title: Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient portal system.
abstract: BACKGROUND
  The United States Department of Veterans Affairs has implemented an electronic asynchronous "Secure Messaging" tool within a Web-based patient portal (ie, My HealtheVet) to support patient-provider communication. This electronic resource promotes continuous and coordinated patient-centered care, but to date little research has evaluated patients' experiences and preferences for using Secure Messaging.
  
  
  OBJECTIVE
  The objectives of this mixed-methods study were to (1) characterize veterans' experiences using Secure Messaging in the My HealtheVet portal over a 3-month period, including system usability, (2) identify barriers to and facilitators of use, and (3) describe strategies to support veterans' use of Secure Messaging.
  
  
  METHODS
  We recruited 33 veterans who had access to and had previously used the portal's Secure Messaging tool. We used a combination of in-depth interviews, face-to-face user-testing, review of transmitted secure messages between veterans and staff, and telephone interviews three months following initial contact. We assessed participants' computer and health literacy during initial and follow-up interviews. We used a content-analysis approach to identify dominant themes in the qualitative data. We compared inferences from each of the data sources (interviews, user-testing, and message review) to identify convergent and divergent data trends.
  
  
  RESULTS
  The majority of veterans (27/33, 82%) reported being satisfied with Secure Messaging at initial interview; satisfaction ratings increased to 97% (31/32, 1 missing) during follow-up interviews. Veterans noted Secure Messaging to be useful for communicating with their primary care team to manage health care needs (eg, health-related questions, test requests and results, medication refills and questions, managing appointments). Four domains emerged from interviews: (1) perceived benefits of using Secure Messaging, (2) barriers to using Secure Messaging, (3) facilitators for using Secure Messaging, and (4) suggestions for improving Secure Messaging. Veterans identified and demonstrated impediments to successful system usage that can be addressed with education, skill building, and system modifications. Analysis of secure message content data provided insights to reasons for use that were not disclosed by participants during interviews, specifically sensitive health topics such as erectile dysfunction and sexually transmitted disease inquiries.
  
  
  CONCLUSIONS
  Veterans perceive Secure Messaging in the My HealtheVet patient portal as a useful tool for communicating with health care teams. However, to maximize sustained utilization of Secure Messaging, marketing, education, skill building, and system modifications are needed. Data from this study can inform a large-scale quantitative assessment of Secure Messaging users' experiences in a representative sample to validate qualitative findings.
authors.affiliation: Department of Veterans Affairs, HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, Tampa, FL, United States. Jolie.Haun@va.gov.
authors.forename: Jolie N
authors.initials: JN
authors.lastname: Haun
authors.forename: Jason D
authors.initials: JD
authors.lastname: Lind
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Shimada
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Martin
authors.forename: Robert M
authors.initials: RM
authors.lastname: Gosline
authors.forename: Nicole
authors.initials: N
authors.lastname: Antinori
authors.forename: Max
authors.initials: M
authors.lastname: Stewart
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
mesh_terms: D000328:Adult; D000368:Aged; D001292:Attitude to Computers; D003142:Communication; D016494:Computer Security; D003219:Confidentiality; D057286:Electronic Health Records; D034742:Electronic Mail; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D018802:Patient-Centered Care; D011320:Primary Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: Department of Veterans Affairs; mixed methods; patient-centered care; patient-provider communication; secure messaging; usability testing; veterans