Internet connections show promise in solving age-old patient ed problems
Information is available when the patient needs it
Need a bridge to provide a continuum between inpatient and outpatient education? Want to help patients make informed decisions on treatment options? Like to provide more time for patient specific education?
Try the Internet. With its potential as an education tool barely tapped, the World Wide Web could be the miracle patient education managers are looking for.
Administrators at Kaiser Permanente, an HMO with members in various regions across the United States, think so. That's why its Oakland, CA-based National Member Technology Group has created a members-only Web site.
"We are building the site with the assumption that its greatest value will be a few years down the road when more and more people are using the Internet; however, the last thing we want to do is wait until the Internet is widespread before we figure out what to do with it. In the meantime, there are a lot of people who can benefit from it right now," says Tim Kieschnick, portfolio development manager for the technology group.
The purpose for the site is to help Kaiser HMO members make better health care decisions. To meet this goal, the site makes it convenient to find detailed information and support in decision making. For example, if a member is trying to decide whether to have elective surgery, a visit to the Web site will help him or her understand the options. Other decision support tools include an on-line advice nurse who answers patients' questions within 24-hours and a bulletin board moderated by clinicians where members can share information.
All Kaiser members receive a Healthwise Handbook that provides self-care instructions and information on when to visit the doctor for a condition, but the Web provides more details, says Kieschnick. "We can put more information on a Web site and make it easier to navigate than a book because members can do searches and use hypertext links," he explains.
Extending teaching time
The possibilities for patient education seem endless. HeartCare, a computerized cardiac recovery program designed by researchers at the University of Wisconsin-Madison, provides access to personalized Internet-based resources. Currently being pilot tested in Cleveland, the HeartCare Project was designed to fill the education gap created by shorter hospital stays. Men and women who have undergone cardiac bypass graft surgery are participating in the pilot study.
Patients participating in the project are given a computer and access to the main HeartCare Web site. From this site, they have access to the entire Internet. "We want to take advantage of the things that are available to patients and their families already on the Net; however, we are trying to make available new information as well because much of what is available on the Net deals with the medical side of cardiac recovery and less with the social side," explains Patricia Brennan, RN, PhD, FAAN, Moehlman Bascom professor at the University of Wisconsin-Madison.
The HeartCare Web site, which is accessed by participants with a password, provides lots of local resources for cardiac recovery services. Also, pages designed for the patient group are located in the Cleveland region. For example, about 40% of the people who have cardiac surgery in Cleveland are minorities, so the site has information that addresses the needs of minority patients.
Each project participant also has his or her own Web site window created, which works like a homepage based on certain characteristics, such as women over age 50 with diabetes. It contains links to pages from the HeartCare Web site as well as the entire Internet. The window is customized with information that is pertinent to the patient's social and medical needs and best helps them manage their own care. "We are trying to make sure that patients have access to information that helps them return to their full role as family member, worker, and community member," says Brennan.
A tool was developed to assess the patient's information needs in order to tailor Internet resources to the patient, which will be made available following the pilot test period.
Also, a tool is being created by project designers to help patients evaluate Web sites they have never seen before. "The tool will help patients determine if the site is relevant to their particular health state," explains Brennan. (For information on helping patients learn to research on the Internet, see story, p. 73.)
The staff at the radiation and oncology department at Allegheny General Hospital in Pittsburgh (http://www.allhealth.edu) said they received many patient calls; therefore, their site provides a "frequently asked questions" section. Also, it contains information about general care following certain procedures. On-line information about procedures and proper care allows staff to spend more time on patient- specific questions, says Web site designer, Timothy L. Husni, president of H2 Design Group Inc. in Pittsburgh.
Also, the Allegheny site provides examples of certain surgical procedures using video and/or digital photography.
In some sections of the Allegheny Web site, patients are asked to fill out a form. When they express interest in a certain topic on that form, they receive late breaking news and other information on the topic via e-mail messages, says Husni. (To learn how to network with other patient education managers via the Internet, see story, above.)
Advanced technology often is not available to underserved populations for educational purposes. That's why the Health Media Research Laboratory at the Comprehensive Cancer Center at the University of Michigan in Ann Arbor is taking a slightly different approach. Researchers created touch screens (interactive kiosks that look like televisions) to use as teaching tools.
For easy access, the kiosks have been set up in public places, such as malls and libraries, throughout the state of Michigan. The goal of The Michigan Interactive Health Kiosk Demonstration Project is to provide the public with access to accurate and motivating preventive health information, explains Amy E. Parlove, kiosk project leader.
Currently, kiosk users are able to learn about smoking cessation, bike helmet safety, immunization, breast cancer, and prostate cancer from the software on the kiosk. However, plans are in place to connect the kiosks to the Internet by the end of 1998. "We want to provide Internet access to the underserved, but we need to be cautious about what we are connecting them to. We want to be able to connect them to worthwhile locations and be able to block them from locations that we don't feel are up to our standards," says Parlove.
Technical problems can frequently throw glitches into well-laid plans. Kaiser is currently working on a complicated messaging system for its Internet site, which would allow members to exchange messages with their physician or care team. "There are all kinds of complicated angles, but we think the capability can help enhance the patient-physician relationship in a way that will help members make good decisions," says Kieschnick.
Different kinds of routing methods would have to be created to divert questions that could be answered more efficiently by someone else. Also, there is the issue of security. If patients are exchanging confidential health information, it's important that only people who need to see the message have access to it, says Kieschnick.
A patient's confidentiality is also an issue with tracking health care information. Since members access the site with passwords, it is technically possible to track any kind of information but not always ethical, says Kieschnick.
Currently, Kaiser's technology group is considering tracking certain information from the on-line interactive health risk assessment to determine if it changes behavior. For example, if women are told they should have a mammogram, it would track how many actually did. The data could be tracked by tying the site into the clinical data repository that stores each member's health care information.
When pages on Web sites are found to be ineffective, they can be modified. "We view every Web site we do as a piece of wet clay to be changed and modified every day based on patient input. One of the best things about the Web as a medium is that you are not running a press and putting ink down. Web sites are not a done deal," says Husni.
Personalized information
The Web is like no other education medium, says Kieschnick. The technology allows educators to tailor information to each individual patient. Also, services can draw people to the Web who are not information seekers. For example, a patient might access the Web if it were possible to get a prescription filled on-line. That prescription could then trigger the computer to provide information to the patient about his or her ailment.
"You may never get a person to come into your health library, see a health education counselor, or attend a health education class; however, they may use the Web to take advantage of convenient transactions. While you have them there, you can grab a teachable moment," says Kieschnick.
While the Internet is becoming more common as a teaching tool, there are costs involved in developing a good Web site. A simple listing of services and facilities with a physician directory will cost about $8,000; however, a site with database-driven directories, chat rooms, and other interactive elements can cost $200,000 or more for hardware set-up, consulting, and implementation, says Husni.
To find a design firm, surf the Internet for high-quality health care sites that impress you, advises Husni. Then contact the institutions marketing department to find out the name of the vendor responsible for the site. Once you have the names of several vendors, make a list of key requirements and objectives for your site. "Always get three price quotes before making a commitment, and don't be surprised if there's a 10-to-one difference from the highest to the lowest," says Husni.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content