Toward a more informed patient: Bridging health care information through an interactive communication portal

Vanderbilt University, Нашвилл, Michigan, United States
Journal of the Medical Library Association JMLA (Impact Factor: 0.99). 02/2007; 95(1):77-81.
Source: PubMed


Health topicsHealth topics included in MHAV may be disease-specific, such as diabetes or Crohn's disease, or may be preventive health topics, such as colon cancer screening. To create customized links to information, the library works closely with healthcare teams in the outpatient clinics to select the most relevant topics given the clinic's specific patient population. After identifying the most relevant health topics for an outpatient clinic, trained EBL Health Information Analysts (HIAs) and junior librarians select the best online consumer sources. At EBL, the HIA job category was created in 1996 for non-librarians who completed a comprehensive individualized learning plan and verification of skills [21–22]. For the MHAV project, HIAs were handpicked based on their aptitude and overall interest in consumer health. Selection of consumer sources is based upon criteria such as currency, authority and accuracy; these criteria are modeled after MedlinePlus Quality Guidelines and the Medical Library Association's User's Guide to Finding and Evaluating Health Information Online [23–24]. The resources are organized into subcategories intended to be easily recognizable by patients.As part of the library's mentoring process, a designated experienced EBL librarian then reviews the collection of links gathered by the HIAs and junior librarians and provides feedback and suggestions for improvement. The EBL team sends the vetted list of health topic websites back to the clinical team to solicit input on relevance and resource selection. After reaching consensus on the website selections for a given topic, and after securing permission from hosting sites to link to their online materials, EBL team members enter the topics into an internally created MySQL database. The MHAV portal software extracts data from this database to present the selected sites for each topic into the portal. Creating a new health topic typically takes one month to complete. Ongoing maintenance for the EBL team includes regularly monitoring links for currency and appropriateness. Figure 1 shows an example health topic page in MyHealthatVanderbilt.Figure 1A library-provided health topic in MyHealthatVanderbiltUpon logging into the MHAV portal, patients are automatically presented with disease topics relevant to them, based on specific information from within their medical record. This information is derived from two primary sources within the record. The first source is the list of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes for each patient. The coded list facilitates easy mapping, but its utility is somewhat diminished by the fact that the codes result from the billing process, rather than being entered directly by clinicians. The second source is the free-text Problems section of the patient summary, which (unlike the ICD-9-CM codes) is actively and collectively maintained by VUMC care providers. Codes derived from the patient's problem list, combined with the ICD-9-CM codes from billing are automatically matched via computer algorithms to the ICD-9-CM codes assigned by library staff to each disease topic. When a match is made, the appropriate disease topic is displayed in the portal, allowing patients to see links to information directly relevant to their care. Preventive health topics are delivered to a specific patient based on demographic characteristics and matched according to U.S. Preventive Services Task Force recommendations [25]. They are also complemented by additional topics of significant public importance. For example, a 65-year old woman who logs into to MHAV will receive information on screening for breast cancer, osteoporosis and colorectal cancer.

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Available from: Taneya Y Koonce
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    • "Efforts to " personalize " patient portals may further increase patient understanding, utilization and satisfaction (Koonce et al. 2007). For example, regular use of a diabetes-specific portal was more likely in patients who accessed information that was personalized and interactive as compared to those that viewed general information about diabetes care (Koonce et al. 2007). For online genetic tests, development of personalized reports based on information provided by the consumer could encourage careful review and use of their test results. "
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    ABSTRACT: Patient trust in personal medical information is critical to increasing adherence to physician recommendations and medications. One of the anticipated benefits of learning of one's genomic risk for common diseases is the increased adoption of screening, preventive care and lifestyle changes. However, the equivocal results thus far reported of the positive impact of knowledge of genomic risk on behavior change may be due to lack of patients' trust in the results. As part of a clinical study to compare two methods of communication of genomic risk results for Type 2 diabetes mellitus (T2DM), we assessed patients' trust and preferred methods of delivery of genomic risk information. A total of 300 participants recruited from the general public in Durham, NC were randomized to receive their genomic risk for T2DM in-person from a genetic counselor or online through the testing company's web-site. Participants completed a baseline survey and three follow-up surveys after receiving results. Overall, participants reported high levels of trust in the test results. Participants who received their results in-person from the genetic counselor were significantly more likely to trust their results than those who reviewed their results on-line (p = 0.005). There was not a statistically significant difference in levels of trust among participants with increased genetic risk, as compared to other those with decreased or same as population risk (p = 0.1154). In the event they undergo genomic risk testing again, 55 % of participants overall indicated they would prefer to receive their results online compared to 28 % that would prefer to receive future results in-person. Of those participants preferring to receive results online, 77 % indicated they would prefer to have the option to speak to someone if they had questions with the online results (compared to accessing results online without the option of professional consultation). This is the first study to assess satisfaction with genomic risk testing by the method of delivery of the test result. The higher rate of trust in results delivered in-person suggests that online access reports may not result in serious consideration of results and lack of adoption of recommended preventive recommendations.
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    • "VUMC'de CICS modeline ek olarak Hastalara Yönelik Enformatik Danışmanlığı Hizmeti (Patient Informatics Consult Service-PICS) ile klinik kütüphanecilerinin vizitelerde hastalar ve yakınlarına da uygun bilgileri bulmaları sağlanmaktadır (Williams, Gish, Giuse, Sahte ve Carrell, 2001, s. 186; Koonce, Giuse, Beauregard ve Giuse, 2007, s. 77). Bu örnekte olduğu gibi, KTK'nin bazı uygulamalarında hastaların ve yakınlarının bilgi gereksinmelerini karşılamak suretiyle hizmet kapsamı genişletilmektedir. "
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    ABSTRACT: Clinical Medical Librarianship (CML) practices which principally aim to carry the medical and health sciences literature to patient bedside have been one of the most reliable solutions to information retrieval problems in regard to medicine and health. Today not only the relevant information, but also the reliable evidence found in the literature is required by doctors and health professionals to support their diagnosis, therapy or research decisions. Consequently CML also involves the principles of Evidence-Based Medical Librarianship (EBML) emerged from Evidence-Based Medicine (EBM) practice. CML is generally achieved through the medical and health sciences librarian’s participation in patient rounds, morning reports or clinical, educational, departmental conferences and it focuses on providing the quality filtered information and evidence to doctors and health professionals, when and where they need them, in order to support their decision making, research and educational processes. This study aims to enlighten the Turkish medical and health sciences librarians particularly, about CML. To achieve this aim, definitions, programs and approaches, advantages and disadvantages of the services are introduced, besides the future applicability of the services in Turkey is discussed. The application of CML in Turkey depends on the existence of qualified medical and health sciences librarians who will be trained through continuous professional education programs on CML and EBML. When these librarians apply effective CML services in the line of EBML in Turkey it will be possible to see the positive effects on medical and health areas and on the profession of librarianship.
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