A brief overview of what the IHS is doing to promote health literacy and health communications in 2011

1. Indian Health System
Health Communication Tools
Improving Health Literacy

2. Health Communications
• Effective use of communication and technology by health care and public health
professionals can bring about an age of patient- and public-centered health
information and services. By strategically combining health IT tools and effective
health communication processes, there is the potential to:
• Improve health care quality and safety.
• Increase the efficiency of health care and public health service delivery.
• Improve the public health information infrastructure.
• Support care in the community and at home.
• Facilitate clinical and consumer decision-making.
• Build health skills and knowledge.

3. Health Literacy
• Health Literacy is an objective of Health Communications.
• Health literacy is the degree to which individuals have the capacity to obtain,
process, and understand basic health information and services needed to make
appropriate health decisions.

4. Overview
• Tools for Assessment
• Patient Education
• Patient Goals
• Patient Engagement

5. Tools for Assessment

6. Tools for Assessment
• Health Factors
• http://www.ihs.gov/RPMS/PackageDocs/bjpc/bjpc0200.05o_aum.pdf
• Barriers to Learning
• Learning Preferences
• Confidence

7. Barriers to Learning
• No Barriers • Interpreter needed
• Visually Impaired • FineMotorSkills Deficit
• Blind • Dementia
• Hard of Hearing • Values or Beliefs
• Deaf • Stressors
• Does Not Read English • Low Health Literacy
• Speaks English as a • Cognitive Impairment
second language

8. Learning Preferences
• Do or Practice
• Read
• Small Group
• Talk
• Media

9. Patient Confidence
• Confidence is used to assess the likeliness that the
patient will take an active role in managing their health
and well being.
• Ask the patient, “How sure are you that you can
manage and control most of your health
problems.”

10. Patient Confidence
Health Factor Definition
Very Sure The patient is confident that they can take an active role and
manage most of their health problems. The patient is very likely to
achieve their health goals.
Somewhat Sure The patient is at least 70% confident that they can take an active
role and manage most of their health problems. The patient is
likely to achieve their health goals.
Not Very Sure The patient is less than 70% confident that they can take an
active role and manage most of their health problems. Support
and education should be provided to assist them in increasing
their confidence and ability to participate in self care activities.
I do not have any The patient does not acknowledge health problems. It is unlikely
health problems that the patient will be willing to set and achieve health goals at
this time. Emphasis should be placed on providing the patient
with support and education to understand their health problems,
improve their confidence and ability to participate in self care
activities.

11. Patient Education

12. Teach back
• What did your doctor tell you the medication is for?
• How did your doctor tell you to take the medication?
• What did your doctor tell you to expect?

13. Ask Me 3
• http://www.ihs.gov/healthcommunications/index.cfm?module=dsp_hc_toolkit
• http://www.npsf.org/askme3/

14. Patient Education
• Document Patient Education Codes
• http://www.ihs.gov/HealthEd/index.cfm?module=pepc

15. Documenting Patient Education
• GPRA and UDS measures
• Meaningful Use Performance Measures
• Meaningful Use Clinical Quality Measures

16. Documenting Patient Education
Level of Readiness to
Topic Sub-Topic Time
Understanding Learn
Education Code

17. Documenting Patient Education

18. Documenting Patient Education

19. Patient Handouts
• http://www.ihs.gov/healthcommunications/pe/index.cfm?
module=search&option=crit&newquery=1

21. Handouts and the EHR

22. Handouts and the EHR

23. Handouts and the EHR

24. Goal Setting

25. Patient Goals Component

26. Patient Engagement

27. Patient Wellness Handout

28. My Wellness Handout Report Date: Aug 13, 2010
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********** CONFIDENTIAL PATIENT INFORMATION [CCL] Aug 13, 2010 **********
DOE,JANIE HRN: 3 CHEROKEE INDIAN HOSPITAL
1 MAIN STREET CHEROKEE, NC 28734
CHEROKEE, NORTH CAROLINA 28719 SMITH, DOCTOR
555-555-5555 828-497-9163
Thank you for choosing CHEROKEE INDIAN HOSPITAL.
This handout is a new way for you and your doctor to look at your health.
______________________________________________________________________
HEIGHT/WEIGHT/BMI - Weight and Body Mass Index are good measures of your
health. Determining a healthy weight and Body Mass Index also depends on
how tall you are.
You are 5 feet and 10 inches tall.
Your last weight was 220 pounds on Aug 03, 2010.
You should have your weight rechecked at your next visit.
______________________________________________________________________
MEDICATIONS - This is a list of medications and other items you are
taking including non-prescription medications, herbal, dietary, and
traditional supplements. Please let us know if this list is not
complete. If you have other medications at home or are not sure if
you should be taking them, call your health care provider to be safe.
1. ALBUTEROL MDI (HFA) 6.7GM Rx#: 1234567 Refills left: 5
Directions: INHALE 2 PUFFS BY MOUTH EVERY 4 HOURS IF NEEDED FOR
BREATHING; **SHAKE WELL BEFORE USING**
2. FLUTICASONE PROP 11O MCG (12GM) Rx#: 1234568 Refills left: 11
Directions: INHALE 1 PUFF 110MCG/INHL BY MOUTH TWICE A DAY

