Section 6.6 Optimize
Optimization Strategies for Client Education
and Report Cards
This tool describes how electronic health records (EHR), health information exchange (HIE), and
health information technology (HIT) can support enhanced patient education; patient access to their
vital data, including the ability to compare their status with normative data; and their ability to
become more engaged patient in self-management.
Time needed: 4 hours
Suggested other tools: NA
Introduction
A number of studies1 have demonstrated that when chronically ill patients have access to their vital
data they are in a much better position to monitor their environment, behavior, diet, and compliance
with medication. Researchers have observed2 that medical outcomes and quality of life improve, and
patients feel more in control of their own health, and have suggested identifying ways to ensure that
patients who want access to their EHR obtain information on health data that is most relevant for
them.
Home care affords an important opportunity for enhanced patient education, engagement, and access
to information about clients’ own care, as well as information about how their health status compares
to norms for improvement.
How to Use
1. Distinguish between public reporting and generic reference material, as well as personalized
report cards, tailored education, and self-management tools.
2. Acquire and utilize strategies to optimize adoption of EHR, HIE, and HIT to support all forms of
patient engagement and self-management.
3. Evaluate the impact of HIT on patient self-management and plan for continuous improvement.
Comparison of Patient Support Materials and Usability within EHR, HIE, and other HIT
Form of Patient Support
Advantages and disadvantages
Generic reference material. Home health
agencies and many other providers subscribe
to services that provide health education
content suitable for:
- Brochures, pamphlets, or other
handout material
- Content for the organization’s Web
site
Generic reference material acquired from a company
that specializes in its development and acquisition is an
important first step in making health education available
to your patients. The material is generally written for the
target audience, in “lay language” with suitable
illustrations and generic advice.
Generic reference material may not have been written
1
Richardson, J. et al. 2012 Monitoring Physical Functioning as the Sixth Vital Sign, BMC Family Practice,
www.medscape.com/viewarticle/767764
2
Cimino, et al. 2001 cited in M. Pieper and K. Stroetmann, Universal Access in Health Telematics, Berlin: Springer,
2005
Section 6 Optimize—Optimization Strategies for Client Education and Report Cards - 1
Form of Patient Support
Customizable educational material is available
as a utility in some EHR systems.
- Some systems enable the
professional user to select specific
educational material and have it print
with the patient’s name, photo,
language, and even large font.
- Some systems enable the
professional user to combine
educational material on multiple
conditions for a single patient so one
unique packet of information can be
provided.
- Some systems pre-populate
educational material with patientspecific information, further
customizing it to the specific patient.
Public reporting of quality outcomes is
designed to assist consumers in selecting the
home health agency most suitable for their
needs.
Advantages and disadvantages
with home health in mind. It does not directly enable
comparison with the educational content and specific
patient’s condition.
When distributed by a home health professional,
generic material may require more explanation than
customizable material.
Educational materials that are customizable through
the EHR provide a closer bond between the material
and the patient and provides specific guidance. The
more patient information that can be incorporated, the
more beneficial the materials. The home health
professional can spend time focusing on specific
messages rather than filling in patient-specific
information missing from generic material.
Although there is some evidence that public reporting is
fulfilling its primary, consumer-based intent, there is
also evidence that agencies are using public reporting
to benchmark themselves, improve, and be more
competitive. Both outcomes are positive.
Results from public reporting will not necessarily
translate directly to the results a given patient can
expect. The reports tend to be far removed from the
patient’s direct care activities. They may be available to
patients via a Web browser or may be pushed to a
patient’s personal health record (PHR) via a health
information exchange organization (HIO).
Patient-specific report cards and diaries
(sometimes referred to as “participatory
medicine”) are intended to motivate the
patient to partner with the home health
professional to improve health, take an active
role in self-management, participate in
decision-making about their care, and assume
responsibility for making behavioral changes.
See also an example of a portal to multiple sources for
public data: http://reportcard.opa.ca.gov/rc2013/
Patient-specific report cards provide very specific, clear
messages about the patient’s health status and can be
generated by some EHRs, especially when linked to an
HIO where multiple providers can contribute data (e.g.,
medications from pharmacy, lab results from lab or
hospital, vital signs from home health agency).
If the patient report card can be tailored to both the
patient’s vital data and specific goals and used as a
diary, it can be even more motivational. These are
sometimes found in PHRs.
