Monday, April 2, 2007

Culture, effect of - Health Literacy -- a Rubik’s Cube

I see by the Joint Commission’s report in USA Today that patient- doctor communication is in total disarray. I see the Joint Commission recommends interpreters to tie up cultural odds and ends. I see barely half of Americans understand enough prose,to bring most health care decisions to appropriate close.

I see Doctor Dennis O’Leary, the Joint Commission Chief says, for patient safety, health illiteracy needs quick relief. I see he says ending doctor jargon is part of the solution, which he adds desperately needs resolution.

It’s sobering when you add the numbers of semi-literate Americans to growing masses of non-English speaking Transamericans. Health illiteracy is a complicated Rubik’s Cube. To solve it, we need a Cyber-oriented lube.

Many of the cubes consist of heterogeneous doctors, serving multi-ethnic populations as disease proctors. Other cubes are made up of barely literate or illiterate patients, more than a few of whom speak languages of other nations. We need to digitally rotate each cube for decor, until the whole blends into one uniform color. One way to solve the puzzle consistently for all is online interactive programs, large and small

These programs physicians can prescribe, and patients can then subscribe in multiple languages for multiple health situationsin simple language with supporting illustrations. That will help achieve and standardize literacy across health care, and it will serve to make safety risks and misunderstandings rare.

In case you’re wondering how Rubik Cube for Health Literacy works in real world of health care, here’s a brief piece from the March 22 Cedar-Sinai Medical Staff Pulse (Los Angeles)

New Web-Based Program Helps Patients Understand Procedures, Risks

Patients can forget up to 85 percent of what they are told by their physician within 10 minutes of leaving the office, according to the Wall Street Journal. This is particularly true for patients dealing with the stress of an upcoming surgery or medical procedure.

To enable patients to learn more about an upcoming procedure at their own pace and in the comfort of their home, an interactive web-based education program called Emmi (Expectation Management and Medical Information) is being rolled out across the medical center by Cedars-Sinai's Risk Management Department. Patients access the Internet program from any computer, using an access code issued by their physician.

Using easy-to-understand language and computer animation, Emmi walks patients through approximately 70 of the most common medical procedures (with more to come), from pre-op to post-op.

The 20-30 minute tutorial also explains about the procedure's benefits, risks and alternatives, and allows patients to pause the program and e-mail questions to their physician, to be followed up later during their office visit. Afterward, a record of the patient's viewing is sent to the physician as part of the informed consent. process.

"Emmi helps physicians by better preparing patients about their care, and it helps patients become more focused during discussions with their physician, which reduces the length of time in office visits," said Carolyn Bell, RN, Esq., director of Risk Management. "Other benefits include improved patient satisfaction, more efficient physician-patient interactions, reduced burden on front office staff and reduced malpractice risk."

The Center for Weight Loss Surgery was the first department at Cedars-Sinai to implement the program last summer. Since then, the Orthopaedic Center, Pediatric Services, Institute for Spinal Disorders, Minimally Invasive Urology Institute, Center for Digestive Diseases and the Heart Center have adopted it.

To date, nearly 1,000 access codes have been issued to patients for procedures ranging from angioplasty, laparoscopic gastric banding (LAP-BAND) surgery, total hip and knee replacement to colonoscopy.

"Our patients are arriving for consultation more fully informed than ever before," said Scott Cunneen, M.D., director of Bariatric Surgery. "Many potential questions have been answered prior to the patient's arrival, allowing us to focus on the most important issues. This is what technology is supposed to do -- make our job easier! I wish the Emmi program was available for every procedure."

Physicians who wish to sign up for the Emmi program must complete a registration form and then schedule a 30-minute training session for their front office staff. No special MD training is involved and there is no cost to physicians.


1. Marie Skelton, Report: Patient Illiteracy Threatens Health Care, March 25, USA Today
2. Moira Gibbons, New Web-Based Program Helps Patients Understand Procedures, Risks, Cedar-Sinai Medical Staff Pulse, March 22, 2007.

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