Increasing health communication resources increase documentation and usage in the Indian Health Service

Background: Health education and collaborative goal setting are essential in the management of chronic disease but are often not documented as discrete data elements. Purpose: The purpose is to provide tools within the clinical information system (CIS) to promote health communication and the ability to document these activities by clinicians through the Electronic Health Record and one day by patients through the Personal Health Record, to increase health communications through patient-provider communication, health literacy, and patient engagement. Methods: The Indian Health Service (IHS) has unique data elements in the CIS and clinical decision support tools that capture patient education and collaborative goal setting activities that are provided by clinicians. Patient education consists of protocols and a standardized data set which collects information on the disease state or condition and topic discussed, the patient's level of understanding, readiness to learn, barriers to learning (including low health literacy), learning preferences, and goal setting. There is a personalized patient-oriented report that can be generated on demand to provide access to medical record information and a short description of what their information means. Patient materials such as handouts that align with the education codes are retrievable by clinicians at the point of care from a database accessed from within the EHR. Results: Increase in documentation of patient education from 777,000 visits in fiscal year (FY) 2004 to 2,223,704 in FY 2007 and there are thousands of “hits” to the patient handout website. Clinicians requested additional tools & enhancements and there is a new goal setting component and handouts in development. Discussion: Health information technology can assist in capturing and promoting patient education and goal setting activities. Integrating patient education materials and documentation tools with the clinical information system has resulted in an increase in health communication; however further assessment on the clinical outcomes needed.