Prescribed Information is Powerful Medicine

By Molly Mettler, MSW

Casting consumers adrift on the Internet does little good, but delivering them the right information at the right moment improves quality of care and cost efficiency.

Brian Howard, a production and quality control manager, had a problem. Howard's seven-year-old daughter, Cassidy, had recovered from a cold, but two weeks later was still suffering coughing episodes every time her friends came over or she was outside playing. The Howards' doctor counseled patience, but time passed without much improvement. Howard and his wife turned to the Internet. The symptom guide on a database supplied by his employer suggested that asthma might be the reason for Cassidy's lingering cough. A second appointment with the pediatrician confirmed that Cassidy had exercise-induced asthma. The pediatrician prescribed Cassidy medication to take before she plays, and her cough quickly subsided.

Not business as usual

The Howards did what millions of Americans are doing every day: going in search of health information that will help. The irony in Howard's case: he is an engineer who worked every day on the very website that helped him. "I can't believe that I never used the [Healthwise] Knowledgebase before. I spend eight hours a day in it!" Howard reported at the Healthwise staff meeting.

With information therapy, the Howards could have gotten to the right information much earlier. Information therapy is the prescription of the right information to the right person at the right time to help make a better health decision. It helps employees understand their health conditions and select the treatments most likely to help.

This is very different from the first generation of e-health, which was largely based on the flawed thinking that information had value in itself. Early content sites were akin to giving patients a key to the pharmacy without telling them when to go, what to look for or what dose to administer. The results were unpredictable and often of little value. Information therapy adds value by connecting the right information to the decision making that influences medical outcomes and medical costs.

The way doctors and patients exchange information — generally mouth-to-ear — is inefficient, incomplete and outmoded. With new technologies, such as electronic medical records and computerized physician order entry, physicians, clinics, hospitals and health plans can reinvent patient education.

Why prescribe information? Because it is as important to a patient's health as any drug, medical test or surgery, yet it gets short shrift in most clinical encounters.

With an information therapy program in place, the Howards for instance, would have been prescribed information on their first phone call based on the reason given for the visit (recurring cough following a cold). Before the visit, he and his wife would have reviewed a symptom guide and been ready to give the pediatrician the diagnostic information he or she needed. With information prescriptions, you don't have to be heroic, lucky or even web-savvy to get what you need. Information is built into medical care in ways that we've never tried before.

Changing the way employees get informed

Consider this current scenario: Jack Morrison, a 49-year-old, has his cholesterol tested. Several days later, he gets a call from the clinic nurse who gives him his lab results: the numbers are borderline high. "Not too bad," says the nurse, but Jack might want to watch what he eats. A typical follow-up? You bet. Likely to result in Jack understanding his situation and proactively managing his cholesterol? No way.

With information therapy, Jack would automatically get a secure e-mail from his physician on what the results mean for him and targeted suggestions for diet, exercise and weight management. Jack could also choose to be guided through a decision-support program that would help him determine if he is a candidate for cholesterol medication.

By prescribing the right information as part of the process of care, the health care system can achieve measurable improvements in medical outcomes, patient safety, cost-effectiveness and patient satisfaction. Just as important, information therapy gives employees choice and control, building skills for self-management of their health.

Information prescriptions can be particularly useful in hospitals. Patients who know what procedures to expect, what their medications are supposed to do and, not incidentally, what those pills look like are significantly less vulnerable to medical errors.

Prescription-strength information

Just like pills, information therapy can be prescribed in different strengths, dosages and formulations. Not all information, however, is created equal. To be considered prescription-strength, it must meet seven criteria:

• Decision-focused — if it doesn't help achieve better decisions, it doesn't help

• Evidence-based — using a balanced review of all relevant research

• Reviewed by experts — in each relevant specialty of medicine

• Referenced — to identify both authors and source

• Up-to-date — regularly revised to keep pace with medical advances

• Free from commercial bias — in development, selection and presentation

• User-friendly — presented in a form and language that patients can easily understand

To meet the workflow requirements of clinical practice, prescription-strength information must also be intelligent, i.e., indexed to billing codes and structured medical languages, such as ICD-9, NDC and CPT.

Three ways to prescribe information therapy

The most potent information prescriptions are made directly by the physician, based on knowledge of the patient and the medical decisions he or she faces. All physicians do this now, but without the benefit of technology support or reimbursement incentives. Handheld computers are starting to provide the necessary support for information prescriptions during office visits. New technologies will also break down the three roadblocks to reimbursement for patient education: unverifiable quality, uncertain clinical efficacy and documentation difficulties.

