Abstract
This chapter will explore the possibilities and the challenges presented by technology in the area of patient education. Beginning with an overview of the use of the medical record in patient care, the chapter will move on to discuss the evolution of electronic health records (EHR) and the emergence of health information technology in the education of patients. Emerging technologies, the primary care physician's role in creating tailored education plans for their patients, as well as the importance of self-directness in learning both for the physician and the patient will also be discussed. The chapter will conclude with an overview of information and health literacy and how these impact shared-decision making and patient activation (the ability to be engaged in one's own health care). The overall goal of the chapter is to present how physicians and patients can use technology in order to facilitate better patient care and improve patient outcomes.
TopFrom Ink To Bytes: The Emergence Of The Electronic Health Record
Patient case records have existed since ancient times. One of the earliest known records comes from the Edwin Smith Surgical Papyrus (Wilkins, 1964).1 When the papyrus manuscript (circa 3000-2500 B.C.) was finally translated in 1930 by James H. Breasted, it was found to be part of a surgical treatise and contained 48 patient case histories systematically arranged by injury and divided into sections: title, examination, diagnosis, and treatment (Wilkins, 1964).
In fifth century Greece, patient case records evolved significantly under the guidance of Hippocrates and his followers (Reiser, 1991a). Case records had two main purposes in the Hippocratic literature: demonstration of the natural cause of the illness and the description of the illness’ clinical course through close observation of the patient’s symptoms (Reiser, 1991a). Hippocratic cases were recorded chronologically and followed a set format. The record began with the preceding cause of the illness and the presenting symptoms of the patient. Next recorded were the actions taken by the patient and the resulting symptoms that prompted the patient to seek care. This was followed by notes on the progress of the illness. Such progress notes were only included in the patient record when there was an important change in symptoms. Case reports concluded with disclosure of the results of the case, which was often death (Reiser, 1991a). The chronologic order of the case gave the Greek physician insight as to when therapeutic action should be taken and focused attention on the symptoms that would most predict the outcome, as a tenet of Greek medicine was not to initiate therapy which would have no effect on the course of the illness (Reiser, 1991a).
In the seventeenth century, sickness was thought to be caused by a single mechanism recognized since the time of Hippocrates, namely the disruption of the equilibrium of the four main building blocks of the body (blood, phlegm, black bile, yellow bile) (Reiser, 1991a). Thomas Sydenham, a seventeenth century physician, recognized that there was a pattern to the symptoms his patients presented with and he began to hypothesize that illnesses could be categorized by their characteristic symptoms (Reiser, 1991a). With this premise, Sydenham began to develop a universal classification of diseasethat has become the basis for the diagnostic process in modern medicine (Reiser, 1991a).
Key Terms in this Chapter
Information Literacy: The skills needed to find, retrieve, analyze, and use information ( ACRL, 2014 ).
Agency for Healthcare Quality and Research (AHRQ): Federal agency whose mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.
Patient Activation: Possessing the knowledge, skills, and confidence to be actively engaged in one’s own health care ( Greene & Hibbard, 2011 ).
Health Information Technology (HIT): Per the HITECH Act, “the term ‘health information technology’ means hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information” (111th Congress of the USA, 2009 AU73: The in-text citation "USA, 2009" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).
Shared-Decision Making: Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences (Healthwise, 2015 AU74: The in-text citation "Healthwise, 2015" is not in the reference list. Please correct the citation, add the reference to the list, or delete the citation. ).
Centers for Medicare and Medicaid Services (CMS): Federal agency within the U. S. Department of Health and Human Services (DHHS) that administers the Medicare program and partners with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards.
Consumer E-Health: A broad category of electronic tools and services that are primarily consumer oriented but that overlap with health information technology ( Ricciardi et al., 2013 ).
Patient-Centered Medical Home (PCMH): The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into “what patients want it to be.” Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care ( NCQA, 2015 ).
American Academy of Family Physicians (AAFP): The American Academy of Family Physicians is the national association of family doctors. It is one of the largest national medical organizations, with more than 115,900 members in 50 states, D.C., Puerto Rico, the Virgin Islands, and Guam, as well as internationally. The AAFP was founded in 1947 to promote and maintain high quality standards for family doctors who are providing continuing comprehensive health care to the public.
Telehealth: The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration ( HRSA.gov, n.d. ).
Telehealth: The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration ( HRSA.gov, n.d. ).
Electronic Health Records (EHR): An electronic version of a patient’s medical history maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports The EHR automates access to information and has the potential to streamline the clinician's workflow. The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting ( CMS.gov, 2012 ).
Self-Directed Learning (SDL): The process by which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes ( Knowles, 1980 ).