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Explore This IssueJuly 2013
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With websites becoming a fixture in patient care, an increasing amount of patient education is being done online—and that can add to a physician’s workload.
Don’t want to try to handle online patient education on your own? Services to provide and maintain that content are becoming more sophisticated and the number of choices for physicians is expanding.
Patient-education segments of physicians’ websites typically include descriptions of illnesses, treatment options, tips for managing an illness, and suggestions for when it is time to call your doctor. Depending on the company, all of the content might be generated by the company itself, or partially by the company and partially pulled from respected sources, such as the ACR and the Arthritis Foundation.
“As the Internet has evolved, there’s a growing understanding that the doctor’s website plays an integral part in the delivery of care,” says Mark Becker, MD, a pediatrician and founder of Berkeley, Calif.–based Vivacare, a patient-education resource that is free to doctors.
“There has been a spike in patient-education resources online in recent years,” says Kathleen Romito, MD, a medical director with Healthwise, a nonprofit health-education organization based in Boise, Idaho.
“In the last five years, and especially the last two or three years, there’s been a tremendous increase in the number of clinicians using electronic education material. And, I think a lot of that goes hand in hand with the use of the electronic medical record.”
Nuts and Bolts of Online Patient Education
Bob Abrahamson, vice president of marketing at Pennsylvania-based Krames StayWell, says that generating and maintaining patient-education content might be more difficult than doctors might think.
“A lot of doctors think that they’re really good communicators, but when the rubber hits the road and they really start to create patient education on their own, it’s harder than they think and it’s going to end up taking them a lot more time than they think,” he says.
Herbert Baraf, MD, managing partner at Arthritis and Rheumatism Associates in Washington, D.C., and clinical professor of medicine at George Washington University, says he chose to start using Vivacare after he heard about it from a dermatologist colleague.
“It’s not our sole source of medical information,” he says, but “it’s fairly comprehensive and it’s vetted.”
“I don’t anticipate that our website is the beginning and end of a patient’s search about their own conditions, but I think it’s a good thing for the website to be able to present a one-stop shop where you can find what you’re looking for,” he says.
He added that patient education is “just one element” of a website, and that most patients still mainly use a practice’s site for nuts and bolts, like seeing what a doctor looks like, finding out where they trained, or to get directions.
Some companies providing the patient-education services are reluctant to share the cost, in part because the range of licensing fees is very wide since they depend on the number of doctors or the number of users of the content, and on the nature of the services requested. Abrahamson would say only, “It’s not hundreds of thousands, it’s not a few hundred dollars.”
Dr. Romito with Healthwise says, “I look at it from a physician’s perspective and I think, ‘Wow, what a bargain.’… Physicians are seeing the value in the information that we have available.”
Here are some of the options available for doctors looking for help with patient education on their websites:
Healthwise: The nonprofit, whose mission is to help people make better health decisions, was founded in 1975. They provide patient education, technology, and services for health plans, practices of all sizes, hospitals, integrated delivery networks, some government agencies, and care management organizations.
In addition to providing patient instructions about specific episodes of care, what to do at home, and when to call for help, Healthwise offers a Knowledgebase that includes in-depth content about specific conditions, interactive tools such as decision aids, and videos that support behavior change.
Karen Baker, senior vice president of consumer experience at Healthwise, says, “Our goal is to make sure people have the information and tools they need to partner with their doctors to make decisions and change behavior.”
Content developers, who work in-house at Healthwise, create the evidence-based, plain-language material, which is vetted by in-house physicians and by physicians under contract who review certain specialized content.
The material is updated on a continuous basis, Healthwise says, with subject matter experts reviewing the medical literature daily and then consulting with physicians to decide which changes should be made.
“Our user experience team gathers input from patients to make sure our content and tools meet their needs and reflect their experiences, and it also collects follow-up feedback that helps us continue to enhance and improve our patient-education assets,” Baker says.
Krames StayWell: This company was created in
2011 after the merger of Krames Patient Education, founded in 1974, and StayWell Custom Communications, founded in 1984. Most of Krames StayWell’s clients are hospitals and large health plans, but the company also works with small physician groups as well as employers.
The health information provided includes thousands of articles on health conditions and treatment options and multimedia offerings like videos and podcasts.
“Depending on what interests you as a patient or as a consumer, and depending on what your learning preference is, you’re going to be able to find the answers you’re looking for in a way that you want to learn,” Abrahamson says.
The website created for each client carries the branding of the institutions and the practices, he says. Clients pay an annual licensing fee.
The content is created in-house and is on a two-year review cycle, Abrahamson says. “It’s not only scientifically accurate, but it’s accessible and actionable by the patient so that they can understand it,” he says. “It helps them make a decision, it helps them manage their care.” To make sure the material is accessible, the content developers use an assessment that takes into account 22 distinct literacy factors, such as the use of simple language and use of the active voice, Abrahamson says.
Vivacare: Dr. Becker started this company in 2007, but says he has been developing patient-education programs since 1995.
Vivacare works mostly with independent medical practices. The educational content comes from Vivacare, medical publishers, and other organizations. Its initial focus was in dermatology and neurology, but since then it has expanded to 15 specialties. Dr. Becker estimates that only about 30% of the material in rheumatology is generated in-house by Vivacare. The remainder comes from the National Institutes of Health, patient support groups, and professional organizations, such as the ACR.
Vivacare is free to physicians. Upon enrolling, they gain access to a variety of patient handouts, videos, and patient support tools that are personalized with the doctor’s name at the top of the page. This content can be displayed on the practice’s website, shared on a mobile device, or printed. Information is available on over 100 rheumatology topics.
Vivacare provides enrolled physicians with a snippet of code that, when inserted onto their website, creates an index of patient-education titles and a search function.
The company generates revenue from pharmaceutical or device companies that either pay Vivacare to “sponsor” a disease-education program or to display information about a specific medication. The medication information is meant to support a patient who has been prescribed the product by providing information on how to take the medication and what to expect from treatment.
“Now that your doctor has prescribed this medication, here is information you need to better manage your condition,” Dr. Becker says, emphasizing it is not an advertisement, nor an attempt to get the patient to ask for the medication. He says it’s made clear to physicians which content is pharmaceutical-sponsored information and that they can remove it from display if it does not reflect their approach to care.
The content is reviewed regularly and updated about once a year, but changes that are deemed critical are made more quickly, Dr. Becker says.
Dr. Becker hopes Vivacare fills what he sees as a need in doctors’ patient-education efforts.
“In terms of really helping their patients, physicians can and should offer practical information on their websites about the conditions they diagnose and treatments they prescribe.”
Thomas Collins is a freelance medical writer based in Florida.