Health information systems can automatically "push" targeted information to a patient by e-mail, phone or fax based on what the system already knows about the patient's decision-making needs. System-prescribed information can be sent with every medical lab report, medication prescription and pre-authorization for services.

Finally, consumers can prescribe information for themselves and are doing so more often as they evolve into the role of partner with the physician. Not everything that people find on the Internet, however, meets the prescription strength criteria outlined above in terms of validity or focus on decision making. Systems must also become easier to understand and use, especially for people untrained in medical research.

Employer opportunities

While much of the future of information therapy lies with implementation in clinics, hospitals and health plans, there are important things that employers can do to speed its benefits for employees.

Information prescriptions should become a routine part of workplace-based health service and screening programs. If you do on-site cholesterol testing, be sure that each person gets an Ix prescription explaining what the results mean and guiding the employee to other information that helps in managing heart disease.

Information therapy can become part of benefits plan development with health plans. By offering modest reimbursement for e-visits or information prescriptions "written" during office visits, health plans can greatly influence the rapid development of information therapy.

Information therapy is the defining strategy that changes medical care to patient-centered care. It redefines the role of the patient as a full partner in medical decision making and as a bona fide member of the provider team. It redefines the role of information from being about care to being a basic part of care itself. The right information delivered to the right person at the right time is powerful medicine.

Molly Mettler is senior vice president of Healthwise. Ms. Mettler has authored scores of books and articles on medical self-care and health promotion, and she is chair of the National Council on the Aging. Portions of this article appear in Information Therapy: Prescribed Information as a Reimbursable Medical Service, by Donald W. Kemper and Molly Mettler (Center for Information Therapy, 2002).

More Business & Health Articles About This Topic:

Is the 'Informed Consumer' Any Healthier? (Aug. 29, 2002)

E-health, Your Workforce and You (Nov./Dec. 2000)

Resource Links:

The Center for Information Therapy
http://www.informationtherapy.org/

Healthwisehttp://www.healthwise.org/index.html

Seven Opportunities for Information Therapy

By Molly Mettler, MSW

Information can influence health care decisions and behavior at every point along the continuum from prevention and wellness to chronic disease management and end-of-life care.

• Prevention: Routine information prescriptions can extend the preventive services reach of most medical centers from the limited set of immunizations and screenings they now do to a full array of ongoing support in fitness, nutrition, stress management and safety.

• Self-care: This is what a person does to recognize, prevent, treat and/or manage health problems on his or her own. Information prescriptions, whether self-prescribed or otherwise, help people do these things better.

• Self-triage: Decisions to seek medical care focus on three and sometimes four key points: Should I go? When to go? Where to go? And how to go? Getting the right information to the patient at the time of these decisions can save both lives and dollars.

• Visit preparation: A well-prepared patient gains much greater value within the time-constraints of a brief office visit. Information prescriptions that help the patient prepare for what will happen in the visit will lead directly to better decisions, better outcomes and more satisfied patients. Computerized scheduling systems can make this sort of preparation standard procedure for virtually all medical visits.

• Self-management of chronic illnesses: For many chronic diseases like diabetes, arthritis and hypertension, the key to success is adherence to daily self-management behaviors. Regular information prescriptions both to patients and to caregivers can provide valuable and timely encouragement.

• Decision-support: This is the "Holy Grail" of information therapy. In the near future, no major decision for a drug, surgery or invasive medical test will likely be done without information prescriptions to help the patient participate in the decision.

• End-of-life care decision support: Information prescriptions to both patients and caregivers as a part of end-of-life care have both huge potential and complex challenges. Emotionally-sensitive communication of the right information at the right time can help guide families toward decisions that will best meet their needs through the patient's final days of life.

Health Information Rx Program Kicks Off

Physicians can now prescribe information under a new pilot program recently launched in Georgia and Iowa. The National Library of Medicine has teamed up with the American College of Physicians-American Society of Internal Medicine Foundation to create the "Health Information Rx (prescription)" program. Under the program, internists will receive special customized prescription pads, which they can use to offer online direction to their patients, based on the MEDLINEplus website.

Using content from the National Institutes of Health and other public and private online health sites, MEDLINEplus ( www.medlineplus.gov ) contains information on over 600 specific health topics. Patients can search the site for basic information on symptoms, diagnosis and treatment, current news, research studies, clinical trials, tutorials and more.

Molly Mettler. Prescribed Information is Powerful Medicine.

Business and Health

Jul. 1, 2003;21.