Table 4.

Findings and recommendations.

Domain, subdomain, and pain point				Recommendation
Domain: upgrade to My HealtheVetPremiumaccount
	Utility
		Currently nonveteran or non-VAa patient delegates have to select the veteran or VA patient status to be eligible for a My HealtheVet Premium account, which is required for delegation	Update options to include all eligible criteria
	Accuracy
		Site content indicates that nonveteran or non-VA patients are not eligible for delegate registration	Update site language on eligibility criteria
	Functionality
		The system displays incorrect activity details in the account activity log	Update the system to display correct activity details in the account activity log
Domain: VDTb registration
	Access
		Delegation invitation only lasts 3 days	Extend invitation to 1 month
		Lack of a standard operating procedure for in-person registration or for assisting delegates in registering for a sign-in partner	Create a standard operating procedure to assist veterans and delegates
		Delegation requires My HealtheVet Premium account to initiate the registration process	Consolidate the My HealtheVet Premium account registration and delegation option
	Learnability
		Delegation lacks instruction on how to register	Create directions on how to register for delegation
		Lacks clear indication of steps completed and remaining	Create a progression bar indicating the steps of the registration process
	Efficiency
		Delegation requires registration for 3 additional sites (ie, Sign-In Partner, My HealtheVet, and My HealtheVet Premium)	Streamline the supplemental registration process and provide technological support
		Delegation authorization process requires multiple signatures	Simplify and streamline the authorization and signature process
	Affordance
		Delegates do not understand being redirected to My HealtheVet for delegation registration	Provide awareness and technological support for veterans and delegates navigating the registration process
	Intuitiveness
		Delegation invitation emails contain misleading language	Revise outgoing correspondence to ensure clear language
	Functionality
		Delegation authorization form processing is not enabled after signature	Enable processing after signature
		Mismatch of the data requested and systems input data for social security number and date of birth fields	Correct the fields for social security number and date of birth
		Invitation email not sent right away	Automate invitation email after registration is completed
Domain: sign-in
	Intuitiveness
		My HealtheVet offers multiple sign-in options without indicating which will provide delegate access	Provide clear instructions on choosing the correct sign-in to view the veteran’s My HealtheVet account
	Ease of comprehension
		Content on the delegation sign-in page is difficult to understand for registrants and users	Revise the delegation sign-in page content to ensure clarity and comprehension for diverse literacy levels
	Functionality
		Delegate is unable to access the veterans’ activity log when using the default log-in	Provide clear instructions on the My HealtheVet log-in page to indicate that delegates should use a sign-in partner to view veterans’ account
		Unable to log in to the delegation system	Enable proper log-in
		System does not display username when logged in	Display the name of active account user
Domain: use
	Clarity
		Secured email does not clearly distinguish between veteran and delegate senders	The author and subject line should distinguish secure emails from the veteran from those from the delegate
	Utility
		Providers do not have access to nonveteran delegate information	Include basic information on delegates (eg, sociodemographic data and relationship with veteran patient)
		Delegates do not have the option to access veterans’ secure emails	System option for the delegate to obtain access to the veteran’s secure emails
	Functionality
		Notification is sent to either the veteran or delegate but not both	Provide a mechanism to notify both the veteran and delegate
		New message notification is inaccurately displayed	Inbox notification should accurately display new messages
		Save button on the My Profile page is not enabled	Enable the save button on the My Profile page
		Secured email inaccurately displays the delegate’s name in the place of the veteran patient’s name when the delegate is also a veteran	Ensure accurate indication of the corresponding party (veteran, delegate, and provider)

^aVA: Department of Veterans Affairs.

^bVDT: Veteran Delegation Tool.