Care Coordination and Interoperable Health IT Systems Unit 11: Supporting Patient-Driven Care Coordination Lecture c – Information-Driven Patient Education Welcome to Care Coordination and Interoperable Health IT Systems, Supporting Patient-Driven Care Coordination. This is Lecture c, which will cover information-driven patient education. This material (Comp 22 Unit 11) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Health IT Workforce Curriculum Version 4.0

Supporting Patient-Driven Care Coordination Learning Objectives Objective 1: Explain the importance of patient-driven care coordination Objective 2: List ways a patient can use technology to drive care decisions Objective 3: Describe the concept of patient-initiated information exchange This unit will cover the following learning objectives: 1) explain the importance of patient-driven care coordination; 2) list ways a patient can use technology to drive care decisions; and 3) describe the concept of patient-initiated information exchange. This unit will explore the use of technology to support and enable patient driven coordinated care. Health IT Workforce Curriculum Version 4.0

Definition Patient education includes materials and activities that provide information to patients to improve their health behaviors and health status. An educated patient is better prepared to participate in their care, prevent errors, improve their outcomes, and impact the length of health care interventions. To make informed health care decisions, the patient must have access to information. Patient education includes materials and activities that provide information to patients to improve their health behaviors and health status. An educated patient is better prepared to participate in their care, prevent errors, improve their outcomes, and impact the length of health care interventions. Health IT Workforce Curriculum Version 4.0

Introduction How can we help patients to be full partners in their health care? A knowledgeable and educated patient is better prepared to participate in shared decision-making For more information on shared decision-making, see component 25 unit 7 Patient education delivered during a hospital stay or a clinic visit is not retained Patients who understand their hospital discharge instructions are 30% less likely to be readmitted to the hospital How can we help patients to be full partners in their health care? A knowledgeable and educated patient is better prepared to participate in shared decision-making. For more information on shared decision-making, please see component 25 unit 7. Historically, patient education has been delivered during a hospital stay or at the end of a clinic visit. Patients have difficulty retaining information that is delivered in this way. Patients who understand their hospital discharge instructions are 30% less likely to be readmitted to the hospital. Health IT Workforce Curriculum Version 4.0

What do patients want? Information available on demand Information that is sent proactively Information that is personal Information that is interactive Emotional support that is available along with the information What do patients tell us about their health education wants and needs? Patients want information on demand. They want information that is proactive, personal, and interactive. And, patients want to have emotional support available to them along with education. Health IT Workforce Curriculum Version 4.0

Vision Patient empowerment through knowledge Interactive technology that allows the patient to control acquisition of knowledge Education and information that is delivered at a place and time when patient is ready to learn Based on patient feedback and research, we need to provide education that empowers patients. Patient empowerment allows for treatment decisions that are supported with information gained from the use of interactive technology. Interactive technology allows the patient to determine and meet their educational needs at the place and time where they can best learn. Health IT Workforce Curriculum Version 4.0

Technology Television Videos Internet Email Health education apps EHR driven patient education Patient portals We have enough research to know that pages and pages of paper handouts given to the patient when they are least likely to retain information do not empower self-directed health care. How can technology be used to improve patient education, retention of information, and empowerment? Technology used for patient education includes the television, videos, the Internet, email, health education apps, EHR-driven education, and patient portals. Health IT Workforce Curriculum Version 4.0

Television Patient information delivered by television is found in many inpatient settings These systems allow patients and families to select and view health education of their choosing during an inpatient stay Interactive television systems are used in many inpatient settings. These systems allow patients to select and view health education of their choice during their inpatient stay. Health IT Workforce Curriculum Version 4.0

Television (Cont’d) Patient-driven; learn when ready and able May not absorb information due to health status May not include all topics needed Information is not customized to the patient Relies on memory While convenient and widely used, there are downsides to this method of education. The patient may not be able to absorb and understand health information when they are in a state of decreased health. Information topics may be limited and are not customized to each patient’s needs. And, patient education delivered by television relies on the patient’s memory to make changes in their health behaviors based on what they viewed earlier in time. Health IT Workforce Curriculum Version 4.0

Video / DVD Flexible use: Hospital, clinic, or home-based View and review information when patient is ready to learn Relies on memory Minimally interactive Not customized to patient needs Must have video or DVD player technology Video or DVD technology can be presented during an inpatient stay or as a part of a package of information provided to the patient with a new diagnosis or treatment plan. Video technology allows the patient to view and review information when they are ready to learn, but the technology relies on patient memory to initiate and sustain behavior change. The information delivered by video or DVD is not customized to the patient needs. In addition, the patient must possess the video or DVD technology so they can view information. Health IT Workforce Curriculum Version 4.0