29. Directions: TAKE ONE (1) TABLET BY MOUTH DAILY FOR KIDNEY PROTECTION
! AND BLOOD PRESSURE
4. GLIPIZIDE 10MG TAB Rx#: 1234570 Refills left: 8
Directions: TAKE ONE (1) TABLET BY MOUTH TWICE A DAY
5. METFORMIN= 500MG *PLAIN* TABS Rx#: 1234571 Refills left: 10
Directions: TAKE THREE TABLETS BY MOUTH EVERY MORNING AND TAKE
! TWO TABLETS EVERY EVENING TAKE WITH FOOD FOR DIABETES
TREATMENT
______________________________________________________________________
BLOOD PRESSURE - Blood Pressure is a good measure of health.
Your blood pressure was 110/65 on Aug 10, 2010.
Your blood pressure is good! It is very important to have your blood
pressure checked often.
______________________________________________________________________
SCREEN FOR HUMAN IMMUNODEFICIENCY VIRUS (HIV)
HIV is a virus that causes a serious infection. HIV infection
can cause sickness and death. A person can have HIV for many years
and not know it. Everyone should be tested for HIV when they are
between 13 and 64 years old. According to our records, you have not
had an HIV test. Talk to your provider about how you can get an
HIV test.
______________________________________________________________________
ALLERGIES - It is important to know what allergies and side effects you
have to medicines or foods. Below is a list of allergies that we know of.
Please tell us if there are any that we missed.

30. ______________________________________________________________________
ALLERGIES - It is important to know what allergies and side effects you
have to medicines or foods. Below is a list of allergies that we know of.
Please tell us if there are any that we missed.
NUTS
PENICILLIN - SEVERE EDEMA
______________________________________________________________________
IMMUNIZATION (shot) RECORD - It is important to keep track of your
immunizations.
You received the following immunization(s):
DTaP on 01-Oct-1960
DTP on 11-Feb-2005
Td-ADULT on 06-Jul-2004
Td-ADULT on 07-Jun-2005
IPV on 15-Jun-2005
HEP B PED on 08-Apr-2009
FLU,NOS on 26-Aug-2004
FLU-TIV on 19-Apr-2005
PNEUMO-PS on 01-Nov-2004
PNEUMO-PS on 07-Jun-2005
___________________________
___________________________________________
1 Immunization Due
HEP B ADLT
______________________________________________________________________

31. Your total cholesterol result was 150 mg/dL on Aug 10, 2010.
Your last LDL (bad cholesterol) result was 70 on Aug 10, 2010.
Your last HDL (good cholesterol) result was 40 on Aug 10, 2010.
Your last triglyceride result was 120 on Aug 10, 2010.
LDL (bad cholesterol) should be under 100 mg/dL. Your LDL cholesterol
is good! You should have your cholesterol checked every year.
______________________________________________________________________
DIABETES CARE
HEMOGLOBIN A1c
Hemoglobin A1c is a test that measures your blood sugar control over a
3-month period. You should have this test done every 3-6 months.
Your last A1c test on file was 8.0 done on Aug 10, 2010.
Ask your health care provider how you can keep lowering your A1c.
DIABETES KIDNEY ASSESSMENT
Diabetes can cause kidney damage. There are tests that can see how well your
kidneys are working. Getting these tests at least once a year can help your
health care provider protect your kidneys and lower your risk of getting
kidney damage and dialysis.
Your kidneys were tested on Aug 10, 2010. You will need to have your
kidneys tested again on Aug 10, 2011.
DIABETES EYE EXAM
Diabetes can affect your eyes and vision. Early detection of eye problems
can help you to get the treatment you need to lower your chances of having
problems such as blurred vision or blindness.

