With automated education tools clinicians can give patients the information they need to manage their own care when they need it most -- after the office visit. Next step: integrated educational-treatment systems that tailor information to discreet aspects of a patient's condition and link them to vast data resources.

In the simplest terms, the goal of health care is to positively affect the health status of individual patients, either by making sick patients better or by eliminating risk factors that threaten health.

And there are only three ways to do that.

One is by actually performing some therapeutic activity -- surgery, hospitalization, or physical therapy, for example.

Another is proposing that patients do something themselves -- like taking medications or losing weight.

The third is by teaching. It is by far is the most important.

"You can't do either of the other two without it," says Dr. J. Peter Geerlofs, M.D., founder and president of Medifor, Inc., Port Townsend, Wash.

"Especially now -- when you have a health care systems that is focused on providing cost-effective ways of altering health status -- patients need to understand what is going on so they will consent to treatment," he says. "They need to understand and buy into anything you propose that they do for themselves.

"Then there is the recognition that during a person's lifespan, there are only a finite number of interactions in the health care system," he adds. "Throughout the majority of people's lives, patients have to make their own decisions, and it is the teaching role that enables people to make better decisions."

Face-to-face: a waste

But educating patients in the usual way -- face-to-face at the end of a direct encounter in a physician's office -- is, for the most part, a waste of time.

"Even when physicians spend a lot of time talking to patients, patients can't digest all the information they're getting," says Dr. Paul Tang, M.D., medical director of information systems, Northwestern Memorial Hospital, Chicago, Ill.

"First of all, they're getting too much information," says Tang. "Second, they usually have some other concern, and are not engaged in or listening to everything the doctor is saying.

"So the most important questions for patients come up after the encounter," Tang continues. "That's why it's so important for them to have something to walk away with."

Automated patient education tools can help busy physicians quickly and easily find and tailor information to meet a specific patient's needs before they walk out the office door.

Homework for parents

For example, private practice pediatrician Dr. Michael A. Gilchrist, M.D. has been using Pediatric Advisor from Clinical Reference Systems, Ltd., Greenwood Village, Colo., since 1989.

The Windows-based patient education program runs on a standard PC with 8 MB RAM that sits in the corridor outside the exam rooms.

"Whenever a patient has a particular problem, we walk over, call it up on the memory, and print out instructions on an illness, a developmental problem, or even the best way to travel with a baby or find a baby-sitter," he says.

(For more on pediatric health information, see page 28.)

Pediatric Advisor has information on childhood illnesses compiled by the head of general pediatrics at the University of Colorado.

Yet, it can be customized by physicians to fit their own style. And it allows for personal touches, such as adding the name of the child and the date the printout was generated.

The software also provides benchmarks of normal development.

"When my receptionist sees that a patient is coming in for an eighth or ninth-month visit, she pulls up the nine-month instructional sheet, which goes right on the chart before I even see the patient," Gilchrist says.

The sheets explain what a child should be accomplishing as far as speech, growth, and development at specific landmark stages so parents can track what children should be doing when.

"Parents look forward to what they call their `homework sheets'. Many put them on the refrigerator door and check off the items as the child accomplishes them," he says.

The take-home sheets also head off worried phone calls when parents expect too much too soon.

Windows for wellness

Medifor's own Patient Ed clinical software tool for Windows generates customized documents that address the reason the patient saw a physician and provide the details necessary to understand the care plan -- what medications were prescribed and why, home treatments, precautions -- as well as pertinent external resources such as Web sites, books, and videos.

Patient Ed allows physicians to review and choose from among hundreds of disease-specific guidelines or EduCare Templates that are presented in a tab notebook format. Tabs include home treatment, medications, precautions, follow-up and referrals, illustrations, and links to other resources.

If a physician chooses the medications tab, for example, he or she receives an entire universe of the drugs that may be prescribed for a patient's condition. The physician can edit or personalize prescribing instructions or enter other therapeutic preferences.

The program also prints prescriptions automatically and, in addition to personalized patient handouts, it documents progress notes, vital signs, diagnostic and procedure codes, drugs, and other types of care -- all within about 60 to 90 seconds - cutting overall writing and dictating by up to 40 minutes a day.

The next generation

The current crop of computer patient education tools nevertheless may be mere way stations along the road to more fully integrated treatment and education.

Once computerized medical records become a reality -- in perhaps ten to 12 years, Geerlofs believes -- automated education programs can be geared directly to patients' clinical needs.

One of the problems with current systems is they can only superficially personalize data for patients -- by adding their name or giving them general information about their diagnosis.

The systems don't, for example, customize data to take into consideration an individual patients' vital signs, co-existing medical conditions, severity of illness, or socioeconomic factors.

"Patient education needs to be linked to a patient's own clinical data," says Tang, "if not through a computerized record, then through something that applies specifically to them, has data about their disease, and has been endorsed by their physician.

"It also needs to give specific instructions and diagrams," Tang adds. "For low back pain, for instance, patients want clear advice: `Tell me how to lift things. How should I sit or get up?' The more specific, the more concrete, the more graphic, the better"

Outcomes, patient sat

Tomorrow's patient education programs also will be linked with outcomes assessment and patient satisfaction instruments across the full integrated delivery system.

For example, Medifor in the next 18 months will be migrating to a fully open and scaleable database for health systems.

"We will be able to generate outcomes and patient satisfaction questions that are specific to what a physician did during an encounter, and track the quality of education as it compares with HEDIS and other measures of quality for an integrated delivery system or some other third party that is accumulating HEDIS reporting," Geerlofs says.

And patient education will be folded in with other information technologies.

Web-based education

Anna Lisa Silvestri, general manager of the National Member Technology Group at Kaiser Permanente, Oakland, Calif., heads up KP Online, a member-only Web site for the HMO.

KP Online has more than 3,000 active users in three sectors of the country -- Northern California; the Portland, Ore. region; and the Mid-Atlantic states including the District of Columbia, Maryland, and Virginia.

KP Online already provides some linkage between patient education and health care delivery. Members can hook up with the HMO's appointment function to electronically schedule visits with doctors.

At the same time, they can tap into an educational database that has foraged the Internet and selected the clinical information that is most up-to-date and, even more important, valid.

KP Online is prototyping a system that will electronically process pharmaceutical refills and transmit appointment scheduling requests right into its legacy system to improve customer service.

Soon, she expects to automate more business functions for patients, such as downloading claims forms and other types of forms. The system is also expected to provide direct connections between patients with the same medical condition, so patients and health care professionals can share comments and advice.