Hello. My name is Bonnie Westra.

I'm an Associate Professor at the University of Minnesota School of

Nursing. And today's topic is on consumer health

informatics. So, consumer health informatics is

defined as consumer-initiated and/or controlled information for them to be

able to manage their own health. And so we're talk a little bit about that

today, and then talk about specifically some concepts and some principles related

to consumer health informatics. And then look at technologies that will

support consumer engagment in being able to access and use health information

technology. Now, if you look at this slide, one of

the things you'll notice in the upper right hand corner is it says,

healthit.gov. So the Office of the National

Coordinator, who has been helping to develop and support the use of health

information in general for providers. Also is encouraging the use of health

information technology for consumers. And I would highly recommend looking at

this website. Because it talks about, as you'll see on

the bottom, providers and professionals, patients and families, policies and

researchers, and innovators. And so the engagement of consumers is

really key to being able to have a change in transformation in how we provide

healthcare. Consumer engagement in the use of health

information technology is really dependent on the health literacy of what

we call eHealth literacy of consumers. So what you'll find is that about a half

of Americans or 90 million American adults have difficulty processing and

understanding complex text. Nine out of ten adults find that they

have difficulty with everyday health information.

Just even think about the terms, you know, that we use.

What does it mean for instance if I talk about an arthoplasty, versus I had knee

surgery. So we use a lot of terms that are

difficult for the everyday person to be able to understand.

What the implications of that are, is that, when we have challenges with common

health information. We also find that we have challenges

with, even things like health information or medication labels.

In terms of trying to understand how should I take my medications.

You know, what do I really owe on this bill or is this piece of paper even a

bill sometimes because we get a lot of information in the mail.

So when we think about Consumer Engagement in Health Literacy.

You'll find that under The Patient Protection Affordable Care Act, that

health literacy. Is defined as the degree to which an

individual, has the capacity to obtain to be able to communicate process and

understand basic health information and services.

in order to be able to make appropriate health decisions.

So the end goal is how do we really empower consumers to be full participants

in decision making about their health care.

Now, eHealth Literacy has many different definitions, but it also has multiple

components. So oftentimes when we look at eHealth

literacy. We're really looking at seeking, finding,

understanding, and evaluating or appraising health information from

electronic health sources, when we talk about eHealth literacy.

And then how do we apply that knowledge in order to be able to solve health

problems? So what you'll see is there are number of

components to really think about. One is what we call oral literacy.

And that is, can I speak? And can I hear and understand health

information, orally and audio-wise. There is print in visual literacy.

That is, think about reading and writing and understanding graphic and visual

information. And then there's information literal,

literacy, which is obtaining, and being able to apply relevant information.

recently I was talking to somebody and they said I just found out I had stage

four congestive heart failure, I think I'm dying.

And I'm like, tell me about your breathing.

Well I'm fine. And [LAUGH], it's like, I don't think

that's what you have. So being able to understand and find the

appropriate information is critical. Numeracy is an interesting concept, and

that is, how do we think about the ability to calculate and to reason with

numbers? And numeracy covers not only, like,

mathematical sorts of things. But it also covers, for instance, looking

at graphics, and figures, and being able to interpret that information.

And then computer literacy. How do we think about the ability to

operate and to use computers and other kinds of technologies in order to access,

process, and manage information. Now, when you think about health literacy

in terms of consumer engagement. It is really clear from the literature

that without good information and an understanding of the information.

And the importance, patients are more likely to have difficulty with managing

chronic health conditions, like diabetes or high blood pressure.

And, that they're not likely to actually engage in decisions, because they don't

understand. And what we also know from research is

the results are that people who have poor health literacy, have higher utilization

of health services. So they might skip necessary medical

tests because they don't understand why they're important.

They might have poor adherence to treatments.

I found that recently in a study with older adults after homecare.

They were to follow-up with that exercises.

And they thought when the physical therapist left, they were done.

And then when they didn't continue with their exercises, they actually got worse.

And so helping people to understand how do you follow up.

And then they are more likely to end up in the emergency room.

What this means is that they're high costs then as a result of health literacy

that range from $106 billion to $238 billion annually.

And we also know that there are poorer outcomes then as a result.

So if you look at the Agency for Healthcare Quality and Research, they

have a really great toolkit called the Health Literacy Universal Precautions

Toolkit. Now when I first looked at that, I think

of universal precautions as washing your hands.

