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,
"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
"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
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
"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
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
"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
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
"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
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
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
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.