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Information therapy becoming more popular
‘Information therapy’ — paperless patient education — may become widespread within 10 years. Physicians will save time, money; patients will learn more about treatment options.
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Physicians have long known that educated patients make the best patients. “The more they know, the better their compliance and outcome,” noted Stephen Conrad, MD, member of the American Academy of Orthopaedic Surgeons Committee on Patient Education.
But well-informed patients who ask lots of questions take up extra office visit time, already under pressure from managed care constraints. And physicians often cringe when patients arrive with reams of paper and countless questions following an Internet search that turned up bad information. Complicating the whole issue of patient education: Studies show patients remember only half of what they are told during an exam, making much physician/patient discussion unproductive.
Some medical groups have found a solution to these thorny issues by finally leveraging the promise of the Internet in their favor. St. Luke’s Idaho Elks Rehabilitation Services in Boise offers one for example of a group that has made “information therapy” or “Ix” pay off by saving time and money.
St. Luke’s Director Columbus Candies, PT, MPA/HA, told Orthopedics Today, “We have a high rate of spine injury in our area and selected Healthwise to provide us with core spine care education that we then modified to fit our needs. Not only can patients access the information on their own personal homepage, but also at a kiosk in the physician’s office, allowing them to learn about their specific diagnosis while waiting. The physician doesn’t have to spend time repeating the information, which increases his or her efficiency and enables him or her to see more patients.” Patients still feel like they are getting quality health care.
Streamlining
In other words, both sides win. Information therapy puts the ball back in the physician’s court by allowing him or her to select the appropriate information for the patient and streamline the shared decision-making process.
What is new is how physicians are educating their patients. Using technology, such as electronic medical records (EMRs), e-prescribing systems and personal digital assistants (PDAs), physicians can now provide the “right information to the right person at the right time.”
“It is clear to us that information prescriptions will become a part of most clinical visits within the next ten years,” said Donald W. Kemper, CEO and founder of Healthwise and chairman of the Information Therapy Commission of the Center for Information Therapy (CIT).
So what exactly is Ix? Here is Kemper’s definition: “The prescription of specific, evidence-based, current medical information to a specific patient, caregiver or consumer, just in time to help someone make a specific health decision or behavior change.”
How it works
When a physician enters the patient’s ICD-9, CPT or NDC into an EMR, a menu of “information prescriptions” pops up, courtesy of a content provider like Healthwise.org, MedlinePlus.gov or MayoClinic.com. The physician chooses the most appropriate information prescription, tailored to the patient’s specific diagnosis and sends it via e-mail to a secure Web site for the patient to view later. It is important for them to have information to review at home, when they are more focused and less anxious – and will remember more.
Physicians could set up individual, secure patient-information pages on a practice Web site, according to the CIT. These personalized pages could also become an interactive disease management tool — patients could grant access to select reviewers. If new symptoms occur, the physician could reply with updated information prescriptions. Scheduling lab/radiology tests or a procedure, making a referral to a specialist, giving a new diagnosis or prescription, contacting a nurse call center regarding an injury, or informing about a new public health concern (eg, anthrax exposure) or drug recall (eg, Vioxx) could also trigger an information prescription.
“How fast we get there will depend on how fast clinics install EMRs,” Kemper said. “As soon as the EMR is in place, the addition of information prescriptions should become almost automatic. Organizations with a technology infrastructure already in place that are using EMRs and secure patient portals are better prepared for Ix programs. This has usually meant bigger clinics, although we do expect that to change.”
Integrating Ix in your practice
Regardless of practice size, Kemper recommended selecting an EMR with a “personal health record” that patients can access, choosing a content provider, determining what information you routinely prescribe, and automatically connecting the content to the EMR based on the diagnosis, test, procedure, or medication prescribed.
Some EMRs, such as ChartLogic, already have proprietary patient education embedded in their software. “DynoMed is an educational tool that provides medical multimedia content specifically for orthopedists and their patients,” said Jim Strickland, vice president of business development for ChartLogic. “It is designed to easily and automatically incorporate patient education into your practice flow, saving you time and money.” Live or pre-loaded animations demonstrate the anatomy, kinesiology, pathology and surgical treatment of a condition. Some of DynoMed’s 55 multimedia programs have been reviewed by the AAOS and are also being marketed and distributed through the academy.
Those without EMRs can still provide Ix in a paperless, electronic practice environment. For example, DynoMed can be run as a separate module on a standard PC in the exam or reception room and the AAOS Web site, Your Orthopedic Connection, provides evidence-based medical information that is written in easy to understand language that doctors and patients can review together, said Conrad, who also is chief of staff at Seton Medical Center near San Francisco.
Ix can also come through sources such as the Doctor’s Patient Education Network (DrPEN) or the National Library of Medicine (NLM) and The American College of Physicians’ “Information Rx” program, currently being test-piloted in Iowa, Georgia and Virginia.
Kevin Fergusson, MD, MSHA, founder of DrPEN, told Orthopedics Today, “All physicians need to use DrPEN is a prescription pad. They give the patient the DrPEN URL. The patient goes home or to work and enters DrPEN.com in a Web browser that links them to the patient education information. This is similar to what the NLM is doing, but more robust in that we use ICD-9 codes, instead of suggested search terms, to link to over 1000 pieces of patient education information available on the Internet, including the AAOS and NLM’s, medlineplus.gov, Web sites.”
Works on PCs
“Patients without PCs can access the information through computers at public libraries,” Conrad said. “For people who shy away from computers, we print out the information and give or mail it to them,” Candies said. DynoMed offers customized programs on various topics in VHS, CD or DVD format for distribution to patients, as well as brochures that can be printed in-house.
Knowledge is power
“It’s difficult for patients to determine quality in either medical products or services, so physicians play a professional advocacy role by using evidence-based patient education materials that are unbiased by pharmaceutical or medical equipment manufacturers,” Fergusson said.
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However, in this role, even the most dedicated physician is often unable to review or be familiar with all of the material available. Therefore, “having all of this information in one place, in an easily accessible format and continually updated makes it convenient for both the physician and patient,” said Candies, resulting in increased patient satisfaction and loyalty.
“Some pay-for-performance programs offer incentives for increased patient satisfaction,” Strickland said. “Patient education is definitely tied into patient satisfaction and improved outcomes.” St. Luke’s is tracking outcomes to see how Ix impacts quality of care in their community. “Our payers are encouraging the use of Ix and eager to see its outcomes,” Candies said. Although reimbursement or incentives may not be the main issue for Ix right now, “eventually, it may make sense to reimburse physicians more if they do send information prescriptions,” Kemper said.
“Educating patients may also bring other paybacks to your practice,” said Strickland, including increased marketing value and decreased legal liability.
“I like the concept of Ix,” Conrad said. “Anything that saves us time will flourish.”