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Appropriate connections help expedite work on patient education databases
Look for colleagues with the right expertise
To provide easy access to patient education resources that support teaching, many patient education managers are considering creating a database (an organized collection of information records) to be used via the Intranet or Internet.
While a database seems like a good tool for supporting patient education, managers should not rush into a project too quickly. It is important to consider what a database can and cannot do.
"Creating a database can give users access to available materials and organize them in a way that is more accessible to more users," says Diane C. Moyer, MS, RN, program manager for consumer health education at The Ohio State University Medical Center in Columbus.
A database can make it easy to access information quickly and provide relevant and authoritative resources, adds Emily S. Lawson, MSLIS, medical librarian/information specialist at Children's Healthcare of Atlanta.
One benefit of a commonly used database is that patients will be receiving standardized information if there is a process in place to guarantee that all patients are receiving the information or accessing the database, says Tanya Smith, MPH, CHES, manager of the Cancer Learning Center at the Huntsman Cancer Institute at the University of Utah in Salt Lake City.
It also can help staff provide information in a consistent manner and cover specific topics identified as important to the hospital or department, she adds.
A database of educational resources also would aid staff in teaching patients with diagnoses that aren't common on their unit or who have preexisting conditions that impact care, says Peg Allen, MLS, AHIP, a library consultant located in Stratford, WI, and coordinator of the Hmong Health Education Network.
While there are many benefits to implementing a patient education database, it is not a magic wand that will guarantee good teaching. Moyer says having a database will not insure that the right materials are being used to educate patients and family members. It also does not stop clinicians from bringing in other materials that are not on the database.
"A database of information cannot replace the individualized assistance provided by staff giving education to patients and their families," says Smith.
Staff need to be available to provide the in-depth, individualized assistance to patients, she adds.
In addition there is a lot of good, current, medically reviewed information available via the Internet from free services, such as MedlinePlus, and from for-profit organizations, says Smith. Therefore, it's important to spend a lot of time up front determining your organizational information needs. Determine what exists for free, what exists for a fee, what funding is available to purchase ready-made programs, and what staff expertise is available on site to develop content in-house prior to taking on the project, advises Smith.
Do a needs assessment
It's important to determine your institution's needs. In the case of St. Joseph's Hospital Health Center in Syracuse, NY, it was becoming increasingly difficult to keep educational materials stocked on the units. When an Intranet site was implemented, it seemed the logical solution to this problem.
"I knew I wanted accurate patient education material, a variety of it, available to our clinicians in the fastest manner possible. I wanted clinicians to get materials fairly easily, and, once we had an Intranet site, that is where I wanted it," explains Kathy Fitzgerald, MS, RN, CDE, patient educator at St. Joseph's.
The patient education site on the Intranet has internally designed materials, medication sheets from a commercial vendor, and a bank of general consumer information also from a purchased reference.
Also on the site are instructions for using the on demand TV system, a list of the videos that can be accessed on that system, and a list of outpatient programs and support groups. An index provides details on purchased booklets in stock that can be ordered as well.
It is important to decide what the database will do, as that will determine the type of software required to create and implement it. (For details on what questions to ask before getting started, see box below.)
Before work begins on database, ask the right questions
Uncover issues and address them during design
In order to design a good database for patient education resources and materials, managers must ask the right questions. Following is a list of questions from those who have been through the process or are currently working on a database:
When working up the list of software requirements it is best to work with your information technology department, says David Starr, MBA, director of systems development information technology services at City of Hope National Medical Center in Duarte, CA.
Remember you may not know a lot about technology and those in IT aren't familiar with patient education, he says. The two groups need to sit down in a room with a white board and start mapping out what is really important.
For example, IT will need to know what sort of educational materials will be included in the database. Will there be videos or interactive tests? A good systems analyst can help a patient education manager articulate their needs for the database, says Starr.
Once this is completed, a five-or-six page document of software requirements can be written and distributed to vendors in order to find the appropriate product, he says.
Working with IT from the start is a good idea, says Farrah Schwartz, MA, patient education specialist at St. Michael's Hospital in Toronto.
Schwartz began work on an inventory of in-house patient education materials about a year ago.
"I am trying to develop an inventory or repository of materials that have been developed internally by the organization that, in the first phases, would be able to be accessed by staff internally when they were looking for something in up-to-date, approved health education information. Over time I would like to expand that to include patient access via the Internet," explains Schwartz.
