Promoting Health Literacy via Innovative Health Technologies Michael S. Wolf, PhD MPH Associate Professor, Medicine & Learning Sciences Associate Division Chief, General Internal Medicine Feinberg School of Medicine Northwestern University Chicago, IL, USA
Disclosures. National Cancer Institute (NCI) National Institute on Aging (NIA) National Insitutefor Nursing Research (NINR) Foundation for Informed Medical Decision Making (FIMDM) McNeil Consumer Healthcare Abbott Labs Office of Behavioral and Social Sciences Research (OBSSR) National Heart, Lung, and Blood Institute (NHLBI) Agency for Healthcare Research and Quality (AHRQ) Centers for Disease Control (CDC) Pfizer Pharmaceuticals The California Endowment Earthbound
Study Acknowledgements. David Baker, MD MPH(GIM, Northwestern) Terry Davis, PhD(LSUHSC-Shreveport) Darren DeWalt, MD(UNC-Chapel Hill) Greg Makoul, PhD(St. Francis/UConn) Dan Morrow, PhD(UIUC) Denise Park, PhD (UT-Dallas) Ruth Parker, MD(Emory) Dean Schillinger, MD (UCSF) Hilary Seligman, MD(UCSF) Will Shrank, MD(Brigham/Harvard) Elizabeth Wilson, PhD (GIM, Northwestern) Alastair Wood, MD(Symphony Capital/Cornell)
A Snapshot How can we leverage Health ITto - Deliver health information to patients & families - Streamline & standardize health care practices - continuously connect with patients in order to SIMPLIFY HEALTH SYSTEM DEMANDS Learned challenges (capability, cost, translation, etc.) Short and Long-term Objectives A Series of Local Perspectives
A Snapshot How can we leverage Health ITto - Deliver health information to patients & families - Streamline & standardize health care practices - continuously connect with patients in order to SIMPLIFY HEALTH SYSTEM DEMANDS Learned challenges (capability, cost, translation, etc.) Short and Long-term Objectives A Series of Local Perspectives
A Snapshot How can we leverage Health ITto - Deliver health information to patients & families - Streamline & standardize health care practices - continuously connect with patients in order to SIMPLIFY HEALTH SYSTEM DEMANDS Learned challenges (capability, cost, translation, etc.) Short and Long-term Objectives A Series of Local Perspectives
A Snapshot How can we leverage Health ITto - Deliver health information to patients & families - Streamline & standardize health care practices - continuously connect with patients in order to SIMPLIFY HEALTH SYSTEM DEMANDS Learned challenges (capability, cost, translation, etc.) Short and Long-term Objectives A Series of Local Perspectives
A Snapshot How can we leverage Health ITto - Deliver health information to patients & families - Streamline & standardize health care practices - continuously connect with patients in order to SIMPLIFY HEALTH SYSTEM DEMANDS Learned challenges (capability, cost, translation, etc.) Short and Long-term Objectives A Series of Local Perspectives
What Falls under Health IT? Clearly not limited to: Telephonic interventions(schillinger) EHR (wolf) Internet Interactive video & games Handheld devices (cell phone, smart phone, ipad, etc.) Medical devices Computerized agents (Bickmore)
What Falls under Health IT? Clearly not limited to: Hospitals & Clinics Pharmacies Schools Libraries Occupational settings Patient homes Anywhere
Health IT & Health Literacy IOM 2004 HL Report underscored health system complexity as target for intervention Various health technologies can be used to: - convey patient information, promote behavior change - elicit patient issues & concerns, screening - monitor chronic disease - standardize clinical protocols - track patient progress & outcomes - prompt related health care provider behavior
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
Potential Benefitsof Health IT Expand or target audience Tailor tools as needed Timeliness of delivery Standardization of message(s) Layer content Automation of processes of care Efficiency in resources Potential sustainability Relative cost for dissemination (depends on tech)
www.medicine.northwestern.edu/divisions/general-internal-medicine Patient checks in RN encounter RN starts video in EHR MD encounter Decision making Tangible print tools to Pt
Patient R x Tools at Point of Prescribing w/ structured protocol
Chronic Disease Self-Management Tracking system for moving patients forward Front loaded activities Uses existing Microsoft tools to prompt RNs, record calls ACP Guide min. 6 follow-up calls or in-person goal setting encounters 0 1 2 3 4 5 6 7 8 9 10 11 12 Baseline clinic visit Telephone call follow-up Clinic visit OR telephone call follow-up Carve-In vs. Carve-Out Models
