Questions for a potential patient education system
What you should know before you buy
Purchasing a patient education system means a large investment of time and money. Careful consideration of the hospital's needs and how those needs are addressed by the systems out there is a must.
Here are some key factors to consider before buying:
* Is the patient education database a stand-alone product, or can it be networked easily so providers throughout the facility can access materials?
Lake Hospital System in Painesville, OH, has had a patient education program called AfterCare, geared for the outpatient emergency department (ED) setting, for the past two years. The program is from Denver-based Micromedex. The hospital recently purchased the vendor's latest product, CareNotes, to focus on inpatient education, says Debbie Wayman, RN,C, clinical program coordinator for Lake Hospital System.
The ED program was recently put on its network so that more hospital areas can access it, Wayman says. The program includes multiple illness and injury topics, and self-care pieces telling patients what to watch for and how to follow up after leaving the hospital.
'It's now going into med-surg, critical care, obstetrics, and the skilled-nursing rehab unit,' she says. 'Although it's geared for the ED, we're pulling it into other areas because they can make use of some of the components.'
AfterCare's guidelines for self-care, while designed for patients discharged from the ED or outpatient clinics, or for those who have received medication from a pharmacy, can be useful for patients in other areas, Wayman says.
CareNotes, a patient education product for the entire continuum of care, covers the same topics as AfterCare, but broadens what is available. (See angina discharge document from CareNotes, inserted in this issue.)
'Your discharge instructions are in AfterCare, but in CareNotes there is discharge care and pre-care, inpatient, and general information,' Wayman says. CareNotes also includes what Wayman calls 'nice-to-know' information that can be pulled to educate patients' family members, for example, about their condition.
Methodist Hospital in Omaha, NE, has used the Patient Drug Education PC program from Indianapolis-based Medi-Span for about five years, says Mary Wolcott, RN, patient education coordinator. (See table of patient education software companies, p. 58.) The hospital does not have the Medi-Span system on its network. Therefore, nurses and others involved in patient education must come to Wolcott's office or use one of the copies that may be available on their units to get the patient handout they need, she says.
'If it were on a network, they could go to their own computer, call it up, and print it out,' Wolcott says. 'But the cost for networking is considerably more -- really big bucks on a yearly basis.' She points out that one barrier for her hospital has been a charting system it has had for many years that has been virtually impossible to interface with other systems. If the hospital updated its network, that could allow nurses to access Medi-Span from their computers, Wolcott says.
Hospitals looking at new computer systems should make sure the product they are buying has the capability of issuing medication instructions, or a separate system may be required, Wolcott says.
Patients at Methodist Hospital receive the medication information from Medi-Span in two ways: If they are going home with a drug, they get a printout from the pharmacy, which has the integrated version of the program, which is called Patient Drug Education Database. That program, which is more automated, is often part of a hospital's pharmacy software package. Otherwise, the nurse or other health care professional who is caring for them may get a hard copy from Wolcott's office or from a small supply on the patient care unit.
* What type of editing, if any, does the program allow?
In the case of the Micromedex products that Wayman's hospital uses, there are places for her to add individualized information, such as customized medication instructions, to an AfterCare document before it is printed. With CareNotes, however, more individual information can be imbedded in the document, such as fields that allow recording of the patient's blood pressure, and how many times it should be checked, she says.
'It depends on the content,' Wayman says. 'We can add when to take medication or to call us if [something specific] happens. In the one on hypertension, there's a place to put what the patient's pulse is, what the mean pressure is, what the ideal weight is, and 'You should lose X amount of pounds.''
If Wayman changes the content in the documents in CareNotes to reflect the practice patterns of the hospital's own physicians or the hospital's particular demographics, or if she creates new documents, those materials become 'UserNotes.'
'If we author our own [materials], we have our own footnotes, and we do our own annual review because that document is ours,' she says. For the obvious reason that it would defeat the purpose of purchasing materials to put too much additional work into them, Wayman expects to do little editing of the CareNotes.
'I see a few physician-specific documents being created,' she says. 'We have one plastic surgeon that is very specific and detailed about what she wants patients to do, so I do see us authoring a few [documents].'
Although the Medi-Span patient education program that Methodist Hospital uses is very specific as to drug type, it cannot be edited by the user, Wolcott says. There is a provision for putting the hospital's name on each document, however.
* How often is the program updated, and what future materials can you expect?
Their patient education systems are updated four times a year with a diskette, Wolcott and Wayman say. Wayman suggests that hospitals considering buying a system look at the titles available and those proposed for the future to see if they meet the facility's needs.
* What is the reading level of the materials? Are they offered in different languages?
Some programs come with English and Spanish versions, and may offer more than one reading level. Wayman notes that while materials in her hospital's Micromedex AfterCare program are written on a sixth- to seventh-grade level, the vendor brought the reading level down to fourth to sixth grade for CareNotes, the newer program. 'Most studies have shown they needed to bring it down to that level,' she says.
As for foreign language availability, Wolcott points out, 'No matter what part of the country you're from, that's something you need to look at. Probably 10% of our population is Spanish-speaking.'
Before subscribing to the Spanish version of her patient education programs offered by Medi-Span, Wolcott will survey the hospital's various clinics on whether it would be helpful and what the usage might be, she says.
The AfterCare program that Wayman uses includes some materials in Spanish, so users of CareNotes (at present, it is only in English) will venture back into the older program when they have a Spanish-speaking patient, she says. CareNotes, however, will have a Spanish version in the next couple of months, says a company spokeswoman. *
Software Sources for Computer-Generated Handouts
CareNotes, AfterCare (illness, injury, medication instructions)
Micromedex
6200 S. Syracuse Way, Suite 300
Englewood, CO 80111
Telephone: (800) 525-9083 or (303) 486-6400
Patient Drug Education Database, Patient Drug
Education PC (medication information)
Medi-Span
8425 Woodfield Crossing Blvd.
Indianapolis, IN 46240
Telephone: (800) 428-4495
Discharge Instruction Program
Automedics
476 Highway A1A, Suite 6A
Satellite Beach, FL 32937
Telephone: (407) 773-0012
