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Using Electronic Medical Records as patient teaching tools

By Sheri Ross

Healthcare providers have a unique opportunity to not only address current or anticipated health problems with their patients, but also to help patients avoid future negative health consequences by teaching them how to care for themselves. Regular reinforcement increases the likelihood that patients will adhere to the concepts being taught. Incentives can also help to modify patient behaviours and may take many forms, such as recognition for accomplishments or demonstration of improvements, using the tools available within EMR software, including notes and reminders, graphing and trending, and risk assessment tools.

Learning occurs best when several factors exist, including a readiness to learn on the part of the learner and a relationship of trust between teacher and learner, such as exists between physicians and their patients. The physician can assess a patient’s readiness to learn at each interaction, and should be aware of the value that patients place on the teaching provided by their physician.

In a study conducted by Terry and Healey, it was found that patients who received self-care information from their physicians were significantly more satisfied with their care than patients who did not receive the information or those who received it via mail. When patients are positive in terms of receiving self-care information from their physician, it is anticipated that they will be more likely to follow the instruction provided.

While patient teaching may not have been the first and foremost thought when a physician decided to acquire EMR, its value as a patient teaching aid should not be minimized. Physicians routinely access patient records, using their EMR system during patient visits. In so doing, the physician has access to the patient’s most current laboratory results, hospital or diagnostic imaging reports, allergy and medication information, and other pertinent health information.

For example, a note, reminder or risk factor regarding a patient’s smoking status could have been recorded on a previous encounter, and this at-hand information serves as a visual cue to the physician to inquire about current status and reinforce previous teaching related to smoking cessation. A series of notes regarding the patient’s progress with smoking cessation can also be reviewed with patients to help demonstrate that positive progress is being made and to encourage them to continue to pursue their goal of quitting. Understanding the readiness of the patient to receive other types of information on the topic, and knowing where and how to access other resources, the physician can direct the patient to websites for additional information that might further aid them in achieving their goal.

Certain medical conditions can be challenging to manage and may require ongoing assessment with lab tests and subsequent medication adjustments. The graphing and trending capabilities within an EMR program are tools that the physician can readily tap into when teaching patients about managing a particular condition. The old proverb "a picture is worth a thousand words" rings true when showing a patient a lab result, trended and graphed over an extended period of time through EMR software. A patient with high blood pressure, for example, may be prescribed an antihypertensive medication, taught about dietary and lifestyle changes, and asked to monitor weight and blood pressure at home as part of the self-care regime.

The patient can then enter weight and blood pressure readings directly within their health record by using a patient health portal, such as the Health Portal, which is fully integrated with PS Suite EMR. During the patient’s next medical appointment, the physician can graph the patient’s blood pressure readings and weight recordings, and can review the dosage of medication.

As the patient’s weight drops, blood pressure also often decreases, and the need for medication to manage blood pressure is also reduced – by presenting these changes to the patient through the use of graphing and trending capabilities, the patient can readily see the direct correlation between weight and blood pressure readings, and the physician can provide incentive to the patient to continue current activities. If the trended results are less positive, the physician may use the graphed and trended information to reinforce some aspects of the teaching program, and to highlight the changes that are desired.

Another potential use of EMR in a patient-teaching context is the use of risk assessment tools to help patients understand their risk level for certain conditions. The ability to conduct a risk assessment while the patient is present and in the room helps to engage the patient in a conversation related to their own behaviours, along with the factors to consider when assessing risk. This exchange, in itself, can create a readiness for learning, and the patient may then be more willing to receive information related to addressing the identified risks – information that they may previously have not been open to hearing about.

A somewhat more controversial topic related to patient-physician communication is the use of email. Editorials and articles have been written, describing both the benefits and cautions associated with the use of email between patients and physicians. Email has been identified as being very beneficial for logistical-type activities, such as scheduling an appointment or follow-up on an activity, but is also identified as a useful tool for reinforcing previously provided information, thereby supporting the patient education process.

Concerns that the physician could be inundated with non-value-added messages from patients have proven to be unfounded. Additionally, concerns about the secure transmission of messages have been addressed by having patients individually consent to participate in email exchanges with the physician and agree that the communication can occur via regular email mechanisms.

The Canadian Medical Association (CMA) has developed guidelines for physicians regarding online communication between physicians and patients. Likewise, the CMA has developed a patient handout template regarding email guidelines, including email format, appropriate use, expected response time, and privacy, confidentiality, and security information; this same template serves as a patient consent form.

While many of the reported benefits of email communications have been anecdotal in nature, a Kaiser Permanente study involving patients who interacted with their physicians by using email messaging demonstrated a significant improvement in several indicators of health for patients with diabetes and/or hypertension.

Perhaps the latest topic in the milieu related to the use of technology for patient education is the topic of social media. As is the experience with most new technology advents, there are care providers who are open to the use of social media as part of care delivery, and there are those who are opposed or reserving judgment until more is known.

The CMA recently published advice regarding the use of social media by physicians in a report titled "Social media and Canadian physicians – issues and rules of engagement." The report includes a definition for social media and states that information can be shared uni-directionally, as in a blog or multi-directionally in a discussion forum. The article also includes thoughts to consider when deciding to engage in the use of social media and potential benefits of its use for a patient’s health management.

Dr. Freedhoff, a frequent blogger on a specific health topic, reports that he uses his blog site to reinforce teaching he has provided to his patients. He directs patients to reference material he has referred to on his blog, and to previous blogs that reinforce a topic he is presenting in the office for the first time. In addition, he sees benefit in using social media sites to connect patients with one another, so that patients with similar conditions will benefit from an additional support mechanism for maintaining lifestyle modifications, or just discussing their shared experience with others.

The opportunities for using EMR and other computer technologies to aid in the patient teaching process are limited only by the physician’s imagination and capabilities. Technologies will continue to advance, requiring providers to remain aware and informed of changes. Patients’ willingness to use these technologies to improve the efficiency and effectiveness of their interactions with their healthcare providers will continue to advance as well. The challenge to embrace and fully utilize these capabilities is before all of us, and is ours to take on – let’s embrace the challenge!

Sheri Ross, RN, BN, MBA, is a Clinical Director at MD Physician Services Software Inc.

Posted February 2, 2012