dr. Kim Nazi, a management analyst with the VA’s Veterans and Consumer Health Informatics Office. “We’ve got great research partnerships informing this redesign.”Cutting Time for RefillsWhile much about the interface will change, most core features of My HealtheVet will remain in place as the program evolves. The top one is prescription refills.Ralph Stott, 71, another Vietnam veteran and My HealtheVet volunteer at the Lovell Federal Health Care Center, told of one man he helped last year whose various medications could fill a shopping cart. “Believe it or not, he had something like 50-plus prescriptions,” Stott said. “And every time he would go to the phone to put in that order, he would get confused about halfway through it. When we got him signed up for My HealtheVet, a list of all his prescriptions popped up, where he could see them all on one screen. … It took less than 30 seconds.”Stott, a retired Army master sergeant, served with the 4th Aviation Battalion, 4th Infantry Division, in Vietnam. After his military career, he worked as a county purchasing agent for 23 years. Like Samer, he is not only a My HealtheVet volunteer, but also a user. According to Stott, the program has been a life-changer.“They’ve got a wonderful application in it called HealtheLiving Assessment. It’s about a 25-minute survey. It has wonderful charts and graphs that pop up and show you, if you answered the questions truthfully, how long you’re expected to live. Mine came out to be 92, but I thought I was being robbed of 10 years. After all, I don’t drink or smoke.“But in the part that talked about body mass index, I realized I was a little overweight. So I started following up on some of the suggestions in the program. I went into My HealtheVet and dug out their food and exercise journals. I was encouraged to start running 2 miles a day and lifting weights. In one year, I lost 21 pounds.”Plethora of ToolsMy HealtheVet contains a plethora of tools to help patients enter their own health data, track their progress, and learn about various conditions.“I’m not a veteran and I’m not a VA patient, but I have a basic My HealtheVet account,” said Susan Haidary, My HealtheVet’s national stakeholder manager. “I can enter in my medications, my lab results, use the food and activity journals. Anything I have self-entered, I can pull that information into this very nice, professional-looking summary via the VA Blue Button on My HealtheVet.”VA patients who go through a one-time, in-person authentication process at their VA medical center or outpatient clinic gain access to a wider range of features. The information in their VA electronic health record—including prescriptions, lab results, and notes from providers—becomes available to them, with a variety of tools to organize and format the data.By clicking on the Blue Button, users can download and print out all this information. “You can go in and see tests, appointments, previous prescriptions, doctors’ notes. When you see a health care provider and they are typing their notes—you get to see exactly what they said. It’s incredibly useful for tracking your own health,” Samer said.One of the main uses allows patients to share their information, as needed, with providers outside the VA. VA patients who need to go to a non-VA emergency room are able to log on to a computer and quickly point providers to key information in their My HealtheVet account.Even with more routine care, the feature strengthens communication among VA and non-VA doctors. For that matter, even a VA provider may want to see all the self-entered health stats in a veteran’s file that don’t show up in the VA electronic health record. Eventually, Nazi said, information that veterans enter into My HealtheVet on their own, such as blood pressure readings, will also be directly available to clinicians, with users’ consent.Secure Messaging PopularAuthenticated, or “premium,” users of My HealtheVet can also use a feature called Secure Messaging. Similar to email, it’s a direct pipeline between VA patients and their VA providers.“Secure Messaging has now expanded from primary care to many other areas,” Haidary said. “The No. 1 feature remains pharmacy refills. That’s why many veteran patients initially registered on My HealtheVet. But once they learn about Secure Messaging, they use it because it offers convenient access to their VA health care team members for non-urgent issues. For clinical staff, it’s a personal and efficient way to communicate electronically with their patients. It’s a win-win.”Research confirms the value of the feature for both patients and providers.“What we know about Secure Messaging is that it can increase efficiency,” Nazi said. “It certainly avoids phone tag. What providers in my study told me was that because it’s asynchronous, it’s actually a much more efficient way for them to communicate with patients. They can sit down and complete their secure messages when they have time in the day, rather than having to interrupt their schedule for a phone call.”The research has also found that Secure Messaging boosts continuity of care. “Providers tell us it gives them a way to communicate more frequently with patients, in between traditional face-to-face visits. And they actually get to know their patients better,” Nazi said. “One finding was that it decreased the threshold at which patients communicated with their primary care team. A patient may have had a question, concern or update but felt it didn’t warrant a visit or even a phone call. But their comfort in simply sending a secure message in between visits was high.”Patient EmpowermentResearchers are also continuing to look at the relatively new OpenNotes feature in My HealtheVet, which shows users all their providers’ clinical notes. The VA was one of the first systems nationwide to offer such access.One VA study found that patients using OpenNotes had a better understanding of their treatment plan and better medication adherence.For his part, Stott is feeling pretty empowered already. He has stuck with his new exercise regimen, and he is looking forward to redoing his life-expectancy assessment on My HealtheVet. “Maybe I can get my 10 years back and make it to 102,” he said.