Page 102 - Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

ConCLUDinG DiSCUSSion

Marchibroda responded that, currently, health literacy is separate
from the development of HIT systems. The focus is on putting electronic
health records into physicians’ offices and helping emergency rooms to
obtain data. The focus is very provider-centric in other words, and there
are many barriers to that adoption. Consumer-facing applications are
happening in some areas—Whatcom County, for example—and per-
sonal record organizations are working directly with employers or health
plans. To bring health literacy more broadly into the development of HIT
requires addressing some of the barriers to implementation, particularly
making the business case.
There are also other things that could be done, Marchibroda contin-
ued. The first is raising awareness of how important health literacy is in
the development of these systems. The second is raising expectations of
what is expected from providers in terms of health literacy. In terms of
measurement, one might start with some process measures but what ulti-
mately drives change is what is rewarded in health care. It is important to
show that obtaining higher-quality health outcomes requires more effec-
tive consumer–clinician engagement and understanding.
The questioner responded that focusing on improving physician
understanding of health literacy may result in the kind of situation that
now exists with IT systems for prescription medications. That is, the
systems are designed for ease of communication between the pharmacist
and the physician, but that does not necessarily have anything to do with
increasing patient understanding about taking medication.
Seidman said that there has been a great deal of conversation about
health behavior change and how to get individuals to make different
choices or to learn certain skills. But it is important to remember that
people are embedded within communities and individual practitioners
are embedded in organizations. Perhaps some of the largest gains could
be made by looking at that bigger picture.
Systems are critical, he continued. Many approaches assume that
everyone has the same advantages. However, those who are poor, unwell,
or uneducated have many things working against them. For example,
the action taken in the Arizona Medicaid program to give people e-mail
addresses was a system action. Going to where people are rather then
expecting individuals to take responsibility is a shift in organizational
thinking. Such a shift would include creating health-promoting types of
systems that help develop literacy cultures. The wiki has been discussed
before. The power of the wiki is that there are a number of people working
together, beyond the individual. One is actually tapping into the system
in which those people are embedded.
One participant said that in order to make sure decent electronic
health records are widespread one should work with the patients, the

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