ix in the treatment process, internet healthcare strategies, 04/05

Information prescriptions (Ix):
Bringing Internet-based health
content into the treatment
process; patients to yo
process; patients to y ur site

Information therapy is a process in which clinicians
Some Ix for information therapy
recommend specific Web content to their patients. Systems can systems planners
be highly automated and used in conjunction with patient portals, electronic medical records, personal health records, or insurance company claims databases. Or they can be manual and informal on the prescriber's end, where doctors simply recommend specific URLs to their patients. With careful available for professionals interested in information prescription (Ix) systems coordination, any of them can bring more patients to a For years, hospitals, medical groups, and other organizations have used good health content to attract users to their Web Information on presentations scheduled sites, get them to remain longer, and encourage them to for the 2005 Information Therapy Conference, to be held September 21- consider using services relating to the content they've found. But static content no longer distinguishes a provider site, since virtually all have it. So organizations are seeking ways to generate more interactivity through applications such as personalized portals, personal health records, and systems that • How personalization, based on patient- Tools for patients
entered data, procedure codes, and demographics, can be integrated into One way to make good use of health content is Web-based • Consumer health information standards information therapy. In essence, information "prescriptions"— • Delivering Ix in "the biggest and often abbreviated as Ix—attempt to use health content in the Viewed one way, health content is always part of the treatment Abstracts and slides of presentations Patients who educate themselves about their conditions and treatment options are likely to change the decision-making paradigm. But information therapy is a process in which Information on how to join the Ix providers in some way recommend specific content—usually Champions Online forum, a virtual clinicians to site planners to IT experts, Often this is done at the time the patient is first diagnosed, after the doctor has spent what limited time is available explaining "A primary benefit of information therapy is reinforcement," says Joshua Seidman, executive director of the Center for Information Therapy. "Studies have shown that patients forget more than 50% of what the doctor tells them." When patients go home with a prescription for Web content, the chances that they will actually understand their condition are improved, Seidman asserts. Copyright COR Health LLC. Reprinted by permission. The information therapy movement grew out of a health plan Web site for health content would recognition that patient education is part of each clinician's job, but is a task that few have the time, not to mention the skills, to do well. But the process of prescribing URLs/pages can range from completely manual to completely Most doctors try their best to inform patients automated, and from being based on pre-set about their conditions and the tests they will be criteria to being more seat-of-the-pants and taking, but many of their patients leave the office informal. Which is not to say that any formal with only a vague understanding of the situation. implementation of information therapy precludes the patient from exploring beyond the URLs or "It's not rare for patients to be lost In fact, in most cases, the prescription is considered only a starting point for the patient, and may or may not send the patient to the provider organization's own site. But it almost always improves the patient's satisfaction. Can be proffered "as needed"
The second important attribute of information therapy is that the information can be provided Filling cost-containment cracks
at the point in time when it can be most helpful believe the model can help fill the gap left open This may be when the patient is first diagnosed by the need to squeeze cost out of the American with a condition, or it could be a year later when reinforcement of a regimen might be deemed They say there's a contradiction in a system where briefer doctor visits leave many patients Information therapy, as Kemper sees it, requires in the dark while those same patients are being giving the patient access to credible, evidence- based information at every step in the treatment process. Unlike the traditional model of patient • The proliferation of new drugs has made education, where patients diagnosed with a specific condition may receive a stack of literature on the first day, Web-enabled Ix can be • Shorter hospital stays require patients to do transmitted continually as the situation changes. more of their pre-surgery preparations and their after-surgery recuperation at home. "You have to develop information that is right for • And the increased emphasis on lifestyle the person who is receiving it at the time they changes means that more healthcare activity are receiving it," says Kemper. In some cases, takes place at non-healthcare facilities such this involves predictive modeling: knowing when patients need specific information, and the kinds of information they need at every stage of their How Web-enabled Ix differs from general
condition from diagnosis to acute treatment to health content
Information therapy is a broad term that can Seidman also cites a number of Web-enabled encompass many different types of projects, and information therapy projects in which the health differs from general Web content in a number of content sent to patients is triggered by events. Most of these systems are activated by an electronic health record or an insurance Is provider prescribed
company claims system when a patient receives First, the specific information or URL is prescribed by a provider. Simply suggesting that a patient visit the hospital, medical group, or Copyright COR Health LLC. Reprinted by permission. Can be demographically tailored
Similar applications are being piloted by And just as a provider may recommend some therapies based partly on demographics—such as asking selected older patients to start taking Content provision based on the
electronic medical record or DM
recommendations in an information therapy guidelines
program can also be demographically based. "If a 60-year-old man is about to get a physical, you Larger healthcare organizations, especially want to supply him with different health content those that have specialized in creating internal than you'd give a 30-year-old woman," Seidman health content, are in the forefront of the provider-based information therapy movement. Automated content provision based on
For example, The Cleveland Clinic is working to diagnostic codes, claims
connect content it has created with entries in the organization's electronic medical record system. In a manual system, the doctor would suggest Web content based on either a checklist or Healthcare information in general is a key simply the physician's knowledge of credible ingredient of the relationship The Cleveland Clinic develops with its patients, says CEO information. However, Seidman says, many organizations are considering or beginning to The Clinic licenses Web-based health content to messages to patients based on diagnostic code. other organizations, but in providing content to its own patients, Harris says, "We know In terms of the technology required to allow for this model, Healthwise's Kemper, for one, isn't prescriptive in the information we provide." looking for new technology but "piggybacking" That is, when Clinic patients view their electronic medical records online and see test results, they On a basic level, piggybacking can be used with can also click on links that direct them to an electronic prescribing system. Whenever the detailed information explaining those results. clinician fills out a prescription using the system, the application prints out drug information "This gives them information at the very time content or specifies Web links for the patient. they are motivated to read it, and are capable of This, however, is already being done by most doing something with the information," Harris A more advanced version, one that hospitals But importantly, he adds, the system isn't limited could consider implementing, would be to to providing information therapy during acute piggyback the information therapy program on interventions, when a patient is diagnosed with a the electronic medical record. Whenever an condition. It can also be used on an ongoing order or procedure code is entered, it triggers a basis to keep patients healthy—to recommend process of sending the patient to content on the flu shots or summertime exercise options, for hospital's Web site. So the code for the colonoscopy will initially trigger information, via a secure Web site, on what a colonoscopy is. Or it can be used to dole out content in easy-to- digest doses over the course of weeks, months, Later, as the date for the procedure gets closer, or even years as a patient learns to live with a it can send reminders on how to prepare for the procedure the night before, and the day of the For those patients who have chronic diseases that are challenging to manage, Harris says, The Privacy experts say HIPAA rules preclude Cleveland Clinic is moving to online disease sending information based on a diagnostic code to a patient's e-mail account. So generally e-mail is used only to let the patients know that a Currently, The Clinic is conducting surveys on message is waiting for them at a secure Web how best to influence behavior and improve Copyright COR Health LLC. Reprinted by permission. One study, funded by the Robert Wood Johnson Some of the initial resistance to the project came Foundation, will try to determine the best means from doctors who already had their favorite sites and time to apply prescriptive information in for each of those conditions. But Kienzle says that eventually many physicians "Saw the benefits of the one-stop shopping they could get High-technology not essential on the
prescriber's end
The challenge of measuring compliance
To a certain extent, the concept of information and outcomes
therapy has been linked to technology-based models. But it doesn't necessarily have to be a Speaking from his own experience using the technology-based project on the physician's end. prescription pad approach, Kienzle recalls that at first he was diligent about checking off the In fact, low-technology solutions may fit in with appropriate URL for the patient's condition, but physician workflows more easily, since many of then eventually moved to simply giving the those workflows are paper-based. And a model patient the URL of MedlinePlus' home page, still that doesn't depend on technology can be using the prescription pad or another piece of technological solutions are being developed. Michael G. Kienzle, MD, a professor of medicine at the University of Iowa's Carver College of Medicine, points to a successful low-technology information therapy pilot project he was involved One primary goal of the project, which was co- sponsored by the National Library of Medicine and the American College of Physicians, was to get internal medicine doctors directly involved in educating their patients using Web resources. (See Kienzle's presentation, "Take this they get a better idea of the large number of information and call me in the morning," from the resources available on the site. They may then go back to the site on their own, to find other information for themselves or for others. "Research conducted by various groups On the downside, the researchers who designed confirmed that patients may use the Web to get the study had hoped to use increased visits to information, but that they prefer to get the the specific URLs on the prescription pad information from their own doctor. This project checklist as a measure of success. Since so attempted to make that happen," says Kienzle. many doctors decided to send their patients to the MedlinePlus home page, those data were To create a simple model that could be used by the largest number of doctors, the pilot "Used what for all doctors and patients is a common For this and other reasons, Kienzle says, "We token: the prescription pad," Kienzle explains. struggled with figuring out how we determine the impact of the pilot project." In his own practice, Kienzle believes the study was successful in he began to question patients informally, and recruiting doctors, who included about 150 says he received positive comments. But that's internists in Iowa and 300 in Georgia, because the program followed the normal workflow for While some data were collected, most related to how doctors used the system, not the effect on The doctors were supplied with prescription patient health. For now, doctors may just have to take it as a matter of faith that providing Web MedlinePlus. Each URL provided information on content is at least somewhat beneficial to some a common condition, such as hypertension or patients. But since the pilot project added very diabetes. Doctors could write in a URL on a line little work and no technology cost, a positive Copyright COR Health LLC. Reprinted by permission. cost-benefit ratio should be easy to achieve with Still, information therapy boosters believe the model has the power to change the course of Says Kienzle, "The actual clinical impact of the information for patients is very difficult to Says Kemper, "From the provider's perspective, determine, and was beyond the scope of our the patient is more likely to have complied with project. So many factors affect the health of a the requirements of the procedure or of the patient on a daily basis, it's hard to tease out the regimen. From the patient's point of view, they effect of a single relatively modest intervention Patients may nod obediently when the doctor "Most of the rationale for doing it is derived from necessarily mean they understand, Kemper education and chronic illness management and adds. With the information therapy model, they are more likely to really understand the situation intense educational programs and interventions. at hand. "And that has to affect the patient's "It's a little bit of a leap of faith to go from these studies to a less intense and more informal program like information prescriptions, but that's the basis for the belief that they might help patients stay healthy through access to better For more information about Healthwise, the Center for Information Therapy, and the 2005 Information Therapy Conference, go to: . Copyright COR Health LLC. Reprinted by permission.

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