Using the Internet as a Patient Education Tool
http://fpen.org/allina/ipe.html
Paul Kleeberg, M.D.
Revised: November 3rd, 2000
Objectives
Background
How do I use it?
Patient Education
Medformation.comFinding Information on the Web
Healthwise Knowledgebase
CHESS
MEDLINEplus
Healthfinder
Other Internet Resources
Search EnginesJudging Quality
Metasearch Tools
Metasites
Medline
In Summary
At the end of this talk, you should be able to:
Many have written about the growth of the Internet and its importance to health care. Here are a few statistics:
There is a great deal of information directed at patients on the Web. What is most important is finding information that is reliable and consistent with Allina’s standards of care. For the purpose of discussion, I will separate the educational tools that are available into four types:
Allina Hospitals and Clinics maintain a health information web site called Medformation.com. This web site provides access to local health information as well as easily printable handouts that you can give to your patients. The information is provided by Clinical Reference Systems and has been used by physician offices since the early eighties. It is also the same handout material in Logician, the automated medical record that is being installed in the Allina Clinics. Medformation.com also provides interactive tools for body mass index assessments and calculating calories burned. Examples of the different types of tools available on Medformation.com:
Medica provides access to the Healthwise Knowledgebase from its web site. This tool provides more comprehensive information about a broader range of diseases and rare disorders. Pages are cross-linked and allow the individual to explore on their own to find more information. Healthwise also contains tools to aid in decision making. One example is leading the patient through the decision of whether or not to start hormone replacement therapy. If you do not have access to the live version of the knowledgebase on Medica, You can view a demo version on http://www.healthwise.org/. Examples of the different types of tools available within this resource:
Allina Medical Clinic has recently started a pilot with the Comprehensive Health Enhancement Support System (CHESS) (http://chess.chsra.wisc.edu/Chess/). This is a web-based health resource designed to educate and equip people facing a health crisis. CHESS provides educational modules that give in-depth information about specific diseases such as breast cancer, prostate cancer, heart disease, menopause and asthma. The modules provide not only information, but also provide decision support tools, ask an expert and on-line discussion and support areas.
A resource that has recently been enhanced is MEDLINEplus (http://medlineplus.gov). Collected by the National Library of Medicine, the resources on this site appear outstanding. In addition to links to other medical resources on the web, there is a medical encyclopedia that includes information about diseases, nutrition, surgeries, symptoms and tests among other topics. Definitely worth a look.
The U.S. Department of Health and Human Services maintains a listing of what they consider to be reliable consumer health and human services information. It is called Healthfinder (http://www.healthfinder.gov/). I refer to this site quite often when I am looking for reliable health information that I can trust is non-biased.
Specialty Societies frequently provide patient information handouts on the medical society web site. Examples of these are the American Academy of Family Physicians, and the American Academy of Pediatrics. Many on-line drug stores will provide information for consumers about their medications. I have found these sites will often have this information soon after the drug is released. RxList is an example of a site I have found useful.
_Finding what you need on the Web_
What if you have looked on all these places and you still cannot find what you need. There are four general classes of tools that you can use to search for information on the web. These are search engines, meta-search tools, meta-indices, and Medline search tools. Each has its own strengths and weaknesses.
Search engines randomly index pages on the web. Though some say search engines give unsatisfactory results, I maintain that a well tuned search will give you excellent results in short order - faster than looking it up in a text in on your shelf.
To use a search engine you must understand how your results are arranged. With most search engines such as AltaVista results are arranged according to the number of times your search terms appear in the document. The more a term appears on a web page, the closer that page moves to the beginning of your search results.
With some search sites, not all your terms have to appear in the results. That rare medical term, though it may be the most important to you, might not be present in your first few results.
Google is a search engine that uses a unique method for ranking the results. It ranks them according to the number of other sites that link to the target document. In a sense it is using an unorthodox method of peer review by assuming that if a lot of sites link to the page, it must be good.
You will get better results if you keep these things in mind:
I recommend that you become familiar with the advanced techniques in one or two search engines and use them for your quick and dirty searches. Google is the search engine I use most frequently.
These tools are useful if you wish to canvas more of the Internet with your search. Since none of the search engines exhaustively index the web, it is sometimes valuable to blanket several sites at the same time to find that rare article. There are two different types of tools you can use to perform this type of search: A web site or an application that resides on your computer.
These sites can serve two purposes. One is to allow you to browse for information. Another is to allow you to perform a focused search.
My favorite metasites is Medical Matrix but a better known example of a metasite is Yahoo.
There are many tools that allow you to search the peer reviewed medical literature. My two favorites are PubMed provided for free by the National Library of Medicine and Ovid provided for free to any affiliated physicians and employees of Allina. Once again it is best to become familiar with one of them so that you may refine your search techniques and increase your efficiency.
Ovid is a robust MEDLINE search tool that will provide you with on-line access to full text of some medical journals. It will also indicate which of the journals reside in one of our libraries so the article can be easily retrieved. Instructions for requesting an Ovid password are available on the library’s web page.
PubMed allows you to save your search strategies allowing you to check them for recent updates. There are two methods for doing this. One method allows you to save your search strategy as a bookmark in your browser. This makes it very easy for you to scan recently published articles in areas of interest to you. Instructions explaining how to do this are available on-line. A newer method is to use the “Cubby” feature that recently became available. I have not tried it yet but I understand it is an easy method for saving and retrieving searches.
Just as one would evaluate a medical journal or any other article appearing in printed media, it is important to look at the publication (web site) the publication’s source of funding and the source of funding for the study. When evaluating web sites, a quick glance of the site’s domain can tell you a great deal:
|
.com |
commercial site |
|
.edu |
educational institution |
|
.edu/~paul |
Paul’s web pages at the educational institution |
|
.gov |
Government site |
|
.org |
Non-profit organization |
|
.net |
A regional internet provider |
|
.us |
United States |
|
.au |
Australia |
|
.jp |
Japan |
|
.uk |
United Kingdom |
For more information about top-level domains see the Internet Assigned Numbers Authority at http://www.iana.org/. You will find a listing of the top level domains for countries there as well.
A more thorough discussion of judging quality written by Allina Health System’s Medical Librarians can be found at http://fpen.org/train/web/evaluating-sites.html.
The Internet provides us with an opportunity we have never had before. It allows our patients to have access to incredibly rich, reliable and up-to-date medical information. Not too long ago this information could only be found in medical libraries and bookstores. Today, people have access to this information in the comfort and privacy of their own homes. It is our responsibility to foster this thirst for information and help guide our patients to find information that is reliable and reputable.
For more information, contact:Paul Kleeberg, M.D. O o Paul@Allina.Com Allina Health System -+---+- Voice: 612-775-1338 1375 Willow Street |_o_| Family Practice & Minneapolis, MN 55403 USA / \|/ \ Information Services