Health Literacy, eHealth, and Communication Putting the Consumer First: Workshop Summary (2009) / Chapter Skim
Currently Skimming:
2 Overview of Issues
2 Overview of Issues
Pages 3-28
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Chief Executive Officer, eHealth Initiative and eHealth Foundation Implementation of eHealth and health information technologies is seen by many observers as an effective way to address current concerns about the quality and safety of the U.S. health care system.
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. Health insurance premiums for workers and their employees have increased by 78 percent since 2000, while workers' earnings have risen by only 19 percent over the same time period (Kaiser Family Foundation and Health Research and Educational Trust, 2006)
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Much of the plan is based on work by Ed Wagner who put "The eHealth Initiative and the Foundation for eHealth Initiative are independent, non profit affiliated organizations whose missions are the same: to drive improvement in the quality, safety, and efficiency of healthcare through information and information technology. Both organizations are focused on engaging multiple and diverse stakeholders -- including hospitals and other healthcare organizations, clinician groups, consumer and patient groups, employers and purchasers, health plans, healthcare information technology organizations, manufacturers, public health agencies, academic and research institutions, and public sector stakeholders -- to define and then implement specific actions that will address the quality, safety and efficiency challenges of our healthcare system through the use of interoperable information technology" (eHealth Initiative and Foundation for eHealth Initiative, 2008a)
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. Components of eHealth include electronic health records (EHRs)
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. In June 2006, when the eHealth Initiative Foundation conducted a number of focus groups and a phone survey of individuals in the Gulf Coast area on the topic of electronic health information exchange, it found that 70 percent of those individuals favored secure, electronic health information exchange that is "protected and exchanged under current medical privacy and confidentiality standard procedures" (Shea et al., 2007)
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The eHealth Initiative Foundation conducts an annual survey of Information Exchange Initiatives. The fourth annual survey of health information exchange at the state, regional, and community levels, conducted in 2007, found that of the 130 initiatives responding to the survey, 20 were at the beginning stages of effort (stage 1 or 2 -- see Table 2-1 for TABLE 2-1 Seven-Stage Framework for Assessing and Tracking the Development of Health Information Exchange Initiatives at the State and Local Levels Stage 1 Recognition of the need for health information exchange among multiple stakeholders in your state, region or community.
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Marchibroda concluded that, given the momentum of health IT, it is now a time of tremendous opportunity to develop eHealth systems that can address health literacy issues. At the same time, if such issues are not attended to, the creation of eHealth and health information applications may actually exacerbate existing problems, rather than providing a mechanism to help solve them.
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. A quick search for information on the common cold can be used to illustrate the difficulties in eHealth literacy.
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eHealth literacy is "the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem" (Norman and Skinner, 2006b) Such a definition is consistent with Logan's contentions that use of the Internet is complex and its use plus the use of other networked tools constitutes a new lan The Canadian Health Network was operating at the time of this workshop, however it has since ceased operations.
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They also have difficulty understanding that the media has both explicit and implied messages and they have difficulty deriving meaning from media messages. The third general skill involved in eHealth literacy, information literacy, involves a more general understanding of information.
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As described above, the specific skills involved in eHealth include computer literacy, science literacy, and health literacy. Computer literacy is a general awareness of and skill in using computer-based technology to solve problems (Logan, 2000)
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Identifying these skills and understanding the extent to which individuals possess these skills should help in the design of better eHealth tools and systems. The eHealth literacy scale (eHEALS)
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These skills are teachable, but they require constant remediation and updating. Strategies for Raising Health Literacy in Arizona Medicaid Members: New Approaches for State Medicaid "Health Knowledge Builders" Anthony Rodgers Director, Arizona Health Care Cost Containment System "Health literacy is one of the most widespread obstacles to achieving better health outcomes in the United States" (AgrAbility Project, 2005)
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Such a system would enable Medicaid to use the data in its files to provide clinical decision tools that allow physicians to see the individual patient episode of care or care plan and also make it possible for AHCCCS to aggregate this information for a broader perspective of the health of the Medicaid population. Finally, the system needs internet and communication tools that support the delivery of personalized health information and health literacy competency for Medicaid beneficiaries.
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The enabling technologies are the health information exchange infrastructure, electronic health record infrastructure, the Web-based e-learning programming infrastructure, and the knowledge building and transfer infrastructure. With properly configured enabling technologies creating the processes through which the various Medicaid programs (e.g., acute care, long-term care, disease-management health education, and population-based education)
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Such products will include e-learning modules, electronic health assessments, Web-based health coaching, Web-logs, streaming video,13 Web-based health awareness campaigns, eHealth-connected provider offices for access to downloadable personalized health videos, and podcasts. Multimedia education will focus first on raising the health literacy of those with chronic diseases and, in particular, will be aimed at helping individuals understand their chronic illnesses.
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. The mission of the website is "to build health and wellness literacy in AHCCCS members so that they make decisions that improve their health care quality and reduce preventable health care care costs through the utilization of interactive, personalized health education and health literacy competency" (Rodgers, 2008)
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, and each patient will also access his or her personal health account which will contain a personalized audio/video file of e-learning programs. In this future vision, once a patient accesses his or her personal health account, the physician will be able to view the information and make sure that the patient understood the individual e-learning programs, since patient responses will be automatically uploaded to the electronic health record (EHR)
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Rodgers concluded by predicting that AHCCCS eHealth, properly configured, will help address one of the major obstacles to achieving b etter outcomes, that is, eHealth literacy. Discussion George Isham, M.D., M.S.
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One could also create an education room, but since AHCCCS plans to ultimately offer these services in provider offices where space tends to be limited, creating a separate education room may not be the best option to pursue. The hope is that access will eventually be available in the homes.
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The National Library of Medicine has illustrative tutorials on its Medline Plus in both Spanish and English. These are very popular with those with low health literacy and with those who work with such populations.
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Ultimately, the idea is to put the application online so that as they apply, they also fill out a health assessment form which will immediately provide information to the health plan that has never before been available. One participant said that she sees health literacy as patient-centric.
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In 2008, for example, analysts expect that $1.8 billion will be spent on chronic care management, most of which will be paid for by health plans or employers. Connecting consumers who have chronic conditions to e-learning systems built to address low health literacy issues -- systems such as the one described by Rodgers -- could offer a compelling business case for health literacy.
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One participant stated that when she thinks of populations with low health literacy she thinks of recent immigrants, the elderly, and those with limited English proficiency. Would the tools that are being developed for eHealth actually disenfranchise these groups even more?
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What is needed is a system that people can navigate, one in which a set of skills can be taught and used throughout health care. While cost may be the driver, the real bottom-line quest is, Do these systems actually improve the health of the population?
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