Tomsik  Briggs

Healthcare providers are knee deep in efforts to meet Stage 2 meaningful-use (MU) requirements in a timely fashion. While there are many uphill battles facing providers and technology vendors alike, one notable challenge voiced across the industry relates to the complexities of setting up patient portals.

While not directly required in Stage 1 MU requirements, patient portals have been identified as a natural and effective approach for achieving a number of objectives, including providing patient access to:

  • Health information in a timely manner;
  • Clinical summaries of office visits; and
  • Patient-specific education resources.

With Stage 2 already in motion, many industry professionals believe that patient portals will be necessary for healthcare organizations to meet requirements laid out for more active electronic engagement of patients. Specifically, patients will need to be able to view, download and transmit information directly from their personal health record within an electronic health record (EHR).

Patient-centered requirements are only expected to expand and deepen as the industry moves into Stage 3 and beyond. Simply put, the movement is all about getting more of the health record into patients’ hands and educating them for more active engagement in their care.

In many ways, it’s a significant power shift. Clinicians will no longer be the gatekeepers of health information. And while empowering patients is an important element of the patient-centered care movement, the transition comes with an inherent responsibility on the part of healthcare organizations: ensuring that appropriate resources and education tools are available to patients and support a clear understanding of all elements of care.

Because clinicians tend to communicate in a language very different than that of patients, a key ingredient to patient portal success will be the availability of consumer-level content, presented in an easy-to-understand way.

Consider that some advanced patient portal initiatives provide access to health summaries (including procedures), problem lists, lab and test results, medication lists, allergy lists and immunizations. As patients are provided with direct access to all of this information, they must be armed with the knowledge of how to analyze and act on it.

Challenges to patient education in patient portals

According to a report recently issued by the Institute of Medicine (IOM), nearly half of American adults do not adequately understand and use written health information. Specifically, 90 million people have been classified with limited health literacy.

Defined by the IOM 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,” health literacy and the staggering statistics regarding limited health literacy have formed the basis of a number of national initiatives to improve how consumer health information is presented.

As Stage 2 requirements encourage greater use of patient portals and more email communication between clinicians and patients, the barriers to proper patient education become even more pronounced. With less face-to-face interaction, effective patient education methods that can be achieved through verbal dialogue and teach-back methods in a clinical setting must now be accomplished through written resources within a patient portal. Teach-back methods – where patients are able to verbally provide a detailed explanation of what they have been taught – provide assurance to clinicians that comprehension has been achieved. This kind of confirmation will not be available through patient portals.

Research suggests that a wide communication gap already exists between providers and patients in regards to basic medical terminology as well as the value proposition of the information presented. Alongside this knowledge gap is a lack of appropriate tools that address the challenges of limited health literacy from a written, cultural and linguistic standpoint.

This is particularly true for patients who need access to resources in languages other than English. For these individuals, an obvious unmet healthcare need is the inability to clearly comprehend instructions and information provided in non-native languages. The Health Resources and Services Administration (HRSA) recently reported that the number of people in the U.S. who speak a language other than English has grown by 140 percent over the last three decades.

Along with the challenges of providing resources that truly address limited health literacy, it is also difficult for healthcare organizations to keep content up to date. In an ever-evolving healthcare landscape, the latest industry facts, evidence and best practices can quickly become outdated. Resource-strapped hospitals and clinical settings are simply unable to address this need for regular monitoring of content, such that patients can always trust that the information is accurate.

Improving the outlook

Many hospitals are currently researching the options available to build patient-centered websites or patient portals to facilitate easier communication. To ensure compatibility, many EHR vendors are finding that they need to develop patient portals as an extension of the complete EHR system. As developers progressively consider how to approach the foundation of these applications, it will be critical that they work with educational publishers to create libraries of clinical topics that are written with non-clinical patients in mind. Also important is to identify solutions that provide regular updates to content as industry evidence changes.

The National Action Plan to Improve Health Literacy has outlined seven goals to improve health literacy. These combine strategies for improving delivery of patient education, as well as collaborative efforts on local and state levels to promote better education and knowledge of today’s critical healthcare issues.

A primary goal outlined in the plan is the need to “develop and disseminate health and safety information that is accurate, accessible and actionable.” Attaining this goal through patient portals requires that patients have access to resources that are actionable in that they can be understood by a diverse population encompassing all ages, races, incomes and education levels. While the needs of these groups may vary, one common denominator for all patients – who may be facing significant stress from illness or injury – is the need for clear and simple information.

Critically important to identifying appropriate education tools to integrate into patient portals is an understanding that not all reference materials are equal in their ability to address limited health literacy. Vendors need to consider how best to provide education leaflets for drugs and diseases designed to reach the average reading level of the public, as well as consumer-level interaction monographs that can be used in conjunction with some clinical decision-support functions. Other considerations include language support and large-print options for the sight impaired.

Simplicity should be a primary driver when considering sentence structures and graphics. Industry recommendations suggest fifth- and seventh-grade reading levels as good targets for reaching the masses, but the reality is that most resources currently available are written at a higher level.

Also, resource materials should take into consideration that learning styles vary. Some patients respond well to the written word; others respond better to simple, age- and audience-appropriate illustrations accompanied by short, bulleted statements. Drawings that are action oriented or tell a story can confirm or reinforce the message relayed through the written word.

An overarching need is language support. Healthcare organizations should be prepared for the reality that meeting the linguistic needs of patients is expected to remain a focal point of national regulatory discussions going forward. The National Standards on Culturally and Linguistically Appropriate Services (CLAS) states that “healthcare organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service areas.”


Patient-centered care is a positive movement that has the potential to transform and improve care delivery through more proactive patient engagement. Critical to the success of this movement are patient education strategies that address limited health literacy through the provision of appropriate consumer-level content that addresses written, cultural and linguistic needs.

As Stage 2 MU drives more active electronic access to patient records and more electronic interaction between patients and clinicians, access to the best educational resources in patient portals will be critical to success. Meaningful use is just one of many federal initiatives driving the need for more focused patient education strategies designed to eliminate the revolving-door effect in healthcare.

Forward-looking healthcare organizations understand that a culture of patient education that draws on the best resources and teaching strategies will be critical for success in the present and future pay-for-performance landscape. HMT

About the Authors

Elizabeth Tomsik, BSPharm, PharmD, BCPS, is adverse drug reaction manager, Wolters Kluwer Health. 

Bonnie Briggs, BSPharm, is director, product management, Wolters Kluwer Health. For more on Wolters Kluwer Health: