Electronic Age Loses Out to Paper in Patient Education

August 3rd, 2012

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By , BSN, RN

Electronic medical records (EMRs), electronic health records (EHRs), personal health records (PHRs), electronic charting, databases, and texting, the Blackberry versus the iPhone—what do all these things have in common? These are the ways healthcare professionals (including nurses) communicate these days.

The electronic age is amazing. However, a recent study shows that it is printed paper that is most effective and most used when communicating with our patients.

The healthcare communications agency HealthEd Group recently released a report on the most effective ways healthcare providers—other than doctors—communicate with their patients. The results showed 55% of health professionals polled said they rely on paper-based communications when talking with their patients. That’s right, we still prefer paper to electronics.

So why are we still relying on printouts and written information to educate our patients when this is the electronic age? One of the first reasons cited by healthcare providers as to why so many print out paper information for their charges was straightforward: 61% said they didn't pull out laptops and smartphones during appointments because educational technology was just too expensive. Others said regulations lessen their own ability to be creative when presenting information.

Another reason is that those doing the educating view themselves as “the de facto search engine or curator of health information for patients and care partners,” said HealthEd’s Susan Collins, SVP, health education R&D. The healthcare educators winnow down the tremendous amount of healthcare resources available, and steering clients away from misinformation towards more reputable sites,” she added.

Also cited in the study was that educational tools often don't take into account health literacy. Healthy People 2010 defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

According to the study only 12% of patients qualify as health literate. That means most folks don’t necessarily understand what's online, let alone know if they are finding their information from reliable sources.

That makes the digital world less valuable for them (and even a little dangerous), and it's an area respondents cited as being forgotten in the educational technology effort.

Those patients who do go online to track down information pose an educational challenge of their own: the survey showed that while 30% of educators said patients are unable to distinguish between credible and unreliable sources for health information and nearly 59% said patients are bringing in downloaded materials to discuss in their clinical visits. I think we all have been confronted by patients who come in telling us what is wrong with them, how they should be treated, and they need to be prescribed some certain medication as part of their treatment process.

This is often a case of a little information can be dangerous. It also brings us back around the healthcare provider being a human search engine and being able to edit out the bad information. Printed materials of our own in hand give us teaching tools that are concrete, can be personalized for each patient concerned, highlighted for important issues, and easily referred to without having to carry around a computer.

The surveyed educators included nurse practitioners, registered dietitians, diabetes educators, and social workers; the people who, in many instances, take the physician’s diagnoses and make them understandable, workable situations for the patient’s everyday life. “This is the group doing the translation…in terms of how to cope with a diagnosis or how to translate what treatment recommendations doctors made into adherence,” explained Collins.

“We actually go deeper and broader in our discussions than most MDs,” said Mindy Nichols, a certified diabetes educator and registered dietician. “The MD usually gives the diagnosis and suggestions to maintain control of the disease, and the certified diabetes educator assists with personal understanding of that diagnosis and prescription.”

I can think of many reasons to forgo my laptop or tablet in exchange for paper or printed teaching materials. For example, particularly when you are talking about a geriatric population, they may not be electronically literate. Much of our current senior citizen population doesn’t use computers. They prefer handouts they can refer back to repeatedly and carry around with them.

Also, when you are dealing with older patients you are often dealing with vision deficiencies. Presbyopia and cataracts make everything hard to see and computer screens are particularly difficult. With printed materials you can effectively make the words larger or change their color. Plus with many computer screens you have to be very specific about where you sit to see the screen clearly or at all. With paper the patient can move it to wherever they can best see.

Another reason behind our tendency to resort to print is that even today, as you are reading this on a computer, not everyone actually has computer and internet access. They may not be able to afford it or in the case of some people I know, their rural location hasn’t allowed for it. Paper is pretty universal.

I know from my own perspective (and I love the electronic universe) most of us can’t hang our computers on the wall, or the mirror in the bathroom to refer to our individual healthcare instructions. Paper fits the bill. You can copy it, you can tape it up, use a magnet to hold it on the fridge, fold it and put in your wallet or purse and always have the instructions you need quite literally, at hand.

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