Introduction:
The Increase Enrollment in MHV project was born from the Veterans Administration (VA) Innovation Program. Through this initiative, prospective projects submitted by VA employees scrutinize for benefit, funding, and development. Selected projects move to the first of two innovation phases, a prototype low bar phase, where the requested functionality is developed outside the VA Network in a virtual cloud environment known as the Future Technology Lab (FTL).

Problem Statement:
Currently, the MyHealtheVet (MHV) web portal is a vastly under-utilized resource by Veterans. As a result of its underutilization, patients are left with long wait times when trying to reach a VHA employee to determine their appointment time, refill their prescriptions, or talk with their doctor. All of these problems could easily be mitigated with enrollment into the MHV web portal. Veterans are not consistently asked about their desire to enroll in MHV or what their current MHV status is. The one standardized process performed by all Clerks across the VHA is the pre-registration of patients when they arrive for their appointment. To streamline the education of patients on MHV, VA requires a prompt in the VistA pre-registration screen to indicate both the Veterans' desire to participate in the MHV program as well as their current MHV status.

Proposed Solution:
The development team modified the Preregistration Interface (PI) within the current VistA Registration package, in the VA Innovations Sandbox environment. The modified PI includes query and response line items that define the patient’s desire to be enrolled in MHV as well as accounting for the new Federated Credential Impact update to MHV. If the patient is not interested in participating in MHV enrollment, VistA now populates a list of reason codes for MHV enrollment rejection.
The scope of the Increase Enrollment in My HealtheVet project is to enhance the Pre-Registration module in the VistA Registration package to support the following functionality:
• Display an alert to the clerk when the selected patient is missing required My HealtheVet enrollment information. The alert displays immediately after a patient is selected.
• Display a list of historical actions taken by registration clerks to assist the patient with enrollment in My HealtheVet. Historical actions for the five most recent My HealtheVet socialization sessions are displayed immediately after the alert text.
• Prompt the clerk to ask the patient about their My HealtheVet enrollment status and capture the patient’s response. The clerk is required to elicit a response from the patient to continue the Pre-Registration process.
• Prompt the clerk to select one or more actions they performed to assist the patient in enrolling in My HealtheVet and capture the selection(s). The clerk is required to select an action they performed to assist the patient in order to continue the Pre-Registration process.
• Store an audit of all patient responses and actions taken with the date/time the information was entered. A history of all My HealtheVet socialization responses and clerk actions are captured and are available for ad hoc reports.
• Create three fields to capture the patient’s current My HealtheVet enrollment status (MHV ENROLLED, MHV AUTHENTICATED, MHV SECURE MESSAGING), three fields to capture reasons why the patient declines enrollment (MHV ENROLLED DECLINED REASON, MHV AUTH DECLINED REASON, MHV MSG DECLINED REASON), three fields to capture free text when the declined reasons aren’t sufficient (MHV ENROLL DECLINED TEXT, MHV AUTH DECLINED TEXT, MHV MSG DECLINED TEXT), and two multiples to capture actions taken by the clerk to assist the patient with MHV enrollment (MHV AUTH ACTIONS, MHV MSG ACTIONS).
• Create an MHV enrollment screen to display and allow entry and editing of the three enrollment fields (MHV ENROLLED, MHV AUTHENTICATED, and MHV SECURE MESSAGING) and related declined reason, declined reason text, and actions.
• Keep a date/time audit of updates to the three enrollments fields so the MHV Alert can be turned off for six months after a patient has declined MHV enrollment. After six months has elapsed since the patient declined MHV enrollment, the alert is reactivated.
• Include MHV enrollment status fields in the Pre-Registration consistency check, prompt for missing/inconsistent MHV enrollment status fields.