What are We Ready to Do? Do not drink alcoholic beverages while taking this medicine Carry or wear medical identification stating you are taking this medicine You should avoid prolonged or excessive exposure to direct and/or artificial sunlight while taking this medicine Michael Wolf 04/29/71 Glyburide 5mg Take for Diabetes Take: Morning 7-9 AM 2 pills in the morning 2 pills in the evening Noon 11-1 PM Evening 4-6 PM 2 2 Bedtime 9-11 PM Rx #: 1234567 9/8/2009 You have 11 refills 180 pills Discard after 9/8/2010 Provider: RUTH PARKER, MD Emory Medical Center (414) 123-4567 Pharmacy: NoVA ScriptsCentral 11445 Sunset Blvd. Reston, VA (713) 123-4567 NDC # 1234567
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
Potential Constraintsof Health IT Access to IT (patient AND provider) Patient skills required to interface with IT Adaptability of technology to meet user needs Limitations of clinical and/or patient environment Readiness to accept IT/cultural transformation Skills required of relevant staff to interface w/ IT Communication barriers between IT systems Tethered or untethered platforms Risks of automating certain patient/provider activities (lessons from human factors)
http://www... 131 Adults w/ limited literacy self-reported less internet access and use (Jensen, et al J Aging Health May 21 2010) Anxiety reported with adoption of technologies (N=1204; CREATE Study; Czaja et al Psych Aging 2006) Most older adults struggle with basic web navigation and decision making tasks (Czaja, Sharit, Nair, JAMA 2008) USER TESTING NEEDED FOR ALL MODALITIES
What Happened to my Kiosk? Choosing technology solutions that match the needs of the setting
Effective and SustainableCDSM Tracking system for moving patients forward Front loaded activities Uses existing Microsoft tools to prompt RNs, record calls ACP Guide min. 6 follow-up calls or in-person goal setting encounters 0 1 2 3 4 5 6 7 8 9 10 11 12 Baseline clinic visit Telephone call follow-up Clinic visit OR telephone call follow-up Carve-In vs. Carve-Out Models
Challenges to Sustainability Guide just a soupstone w/o back-up No existing EHR in FQHC sites No additional resources = limited salience, use of tools Need clinic champion to lead practice change Importance of available health IT support 0 1 2 3 4 5 6 7 8 9 10 11 12 Baseline clinic visit Telephone call follow-up Clinic visit OR telephone call follow-up 5% -92% (CI) vs. 88% (CO)
What are We Ready to Do? Do not drink alcoholic beverages while taking this medicine Carry or wear medical identification stating you are taking this medicine You should avoid prolonged or excessive exposure to direct and/or artificial sunlight while taking this medicine Michael Wolf 04/29/71 Glyburide 5mg Take for Diabetes Take: Morning 7-9 AM 2 pills in the morning 2 pills in the evening Noon 11-1 PM Evening 4-6 PM 2 2 Bedtime 9-11 PM Rx #: 1234567 9/8/2009 You have 11 refills 180 pills Discard after 9/8/2010 Provider: RUTH PARKER, MD Emory Medical Center (414) 123-4567 Pharmacy: NoVA ScriptsCentral 11445 Sunset Blvd. Reston, VA (713) 123-4567 NDC # 1234567
What are We Ready to Do? Formatting for 3 panels requires timely re-programming Printers do not have color pre-printed Do not drink alcoholic beverages while taking this medicine Carry or wear medical identification stating you are taking this medicine You should avoid prolonged or excessive exposure to direct and/or artificial sunlight while taking this medicine Michael Wolf 04/29/71 Glyburide 5mg Take for Diabetes Take: Morning 7-9 AM 2 pills in the morning 2 pills in the evening Noon 11-1 PM Evening 4-6 PM 2 2 Bedtime 9-11 PM Rx #: 1234567 9/8/2009 You have 11 refills 180 pills Discard after 9/8/2010 Provider: RUTH PARKER, MD Emory Medical Center (414) 123-4567 Pharmacy: NoVA ScriptsCentral 11445 Sunset Blvd. Reston, VA (713) 123-4567 NDC # 1234567 Pre-programmed and locked USES ALL CAPS Pre-printed on label paper Create new fields for pharmacist Some font sizes locked
Just Because We Can FIMDM Systematic Literature Review (in prep 2010) - 21 comparative studies of multimedia v. print tools (patient ed, decision making, instill attitudes, behavior change) - No true winner emerges -Wilson et al. (J Health Comm2010) + procedural v. declarative content matters + re-review matters + using both video and print matters
Additional Considerations Plan for standardization (Bailey et al 2009; Wolf et al 2009; Shrank & Avorn 2008) System breakdowns: the case of language access (Bailey et al. 2009; Sharif 2010) Search for loopholes: e-prescribing and missing data Do they know how we work? Needing a CQI plan
Press Play Comprehensive evaluations needed to: -assess fidelity + impact on full list of outcomes (root cause analyses) - examine effects by age, literacy level -cost? - target translation, dissemination Critically consider use of new technologies (diffusion of innovation) Seek to improve IT linkages across systems
Contact Information: Michael S. Wolf, PhD MPH Associate Professor, Medicine & Learning Sciences Associate Division Chief Research Division of General Internal Medicine Northwestern University Feinberg School of Medicine 750 N. Lake Shore Drive, 10 th Floor Chicago, IL 60611 (312) 503 5592 mswolf@northwestern.edu