Electronic education materials ensure accuracy, solve storage problems
Technology provides creative solutions to age-old delivery question
In the Fall of 1995, management at the University of Texas M.D. Anderson Cancer Center in Houston made the decision to create physician guidelines and pathways for cancer patient care to be used as a disease management tool. Instead of following the conventional printed method, they opted to embrace technology. With the aid of a consulting firm, the health care system developed a software program called Cancer Manager.
Each package includes a set of physician's orders, pathway documents, consent forms specific to the pathway, an outcome-oriented documentation form, and pathway-specific patient education materials, says Belle Koester, MPH, RN, assistant director of patient education at M.D. Anderson Cancer Center. When a patient is enrolled on a particular pathway, the nurse prints a complete package from a computer on the unit that includes all the components.
There are many benefits to delivering patient education materials to staff electronically, says Koester. It takes less shelf space, and materials can be updated immediately.
"It's very cost-effective. You don't have to throw away 500 to 1,000 copies of a handout because two or three lines have changed," she explains.
The electronic pathways are available at the Houston facility and at the cancer center's remote sites. Within M.D. Anderson, health care providers access materials via the Intranet, a network of computers within the cancer center's medical system. Those outside the immediate network obtain access via the World Wide Web, where the documents are available on M.D. Anderson's Web site to individuals who possess an access code.
"These documents are for clinical use only, and they are not appropriate for everyone to see. Therefore, these documents are flagged so that they can only be used by people we specify," says Koester. (For more information on the Intranet as an avenue for distribution of patient education materials, see Patient Education Management, July 1997, pp. 81-83.)
The ability to reinforce education at the point of service is another benefit of electronic delivery systems, says Emilie Sparks, MS, CHES, publication supervisor for the Southern California Permanente Medical Group in Pasadena. That's why this large HMO put computers on the desks of each of its 3,000 physicians and is making patient education materials available via the Intranet.
Physicians don't have room to keep 200 pamphlets on an office rack; therefore, Sparks made tip sheets to reinforce teaching. The sheets include a series on diabetes teaching, such as foot care.
"Patients will remember less than half of what the physician tells them verbally. That doesn't mean the physician shouldn't educate the patient; it means that the information should be given to patients in written form, so it can be reviewed later," says Sparks.
The physician can quickly print selected tip sheets while the patient gets dressed and have the nurse deliver them. The tip sheets not only reinforce the education, but they also provide a few more details than the physician had time to give, she explains.
No need to reinvent the wheel
While some health care facilities are working on the electronic distribution of patient education in-house, others have embraced outside vendors.
Management at MacNeal Health Network in Berwyn, IL, didn't want the bother of creating patient education materials for an electronic system and keeping them updated. That's why they purchased CareNotes, a computerized patient education distribution system manufactured by Englewood, CO-based Micromedex. "Patient education materials become outdated very quickly, especially in today's ever-changing technology," says Karen Baley, RN, BSN, manager of quality assurance at MacNeal. It's a big job for an institution to keep all their materials up-to-date, she says.
However, MacNeal Health Network has de-veloped areas of expertise, such as diabetes and asthma, with high quality materials to support education. The system they selected provides the flexibility to choose between CareNotes or in-house information. They can scan in their own documents and edit them on the system. "We wanted a system that was broad enough to cover a breadth of diagnoses and procedures but also offered us the ability to customize materials we developed in our areas of expertise," says Baley.
Five years ago, the emergency department at Baptist Hospital of Miami had pre-printed discharge instructions. When the patient was discharged, the nurse would select the sheets pertinent to the patient's ailment. As a result, the patient usually left the hospital with five to seven sheets of paper, depending on the diagnosis.
"We moved to a computerized version because we can customize the information and put everything the patient needs to know in one document. Also, the nurses had to manually write in the name of the referring physician. Now it is part of the database," says Charles Sperrazza, RN, MPH, CHE, administrative director for emergency service at Baptist Hospital. (For information on Checkout by Logicare, the system used at Baptist Hospital, see p. 48.)