What it means is that, everybody washes their hands all the time so that you

don't spread infection. Well a health literacy tool kit is to

assume, everybody has a minimal level of understanding and design the way that you

communicate. Whether its' on paper, or whether it's

orally, or whether it's technology. To you, you design in a way that you

assume that people only have a minimal level of literacy.

And therefore you just hit everybody, instead of testing, and selectively

applying different strategies. So universal precautions refers to taking

specific actions that minimize the risk for everyone.

When it's clear which patients might be affected by health literacy problems.

Now another really great tool is called Ask Me 3.

And what Ask Me 3 is, is that when I go to see my healthcare provider, I should

always be prepared to ask three questions.

What is my main problem? Secondly, what do I need to do about it?

And third, why is it important for me to do this?

If people are prepared to ask these three questions, they're much more likely to be

able to use the information. And to understand and be involved in

decision making. Now the institute of medicine has put out

numerous reports in regards to health literacy, as you can see on this slide.

And so what we know is that it's really an important topic.

And as organizations are beginning to focus more and more attention on consumer

engagement, and patient center care. These are actually great references to go

back to. What do we know, and what might we do

about it. Now, the next thing that I want to talk

about is a little bit more about the consumer use of different kinds of

technologies. When I look at consumer engagement, not

everybody sits down at a computer. They might be using a lot of different

technologies to be able to manage their health.

So, an example is the Fitbit. So, the Fitbit is a technology that's a

wearable device. And it can help you be able to monitor

your health, looking at calorie consumption, activity consumption.

And then being able to really understand how are you doing in terms of managing

your health. Just simply having the feedback from a

device like this, helps people to become more aware of what they're doing to be

able to manage their weight and their exercise.

Another one is blood pressure monitoring. So, today at home, people can have

various kinds of devices that hook right into their telephone.

to be able to monitor their, their blood pressure and to be able to track over

time how they're doing. Another one is a WiFi scale.

So when you think of congestive heart failure patients who are told to monitor

their weight daily. And if they gain more than two pounds in

a day, they should contact their provider.

So this scale has a bluetooth connection. And if your computer's on, simply get on

the scale and it will tell on you as to whether or not you actually weighed

yourself, and what your weight was over time.

There are also sleep [COUGH] Sleep Managers.

So you can actually use a device that will monitor the quality of your sleep.

And so there are a variety of technologies when you think about

consumer health engagement. that can help consumers really look at a

lot of parameters that they have control over in terms of their health.

One aspect of consumer health information technology is a personal health record.

Now many providers offer what we call a portal.

Which allows consumers to access a subset of information from the provider's

electronic health record. But there also are personal health

records that can be stand alone health records.

So you'll see, for instance, that if you go to MyPHR, on AHIMA's website, they

actually have many different kinds of personal health records.

And what I like to tell students is, sign up for a fake email account.

So that when you go and test out these devices you don't get all the

advertisement. That you might not want have come back to

your regular email account, but its a good way to look at comparing different

personal health records. When you look at consumer engagement, in

health information technology, there are also a variety of internet resources that

consumers can engage in. Medline Plus, by the National Library of

Medicine, is probably one of the best known resources for consumer education.

They've really tailored it in terms of how do you, work with health literacy, so

consumers can understand and be able to focus their attention on the critical

information. There are also are, video and podcast on

communication about consumer engagement on the AHRQ agency for healthcare

research and quality website. And then there are also different kind of

internet sites that can be helpful for consumers.

When you look at blogging, there's a consumer website called Patients Like Me,

where patients really share information about how they manage symptoms.

It started with neuro-muscular skeletal diseases and now it has spread to be a

lot of different types of health conditions, and patients share I've had

that symptom. Here's what I tried.

So you have to take a, you know with caution in terms of the advice.

But it's really consumers helping consumers.

Another one is caring bridges, so if you think about people who are diagnosed with

severe illness or have trauma. Instead of, all of the phone calls and

all the emails, they can set up a website where they or a family member can post an

update of how they're doing. And then, they can get on the patient and

their family whoever they share with, can get on and be able to exchange

information through that website. You'll find that Twitter is now becoming

a lot more in use, and it's a way that people will quickly be able to set up a

topic and be able to share information. And then, of course, Fitbit we talked

about. So, in summary, what we've talked about

is high level, what is consumer engagement?

What are some of the health information technologies?

The fact that health literacy and e-health literacy specifically, are

really important for consumers to fully engage, and understand, and manage

information. So they can participate in decisions

about their healthcare. Thank you very much.

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Consumer Health Informatics

Interprofessional Healthcare Informatics

Meet the Instructors