Internet There is a wealth of health information on the Internet Information can be used either independently by the patient to research their health condition or the patient can be linked or directed to health information on the Internet by their health care provider There is a wealth of health information on the Internet. This information can be used either independently by the patient to research their health condition, or the patient can be linked or directed to health information on the Internet by their health care provider. Health IT Workforce Curriculum Version 4.0

Internet (Cont’d) Patient can view and review when they are ready to learn Web sites may be interactive and can measure and reinforce learning Must have Internet access and viewing device As with video-based patient education, Internet-based patient education allows the patient to view and review information when they are ready to learn. Internet patient education may also contain interactivity that measures and reinforces learning, comprehension, and intention to act. In order to use Internet-based patient education, the patient must have access to the Internet and possess a device that can connect to the Internet and allow for viewing and interaction. Health IT Workforce Curriculum Version 4.0

Email Vendors are working on email-based products that will allow care providers to send health information or links to resources to patients based on specified criteria Can be automated Patient can view when they are ready to learn Greater personalization of information Provider can track patient learning activity Patient must have email address and device to view information Vendors are working on email-based products that will allow care providers to send health information or links to resources to patients based on specified criteria. An example of this would be sending regular, scheduled emails to a newly diagnosed diabetic with helpful information that can be viewed when the patient is ready to learn. This technology provides a greater degree of personalization and may allow the health care provider to see what the patient has viewed. In order to use this technology, the patient must have an email address and a device that allows them to receive email. Health IT Workforce Curriculum Version 4.0

Health education apps and games More physicians and health care providers are prescribing or recommending health apps to patients as an educational and behavioral change technology Mobile technology; patient can learn at any time or place Interactive elements to measure, reinforce, and practice learning Not yet widely adopted by physicians, but use is growing Patient must have mobile technology and Internet connection to use More physicians and health care providers are prescribing or recommending health apps to patients as an educational and behavioral change technology. Health apps are mobile technology, allowing the patient to learn at any place or time. Health apps can contain interactive elements that allow the patient to measure their own understanding of information, reinforce learning, and provide opportunities for repeated practice. Less than 25% of physicians currently prescribe mobile health apps, but it is estimated that many physicians will incorporate this technology into their practice within the next five years. Again, the patient must possess mobile technology that facilitates use of mobile health apps and may need some assistance to understand how to use these apps. Health IT Workforce Curriculum Version 4.0

EHR-driven education Education is ordered in EHR and sent to patient viewing device in hospital Patient views when they are ready to learn Completion of education flows back into EHR, where caregivers can assess understanding and reinforce education Requires specific vendor technology, but is not offered by all vendors Cutting edge EHR technology now enables nurses and physicians to order patient education topics within the EHR that is then sent to an associated patient entertainment system in the hospital room. The health topics are listed on the individual patient television or viewing device, where they can view the information when they are able. Completed educational topics are reflected in the patient EHR, signaling the nurse or other health care provider to further discuss the topic with the patient to assess and reinforce learning. This technology is fairly new and requires specific technology, set-up, and equipment to initiate. Health IT Workforce Curriculum Version 4.0

Patient portals Episode-specific information is available when the patient is ready to learn Information can be shared with family and friends Portal may provide links to large health information databases Patients and family can browse and research health information Many patient portals are designed so that specific education relevant to an inpatient or ambulatory care episode is available through the portal when the patient is ready to view or share with others. In addition, many patient portals provide links to an extensive list of health care topics so that patients and families can browse and research health information. Health IT Workforce Curriculum Version 4.0

Barriers Many technologies exist or are emerging to support the goal of interactive and on-demand patient education There are barriers that decrease the ability of the patient to manage their own health education needs Health literacy Language Culture Health care culture Environmental culture Technology Many technologies exist or are emerging to support the goal of interactive and on-demand patient education. However, there are barriers that decrease the ability of the patient to manage their own health education needs. Barriers include patient health literacy, language, culture, and technology. Health IT Workforce Curriculum Version 4.0