Robert Cummins, RN, chief financial officer at Leblanc Family Medicine in Greensville, ID, tried to set up an electronic distribution system on his own. "I wanted a way to quickly print patient education material pertinent to a patient's diagnosis or treatment, so I collected printed material, scanned it into the computer, and tried to organize it alphabetically," says Cummins.
One day while researching new treatments on the Internet, he came across a system called PatientEd manufactured by Medifor based in Port Townsend, WA, and downloaded a demonstration package. It did exactly what he had been trying to do. (For information on PatientEd, see p. 48.)
The software system allows the provider to generate personalized instructions by selecting information pertinent to each patient from the templates available for each diagnosis. For example, if the patient had bronchitis and the physician wanted to include precautions specific to the patient, he or she would select the menu that listed precautions. With the use of a mouse, the physician would click on the instructions specific to the patient and print them. These instructions might include, "Call the office if your cough persists for more than three days."
At LeBlanc Family Medicine, the physician keeps notes and prints the information at a central computer. The patient is handed the material before he or she leaves the office. However, Charles Zelnick, MD, assistant director for Cedar Rapids Medical Education Foundation, has taken the use of the software one step further. He has the residents carry handheld computer devices into the exam room. They are connected to the main computer by a radio link and provide access to the software system in the exam room.
Now when medications for a certain ailment, such as asthma, are being considered, the physician can review the entire list in the exam room and then select one in cooperation with the patient. The selected medication is then checked by touching the screen with a special pen, so information on that medicine will print out on the individualized patient instructions.
"For teaching residents, this is ideal because it doesn't tell them what to do but reminds them of the options available," says Zelnick. Also, it provides an opportunity for the patient and physician to discuss the care plan together, he says.
Health care facilities don't necessarily need to embrace customized systems to benefit from technology. Software off the store shelf can improve the delivery of patient education, says Carol Maller, MS, RN, CHES, patient education coordinator at the Veterans Administration Medical Center in Albuquerque, NM. She uses Access database manufactured by Microsoft based in Redmond, WA, to track patient education materials and keep the stock up-to-date.
Maller is able to run reports that indicate if a booklet is not being ordered.
"If the pamphlet is not being used, the information might be out-of-date, or it might not meet customer needs," she says.
Each title has a stock threshold, depending on the use of the material. When Maller runs a report and sees that the title is at or below the threshold, she reorders.
"You can make the database as simple or as difficult as you want, but even a very simple database is a time-saver. It helps with organization," says Maller.
The Mayo Clinic in Rochester, MN, has a slightly more sophisticated database system. The database can be accessed by all health care workers at Mayo to see what patient education materials are available at the institution. Managers can order multiple copies of any brochure over the system.
"We are working toward a document management system that will allow us to create one master set of content and then deploy it electronically," says Donna Wohlhuter, RN, BSN, health education specialist at Mayo. They are also looking for translation software that would convert the text from English to Spanish on demand in culturally appropriate language.
Although there are many benefits to electronic delivery of patient education materials, there are barriers. Good quality printers are not always available at the point of service, says Wohlhuter. Also, the size of the document can be prohibitive.
"It may not be appropriate to print a large diabetes manual on demand. The problem is having printers available that are dedicated to patient education materials. A lot of clinical settings have one computer for several people to use," says Wohlhuter.
If a system is purchased from a vendor, make sure that the materials target your general population, advises Baley. Note the reading level of the materials and whether the text can be converted to other languages such as Spanish. Also, look at the size of the type to see if it is suited for the elderly or if the font size can be changed. Systems can be expensive, and it is wise to make sure they are appropriate, she says. At MacNeal Health Network, several departments looked at CareNotes before the product was purchased.
Patient education managers must make sure that the use of technology is improving the delivery of patient education, says Koester. Now that Cancer Manager is widely used at M.D. Anderson, Koester is determining a method to evaluate the effectiveness of the program.
"We need to evaluate the availability and accessibility of the materials to the staff and how useful electronic delivery is to them. Also, we need to evaluate the information to see if the patient education in the pathway is helpful to patients," says Koester. (For information on how to train staff to access information, see story, p. 49.)
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