She launched into work on a database using Access software, and after spending time on it, she found it was not compatible with the hospital's IT requirements. Although she is a technology-savvy consumer, she has discovered it is different when designing a system and her expertise does not transfer over.
Someone from IT needs to be in the loop from the beginning unless the patient education manager has the technological expertise or knows a person who can help them build a database, she says.
Tailor to end user
To select appropriate software, the users of the database need to be identified, whether they are nurses, a multitude of disciplines, or patients.
Knowing the end user will not only help patient education managers determine what should be included in the database, but also how sophisticated a search engine is needed to find material, says Abigail Jones, MLIS, MA, consumer health librarian at the John A. Prior Health Sciences Library at The Ohio State University Medical Center.
For example, Google, a common Internet search engine, appears to order information based on the key word or phrase entered, but it is not necessarily true the key piece of information needed is at the top. Jones says it is extremely important that a search engine be intuitive and try to second guess what the consumer of health information is trying to find. A good search engine will pull important information to the top quickly and index it so busy clinicians can get resources quickly, explains Jones.
Poll the intended users to find out what key words or search terms would work in their professions. Jones says she sometimes notices library volunteers who are retired from the medical field using outdated terms in their search, and, therefore, they do not find the information. This sometimes occurs as well when people use trade names.
The best databases are set up so people can browse as well, says Jones. It may have a section in the left-hand column with major categories — such as exercise, nutrition, etc. — that people can click and see subject headings which might lead them to the information without putting in a key word. They find the information through a series of clicks.
"If someone does not have the correct word, they will eventually find the information through a series of clicks. It is like leaving bread crumbs through the forest. Looking for cancer? Click here. A particular part of the body? Click here. And eventually they find it," says Jones.
Cross referencing and search functions make a database more useful when it is designed for use by all clinical personnel, says Moyer. When there are topic headings, there is a risk that titles placed in another category might be missed, she says. For example, a physical therapist may only look under the headings "exercise" or "rehab" when looking for educational material, and there could be titles elsewhere on the database.
A search engine for a database can be sophisticated enough to pull up unique fields such as patient education materials with pictures, says Allen.
Whenever possible, it is always best to get software off the shelf, says Starr. In that way it will be the vendor's job to remain on top of the market and know where the industry is headed and what new regulations are passed that might impact the database.
Also there is instant collaboration when there is a problem because there is a pool of several hundred customers using the same product that may have had similar issues and the vendor can draw on those experiences to help solve the problem, explains Starr.
Lawson recommends that patient education managers make sure extensive research is done on software products before one is purchased. "Research the company and interview other customers so that you can be confident their product is reliable and reputable," she says.
Know your limitations
While a patient education manager takes the lead on a project to implement a patient education database, he or she does not necessarily have to learn all there is about such technology or be the person to actually do the work.
Determine what you do not know, advises Fitzgerald. For example, she did not know how to maintain the site or store information so she looked for people to work with who had the skills she lacked. A person who oversees a databank of forms is the one that posts the information on the patient education database at St. Joseph's. Edited materials are put into a template and posted in the forms catalogue that automatically updates the patient education site.
Allen suggests patient education managers work with a librarian when trying to create a database. "It may be the hospitals' on-line catalogue could be adapted to include all your patient education materials. Most of them are very sophisticated databases," she explains.
It's also a good idea to learn from other's mistakes. Moyer says the current database for patient education inventory at The Ohio State University Medical Center was developed long ago and there have been difficulties making it accessible to other systems.
To avoid this problem, Allen recommends a standard record format. "Software changes over time and you want to be able to take the records and move them from one system to another, and when people design databases not based on that standard record format, it is a lot harder to move things," she says.
Moyer says the Ohio State system is not able to track the use of documents either and that would be beneficial when trying to determine whether a title should be deleted or maintained on the inventory. Maintaining a database can be labor intensive, says Smith, for you must create documents, identify resources, enter data, and update data. At this point, her institution is considering purchasing a product, such as "Cancer Knowledgebase," to provide the cancer-related content and focusing on keeping the local support group and program information up to date.
Most importantly, understand that a database is an evolution that will need to be tweaked from time to time; it is a work in progress, says Fitzgerald. There is an e-mail address on the site at St. Joseph's Hospital Health Center database so staff can provide information about topics they can't find and materials they can't use.
For more information about creating a patient education database, contact: