title: A participatory approach to designing and enhancing integrated health information technology systems for veterans: protocol.
abstract: BACKGROUND
  The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information.
  
  
  OBJECTIVE
  The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans' preferences for using VA HIT to manage their health conditions and exchange health information.
  
  
  METHODS
  The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks.
  
  
  RESULTS
  This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on direct veteran feedback that depict patient preferences for enhancing the synchronization, integration, and standardization of VA patient-facing platforms. Focus group topics include current uses, preferences, facilitators, and barriers to using electronic health resources; recommendations for synchronizing, integrating, and standardizing VA HIT; and preferences on data sharing and delegation within the VA system.
  
  
  CONCLUSIONS
  This work highlights the practical, technological, and personal factors that facilitate and inhibit use of current VA HIT, and informs an integrated system redesign. The Digital Health Matrix Model and visual modeling simulations use knowledge of veteran preferences and experiences to directly inform enhancements to VA HIT and provide a more holistic and integrated user experience. These efforts are designed to support the adoption and sustained use of VA HIT to support patient self-management and clinical care coordination in ways that are directly aligned with veteran preferences.
authors: HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, United States. joliehaun@gmail.com.
authors: Jolie N
authors: http://orcid.org/0000-0003-4075-3763
authors: JN
authors: Haun
authors: Kim M
authors: http://orcid.org/0000-0002-0966-5602
authors: KM
authors: Nazi
authors: Margeaux
authors: http://orcid.org/0000-0002-8744-1874
authors: M
authors: Chavez
authors: Jason D
authors: http://orcid.org/0000-0002-1610-0431
authors: JD
authors: Lind
authors: Nicole
authors: http://orcid.org/0000-0001-8423-6237
authors: N
authors: Antinori
authors: Robert M
authors: http://orcid.org/0000-0003-1438-1767
authors: RM
authors: Gosline
authors: Tracey L
authors: http://orcid.org/0000-0002-7846-4230
authors: TL
authors: Martin
keywords: Department of Veterans Affairs; mixed methods; patient-centered care; patient-provider communication; veterans