The VA Loma Linda Health Care System introduced a patient web portal in Jun 2004. Portal services include medication refill, demographics, appointments, copay status, and periodic healthcare reminders from the Computerized Patient Record System (CPRS). Beginning in 2007, MyHealtheVet, the national VHA patient portal, replaced local services except secure messaging.
Messaging security is achieved using a 128 bit Secure-Socket-Layer (SSL) 3.0 encrypted website and a secure server with a fire wall blocking access to unauthorized users. Messages are permanently stored in an SQL database. New Portal Mail messages generate e-mail alerts without identifying information to providers in Microsoft Outlook and to patients in their personal e-mail accounts.
A Portal Mail patient-user agreement was developed based on guidelines from the American Medical Informatics Association (AMIA). 16
Patients are given a summary of these guidelines and must acknowledge understanding of them. Briefly, the guidelines include appropriate content; avoidance of e-mail for urgent matters; escalation of e-mail for urgent matters or nonresponsiveness; and response time (three working days). Patients attain access to Portal Mail upon signing a user agreement and undergoing in-person authentication. Secure messaging was limited to patients' primary care teams.
One primary care team served as a beta test site. After input from staff for system improvements, training was offered to the remaining four teams. Training was conducted by the authors and the software developer and consisted of background studies on patient-clinician messaging, review of the AMIA guidelines, and hands-on training. Staff access to Portal Mail is granted by the system manager using CPRS usernames and passwords.
Approximately 35,000 patients receive primary care from 5 teams consisting of 7–8 physicians/nurse practitioners (clinicians) (total 39), 4 or 5 licensed vocational nurses (LVN), a registered nurse (RN), a case manager, and 3 patient services assistants. Physicians and nurse practitioners (clinicians), nursing staff, and patients are grouped in Portal Mail according to their primary care clinic assignment using Primary Care Management Module (PCMM) software that tracks primary care patient panels. Patient messages are forwarded to the primary care team. Two staff members on each team review messages and, based on content, forward messages to appropriate clinic staff.