Patient report cards may or may not include specific
instructions for improvement. They must be explained
to the patient and/or family in a supportive, partnering
manner. These should not be introduced as “grades” in
school. The home health professional must be skilled to
Section 6 Optimize—Optimization Strategies for Client Education and Report Cards - 2
Form of Patient Support
Advantages and disadvantages
use them properly.
Motivational interviewing
See also: http://www.jopm.org/evidence/casestudies/2011/04/04/creating-a-participatory-officepractice-for-diabetes-care/attachment/shahady-table-1/
Motivational interviewing is a non-judgmental approach to
increasing a patient’s awareness of the potential problems
caused, consequences experienced, and risks faced as a
result of a health-related behavior – especially those that
contribute to chronic disease (e.g., diet, exercise) and
behavioral disorders (e.g., drinking, isolation).
Steps include involving patient in talking about issues and
establishing rapport, focusing on specific things the patient
wants to change, and allowing patient to plan the specific
steps to implement the desired change so that the patient
feels empowered to actuate the change.
Shared decision-making tools allow patients
and providers to make health care decisions
together.
Patient self-management/patient engagement
tools often refer to technology used by a
patient or informal caregiver to manage health
problems outside formal institutions.
See also: http://www.motivationalinterview.org/
This is a collaborative process that takes into account the
best scientific evidence available, as well as the patient’s
values and preferences. It honors both the provider’s
knowledge and the patient’s right to be fully informed. It is
most applicable to major clinical decisions patient face, such
as whether to have a particular surgery. See also:
http://www.informedmedicaldecisions.org/what-is-shareddecision-making/
Patient self-management/patient engagement tools
include those accessible independently by a patient
and those provided by a health care provider who also
uses motivational interviewing and shared decisionmaking to help patients address barriers to achieving
their health goals (e.g., lose weight, stop smoking).
Some EHRs offer templates to build a patient’s selfmanagement plan of care. Patient education, diaries,
and report cards are helpful adjuncts. Increasingly
patient self-management is being linked to the broader
scope of care coordination in the chronic care model.
See also:
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20
Files/PDF/P/PDF%20PatientSelfManagementToolsOve
rview.pdf
http://informedmedicaldecisions.org/wpcontent/uploads/2012/04/Patient_Engagement_What_
Works_.3.pdf
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm
=1&source=web&cd=4&ved=0CEkQFjAD&url=http%3A
%2F%2Fwww.lphi.org%2FLPHIadmin%2Fuploads%2F
Pt-Engage-Self-Mgt-Knox24859.ppt&ei=EXlxUsDNL8qQyAHWk4CYAg&usg=AF
QjCNFsUt3qW7U12kKNVefKwvNDig4wQ&sig2=ahJt3bYrA23
Section 6 Optimize—Optimization Strategies for Client Education and Report Cards - 3
Form of Patient Support
Advantages and disadvantages
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http://healthinsight.org/Internal/events/05-2312/megalan_talk.pdf
Adoption and Evaluation of Patient Self-Management Results
1. Consider using a tool to plan and track how you aid patient education and self-management
2. At a minimum, list self-management techniques that your agency has or can readily
acquire/develop. Provide staff training and encourage use of these techniques. (Some states
have more state-based reporting than others. CMS Home Health Compare can be a starting
point in the absence of more specific data available within a state. Each agency can also track
its own data through EHR functionality or by contributing to a registry via a local or state
HIO.)
3. Ideally, document the utilization of self-management techniques for each patient.
(Techniques may need to be reinforced with discussions, and some techniques may need to
be used repeatedly.)
4. Although it is unlikely that only one technique will cause improvement, it can be helpful to
focus on a specific goal and document results.
5. Two examples are provided below. Add your own focus areas and techniques.
SelfManagement
Technique
Report Card
Date
Initiated
Baseline
Data
May 2
Uncontrolled
diabetes;
goal: Hg A1c
= 8 in 3
months
May 8
PHQ = 9
(Has
fluctuated
between
7 and 9)
Diabetic diary
PHR to receive
lab results
Depression
Self-Care
Action Plan
Results
after __
Time
Aug 5:
Hg A1c =
8.2
Jun 12
PHQ =
8
Specific
Instructions
to Patient
-Use
structured
diabetic diary
to record diet
and blood
sugars
-Track Hg
A1c values
through PHR
-Have
patient
develop
a selfcare plan
Copyright © 2013
Section 6 Optimize—Optimization Strategies for Client Education and Report Cards - 4
Results
after __
Time
Nov 3:
Hg A1c =
7.4
Aug 14
PHQ =
7
Updated 11-20-13