Page 81 - Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

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

HeALtH LiteRACY, eHeALtH, AnD CoMMUniCAtion

actually was happening. In one community health center, for example,
the chief information officer told the project staff, “Oh, we don’t really
need a PHR because our patients don’t really want to access information
electronically.” But when the staff observed the primary care physician
serving his patients over a 2-hour period, the physician received e-mails
and text messages from patients on his cell phone. It turned out that
the clinician’s patients already were using electronic technology, but
the message was not getting to the administrators of the center. Rather
than making assumptions about what technologies patients do or do not
use, one should use data and observations to determine what is actually
occurring.
The project found that there was a great deal of variability in terms
of the technology that patients were using. For example, in one inner-
city community health center with a population that was about 95 per-
cent Latino, the clinicians said, “All our patients use e-mail.” In other
communities patients were using smartcards. These smartcards contain
patient information which can by read by smartcard readers at health
care facilities in order to quickly obtain information about the patient.
The smartcard readers cost about $15, so this approach is fairly inexpen-
sive to implement. The problem is that facilities frequently do not plan in
advance to buy smartcard readers when they buy their computers.
Similarly, many facilities are implementing electronic health records
without thinking about the portal access. Furthermore, planning for PHRs
is often done without thinking about the link between an individual’s
health information (e.g., a person’s lab data, medical record, and medica-
tion information) and the context within which that information will be
used. This is a serious concern, and it is important to think carefully about
the best way to contextualize content. There is a great opportunity to do
things correctly the first time, to make sure electronic records are patient-
centered, as PeaceHealth and MiVIA have done.
There are many instances when PHRs are implemented but not much
used. Providers don’t promote their use or they may even object to their
use—as in the case that Gauthier spoke of earlier where the physician
threw the Shared Care Plan card in the trash. Patients need to be engaged,
but clinicians must also be active participants in the process because
patients do pay attention to what their clinicians say and give it a great
deal of weight.
Observation shows that people are hungry for information but do
not have very high expectations. As mentioned in earlier presentations,
people need a reason to use technology. Once they have an experience of
value to them, they are much more likely to use the technology. For exam-
ple, technologies could create after-visit summaries in English, Spanish,
or other languages. Given that patients forget 50 percent to 80 percent of

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