The necessity of training vets to access the system has been minimal. “Remember that we have a new breed of veteran now, those that are returning from operations in Iraq and Afghanistan,” Dr. Kasi says. “The way they stayed in touch with their families was through Skype, with e-mail … they are very computer literate, and they almost demand this service.” Evidence of the essential convenience of the service is seen in the time signatures of access. “Most of the secure messages come after 5pm, sometimes all through the night,” he says.
The information is filtered for appropriateness—highly confidential information like HIV status or consultation notes that may be misunderstood—is withheld. Otherwise, a complete history is available for outside consultations, emergency room visits, or trips to the pharmacy. “This is important in rheumatology; our patients are on dangerous drugs. If they can print out what they’re on and avoid polypharmacy, or interactions, or maybe recent lab results show a low white count,” Dr. Kazi notes, outside providers can—and should—be aware of the complete medical picture.
As with the Georgia program, emphasis is placed on enabling the patient to be treated as close to home as possible. VA healthcare facilities are concentrated in certain areas. Veterans are not. Further, beyond Blue Button, telemedicine is coming online at the VA, and the rheumatology section has initiated an e-consultation program for outside providers.
However the connection is made, Dr. Kazi is adamant about the result. “You can improve your care by being informed,” he stresses. “The electronically engaged patient gets better outcomes.”
Rheumatology Research
From the privacy of their own homes, with mouse in hand, rheumatology patients may also participate in research. Kaleb Michaud, PhD, assistant professor of internal medicine, rheumatology in the College of Medicine at the University of Nebraska Medical Center in Omaha, explains: “I spent the last ten years working with Fred Wolfe at the National Data Bank for Rheumatic Diseases (NDB) and we’ve learned the value of having a long-term, observational, epidemiologic study looking at rheumatic diseases like RA.” For the NDB, patients filled out detailed questionnaires regarding their history, as well as ongoing health issues over time.
A new initiative, just launched, called the Arthritis Internet Registry (AIR), will use a newly formulated questionnaire, which will be augmented with detailed blood work. The goal is a deep dive to determine risk profiles, prognostic indicators, and the long-term outcomes of standard or novel treatments.
