Improving Electronic Health Records Patient Education Materials - 2012

Summary: Health literacy refers to an individual’s ability to read, understand, and use health care information to make decisions about treatment. An estimated 90 million people in the United States have limited health literacy. A low level of patient health literacy can undermine communication between physician and patient, resulting in substandard care. Therefore, health literacy must be a factor in the design of health information and patient educational materials to help patients receive better care.

Abt Associates, in partnership with the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH) and Northwestern University’s Health Literacy and Learning Program (HeLP), is leading a study to develop the Patient Education Materials Assessment Tool (PEMAT) instrument to assess whether patient education materials, including those delivered by electronic health records (EHRs) are presented in a way that is sufficiently understandable for patients to make and follow through with relevant decisions. A technical expert panel (TEP) is guiding the development of the PEMAT and other project tasks.

MGH is leading the review of current EHR patient education capabilities and features. The Abt study team will inform EHR vendors and users of their findings on patient education capabilities and features. The team will also disseminate the new instrument.

Project Objectives: 

• Develop an instrument, the PEMAT, to assess the understandability and actionability of patient education materials that can be provided via EHRs. (Ongoing) 
• Complete an environmental scan to identify a set of publicly available patient education materials that rate well on the PEMAT. (Ongoing) 
• Review current EHR patient education capabilities and features. (Achieved) 
• Disseminate findings to clinicians and EHR vendors about the availability of the PEMAT and effective patient education capabilities and features of EHRs. (Ongoing) 

2012 Activities: The focus of activity was on establishing the reliability of the PEMAT. Two rounds of inter-rater reliability (IRR) testing with multiple raters and multiple materials were completed early in 2012. The level of agreement for both rounds was no better than fair, so the study team made considerable changes to the PEMAT, including developing a 60-page user’s guide with explanations and examples for each criterion in the instrument. Additionally, because substantial changes were made to the items after the initial TEP validation, the items in the revised PEMAT were revalidated with a subset of TEP members. Additional IRR and consumer testing and PEMAT completion will occur in 2013.

The report on the review of EHR patient education capabilities and features was completed, and recommendations for the Centers for Medicare & Medicaid EHR Incentive Program’s meaningful use criteria were shared with the Office of the National Coordinator for Health Information Technology (ONC).

Abt presented the development of the PEMAT at the International Conference on Communication in Healthcare in St. Andrews, Scotland in September 2012 and at the Health Literacy Annual Research Conference in Bethesda, MD in October 2012.

Preliminary Impact and Findings: The findings from the review of patient education capabilities of EHRs and subsequent case studies served as the basis for meaningful use recommendations to the ONC.

Target Population: Low Literacy

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation