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● Electronic Health Records

Empowering patients through advanced

EMR use T e role of patient education and health literacy in patient portals.

By Elizabeth Tomsik and Bonnie Briggs H

ealthcare providers are knee deep in eff orts to meet Stage 2 meaningful-use (MU) require- ments 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 identifi ed as a natural and eff ective approach for achieving a number of objectives, including providing patient access to: • Health information in a timely manner; • Clinical summaries of offi ce visits; and • Patient-specifi c education resources. With Stage 2 already in motion, many industry profession-

als believe that patient portals will be necessary for healthcare organizations to meet requirements laid out for more active electronic engagement of patients. Specifi cally, 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 signifi cant 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 organiza- tions: 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

diff erent than that of patients, a key ingredient to patient por- tal 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),

14 March 2013

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: www.

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. Specifi cally, 90 million people have been classifi ed with limited health literacy. Defi ned 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, eff ec- tive 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 comprehen- sion has been achieved. T is kind of confi rmation 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. T is is particularly true for patients who need access to

resources in languages other than English. For these indi- viduals, an obvious unmet healthcare need is the inability to


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