Health literacy “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Institute of Medicine, 2004) Skills to navigate the health care system Skills to communicate with health care providers Majority of U.S. population possesses intermediate level of health literacy Health literacy is defined within the Institute of Medicine report as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” This can include the skills that are necessary to navigate within health systems in the United States and to communicate adequately with health care providers. The majority of the population in the United States possesses an intermediate level of health literacy, including the ability to locate and utilize eHealth resources. Health IT Workforce Curriculum Version 4.0

Language Limited English proficiency impacts comprehension of patient health information Lower English literacy correlates with decreased adherence to health promotion behaviors from providers Language poses an additional barrier to delivery and consumption of patient health information. Limited English proficiency impacts the patient and family’s comprehension of patient education delivered through technology. Studies have shown a statistically significant difference in adherence to provider-supplied health promotion behaviors based on the level of English proficiency. Those with lower levels of English proficiency demonstrated less adherence to recommended health behaviors. Health IT Workforce Curriculum Version 4.0

Culture Information-driven patient education can only be successful if cultural factors support acquisition and use of health information Health care Transition to partnership-based care model Empowered patient Environment Technology must be present Technology must support the patient in health behavior change efforts Information-driven patient education can only be successful if cultural factors support acquisition and use of health information. The health care culture must align with a partnership-based care model so that the patient is empowered to locate, view, and implement new knowledge into their behaviors. The environmental culture must support both the presence of technology that can be used to obtain health information and then support the patient in their efforts to use health information to make changes in their health behaviors. Health IT Workforce Curriculum Version 4.0

Technology Equipment needed to view videos, DVD, and TV-based interventions Internet connection is needed for emerging patient education tools Email address is required for interaction with health care providers Patients need to be able to understand and use technology Technology presents an additional barrier to acquisition, comprehension, and utilization of health information. At the minimum, a patient needs access to the Internet, an email address, and mobile technology to increase the options for obtaining, retaining, and using health information to change behaviors and improve health status. Health IT Workforce Curriculum Version 4.0

Unit 11: Supporting Patient-Driven Care Coordination, Summary – Lecture c, Information-Driven Patient Education A knowledgeable and educated patient is better prepared to participate in shared decision-making Technology can be used to improve the delivery of health information so that the patient can view information at the time and place where they are readiest to learn Although barriers such as health literacy, limited English proficiency, and culture exist, there are many types of technology that have been designed to empower the patient to gain the knowledge needed to successfully manage their own health This concludes lecture c of Supporting Patient-Driven Care Coordination. To summarize, a knowledgeable and educated patient is better prepared to participate in shared decision-making. Technology can be used to improve the delivery of health information so that the patient can view information at the time and place where they are readiest to learn. Although barriers such as health literacy, limited English proficiency, and culture exist, there are many types of technology that have been designed to empower the patient to gain the knowledge needed to successfully manage their own health.

Supporting Patient-Driven Care Coordination References – Lecture c Armenakis, A, & Kiefer, C. Social and cultural factors related to health, Part A: recognizing the impact. Presentation presented at Global Health Education Consortium; 2007. The Beryl Institute. (2011). Patient satisfaction and patient education increase when hospitals offer interactive technology. Enhancing the Patient Experience through the Use of Interactive Technology. Available at: http://www.theberylinstitute.org/news/60203/Patient-Satisfaction-and-Patient-Education-Increase-When-Hospitals-Offer-Interactive-Technology.htm. Cassano, C. (2015). Technology and patient education. Available from: http://nursing.advanceweb.com/Features/Articles/Technology-Patient-Education.aspx Frydman, G. (2014). Some underlying principles of patient-driven healthcare. Patient-Driven Care. Available from: http://www.patientdriven.org/2014/03/some-underlying-principles-of-patient-driven-healthcare/ Institute of Medicine. (2004). Health literacy: a prescription to end confusion. Available from: http://nationalacademies.org/hmd/reports/2004/health-literacy-a-prescription-to-end-confusion.aspx No audio.

Supporting Patient-Driven Care Coordination References – Lecture c (Cont’d) U.S. Department of Health and Human Services. Health literacy - fact sheet: health literacy basics. Available from: http://health.gov/communication/literacy/quickguide/factsbasic.htm U.S. Department of Health and Human Services. Health literacy - fact sheet: health literacy and health outcomes. Available from: http://health.gov/communication/literacy/quickguide/factsliteracy.htm No audio.

Unit 11: Supporting Patient-Driven Care Coordination, Lecture c – Information-Driven Patient Education This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. No audio.