32. Your last mammogram was on Nov 07, 2005. It is recommended that you
receive a mammogram every year. Ask your health care provider to order a
mammogram for you.
COLON HEALTH SCREENING
You are up to date for colon health screening. Your next colon health
screening will be due on Apr 05, 2019.
______________________________________________________________________
My Healthcare Goals
ASHTMA - Lifestyle Adaptation
Goal: will avoid too much time outdoors when the pollen is high
______________________________________________________________________
ASK ME 3 - Every time you talk with a doctor, nurse, pharmacist, or other
health care worker, use the Ask Me 3 questions to better understand your
health. Make sure you know the answers to these three questions:
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

33. Patient Feedback
• “My son was sick and he had to see so many doctors and this could have helped,
it’s easier to carry a record, instead of trying to remember all the information.”
• “Medication listed would have been helpful because it was hard to remember the
names of them - I can’t even pronounce the names.”
• “(When you can’t) establish a (primary) doctor, you can carry a record to share
with doctors at different clinics to make it easier.”
• “This paper would save people a lot of time, especially with waiting. When I had
problems with my chest my family wanted to take me to (my IHS clinic), I said no,
no. Take me to (the big city hospital). When I got there, they had to call (the IHS
clinic) and it took them forever to get my information. It would be quicker if I had
this.’

34. Provider Feedback
• “"I have been telling patients that they are overweight for years, now they get the
handout and are asking me what weight they should be at”
• "Patients are asking for their immunizations and want to know what their blood
pressure should be”
• “Patients will look at their medications on the list and tell me that they are no
longer taking some of them”

35. PWH at Registration
• Patients go to registration to update
information.
• If a PWH hasn’t been printed in 6 months,
registration prints one out for patients to
review prior to their clinic appointment.
• Patients review the document before their
visit and have time to prepare questions.
• New intake form questions.

36. PWH in the Clinic
• The PWH is generated when the patient
is taken into the clinic room or when they
are checked in.
• The nurse or provider review relevant
information on the PWH such as
immunizations or other preventative
maintenance due.
• Use to reconcile medications.

37. PWH in the Pharmacy
• The pharmacy prints the PWH prior to counseling.
• Use the allergy and medication listing to update
the medication profile in RPMS and to address the
requirements of medication reconciliation
• Can serve as a Personal Medication Record as
required for providing Medication Therapy
Management services.
• Provides the patient with an up-to-date medication
profile to take home.

38. PWH and Meaningful Use
• Patient Reminders
• DENOMINATOR: Number of unique patients 65 years old or older or 5 years older or younger.
• NUMERATOR: Number of patients in the denominator who were sent the appropriate reminder.
• Clinical Summary
• DENOMINATOR: Number of office visits by the EP during the EHR reporting period.
• NUMERATOR: Number of office visits in the denominator for which the patient is provided a clinical
summary within three business days.
• Medication Reconciliation
• DENOMINATOR: Number of transitions of care during the EHR reporting period for which the EP
was the receiving party of the transition.
• NUMERATOR: Number of transitions of care in the denominator where medication reconciliation was
performed.

39. Personal Health Record
• A personal health record, or PHR, is an electronic application through which
patients can maintain and manage their health information (and that of others for
whom they are authorized) in a private, secure, and confidential environment.
• A patient portal is an internet application that allows patients to access their
electronic health records and permits two-way communication between patients
and their healthcare providers.

40. IHS PHR
• Integrated with Master Patient Index
• Real time access to health information

41. Medication Display

42. Blue Button

43. Coming Soon: Toolkit
Tools to promote Health Literacy
Tool 1. Health literacy white paper (website)
Tool 2. Health communication and health literacy tools overview presentation
Tools to promote key change 1. Improve Supportive Systems
Tool 3. Signage
Tool 4. Improving Patient Care (IPC) program (website)
Tool 5. Community Resources
Tools to promote key change 2. Improve Spoken and Written Communication
Tool 6. Cultural considerations
Tool 7. Ask Me 3
Tool 8. Teachback Method
Tool 9. Pharmacist consultation
Tool 10. Brown bag medication review
Tool 11. Medication reconciliation (website)
Tool 12. Plain writing handout (website)
Tool 13. Assessing Reading Level Readability Formulas
Tool 14. Documenting patient education / Patient Education Codes Manual (website)
Tool 15. Patient education handouts
Tool 16. Assessing patient education needs
Tool 17. Personal Health Record
Tool 18. Patient Wellness Handout (PWH)
Tools to promote key change 3. Improve Self-Management and Empowerment
Tool 19. Patient goals / Action Plans
Tool 20. Assessing patient confidence
Tool 21. Obtain patient feedback

44. Conclusion