Consumer Health Within an Academic Medical Center

Consumer HealthWithin an Academic Medical Center:

State-of-the-Art Services and Technology

Taryn J. PittmanKristen M. Jagodynski

INTRODUCTION

The Maxwell & Eleanor Blum Patient and Family Learning Center(PFLC) at the Massachusetts General Hospital (MGH) opened to thepublic in March 1998 (1). Established as a consumer health and patienteducation service, the PFLC was created in response to patient feedbackrequesting a centralized learning environment for patients and familiesto obtain quality health information.

GENERAL OVERVIEW (MISSION, VISION, SERVICES)

PFLC’s mission is “to provide the highest quality patient educationand consumer health information services to a diverse community of

Taryn J. Pittman is Patient Education Specialist/Manager (E-mail: [email protected]) and Kristen M. Jagodynski is Health Educator (E-mail: [email protected]), both at Massachusetts General Hospital Patient and Family Learning Center.

Comments and suggestions should be sent to the Column Editor: Michele A. Spatz(E-mail: [email protected]).

Journal of Hospital Librarianship, Vol. 5(4) 2005Available online at http://www.haworthpress.com/web/JHSPL

2005 by The Haworth Press, Inc. All rights reserved.doi:10.1300/J186v05n04_05 51

CHARTING CONSUMER HEALTH

MGH patients, families and staff” (2). The Learning Center’s vision isto “make patient education and consumer health information servicesaccessible to all patients, families, employees and staff of MGH.” In ad-dition, “through partnerships with the community, state-of-the-art tech-nology and library services the PFLC will meet or exceed customerexpectations” (2).

This mission and vision provide guidance in helping patients andconsumers to become better informed about their health, and thus activeparticipants in health care decisions and self-management.

The PFLC occupies 1,800 square feet of space. It has a central andconvenient location on the first floor, main corridor, of the hospital.Over 32,000 patrons used the PFLC in FY04. Services provided to thepublic at no charge include:

• Twelve desktop computer terminals for Internet, e-mail and healthinformation access

• Pamphlets/brochures from commercial vendors (over 300 titles)• MGH-produced patient education materials• Children’s area with books, computer terminal, brochures, pam-

phlets• Thirty consumer health, medical, and trade journals• Patient education videos of over 250 titles• Reference library of over 500 consumer health and medical text-

books• Trained staff and volunteers to conduct information searches• Two small tables at entryway for display of current health topics• Copier and fax machine• Phone lines and an Ethernet line for laptop access to the Internet• Information delivery to patient care units or via U.S. mail

HOURS, STAFFING, BUDGET

The PFLC is open to the public Monday through Friday 9:30 a.m. to6:30 p.m. and Saturday 11:00 a.m. to 3:00 p.m. It is closed on eight hos-pital-designated holidays. The non-salary operational annual budget isapproximately $30,000. Additional resources are available through twodonated funds: an endowed fund donated by the Blum family, for whomthe PFLC is named; and a five-year donation from the Ladies VisitingCommittee (women’s auxiliary).

52 JOURNAL OF HOSPITAL LIBRARIANSHIP

The PFLC is staffed with 1.5 RN FTEs and a 1.0 Health Educator FTE.Volunteers supplement staff by committing to work three hours per weekfor a minimum of six months. They are initially screened and interviewedby the MGH volunteer office for appropriate placement within the hospi-tal. Potential Learning Center volunteers are then interviewed by thePFLC staff and, if all are in agreement, a start date is negotiated. All vol-unteers participate in an orientation and training program designed by thePFLC staff. Orientation itself usually takes six to twelve hours and occu-pies the volunteer’s first two to three weeks at PFLC.

LIBRARY CATALOG

The PFLC collaborates with the MGH Health Sciences Library(Treadwell Library) for assistance in ordering books and cataloging ma-terials. A Medical Librarian provides cataloging services on a fee-for-service basis. The PFLC is billed quarterly for services rendered. Allmaterials and videos are cataloged using the National Library of Medi-cine’s Medical Subject Heading© (NLM MeSH) classification systemthrough an on-line cataloging software program called “MAGIC” byInnovative Interfaces, Inc. The online catalog is accessible as a primarylink on the PFLC homepage and includes a link on how to use andsearch the catalog.

COLLECTION DEVELOPMENT

The PFLC staff collaborates with MGH professional caregivers toselect, purchase or develop patient education materials. Together,PFLC staff and clinicians prioritize (from high to low) the collectiondepth among the Learning Center’s fifty-two subject areas. Additionaldata, including reference statistics and hospital Diagnosis RelatedGroups (DRGs), are reviewed regularly to guide collection develop-ment. Collaborative projects with other clinical departments are alsoconsidered, such as the MGH Mood and Anxiety Disorder Institute(MADI), where the PFLC houses and distributes mental health resourcematerials, and the Patient Quality and Safety Office, which supports ini-tiatives such as fall prevention and infection control.

Three levels of priority for collection depth are assigned. Level I,high priority, indicates PFLC will collect as many consumer/patient ed-ucation materials within the category as possible. For diseases and con-

Charting Consumer Health 53

ditions within these categories, several books or electronic resources areacquired, including materials that provide a more technical understand-ing of the topic. Level 2, medium priority, indicates PFLC will collectas much reference material as possible in these subject categories, in-cluding at least one book or other educational media. Level 3, low prior-ity, means PFLC will meet the needs in these subject categories throughgeneral medical and reference materials. At all priority levels, PFLCstaff meets advanced information needs through the use of Internet re-sources or referral to information professionals.

Reflecting the MGH broad mission as a comprehensive health carefacility serving diverse clientele, the PFLC offers:

• Prioritized coverage of fifty-two identified subject categories basedupon DRGs and demographic data

• A balance in writing and presentation levels to accommodate dif-ferences in reading and cognitive abilities

• A balance in languages offered to accommodate ethnically diverseclientele

• A balance in formats (print, audiovisual, electronic) to accommo-date differences in learning styles

• Books spanning educational levels, from consumer health to medi-cal textbooks

• Pamphlets oriented toward a 6th to 8th grade reading level• Journals with a consumer/popular focus• Videos in most subjects that reflect MGH community needs• Easily accessible Web sites providing a connection to vast patient

and family resources

MEDIA EVALUATION

A media evaluation tool (Appendix 1) was developed to assist in ana-lyzing materials and electronic resources for appropriate placementwithin the PFLC. All media are evaluated for content accuracy, read-ability, cultural appropriateness, usability, authorship, and currency.Each of these areas is further broken down into specific criteria rated ona Likert scale to indicate strong agreement through strong disagreementor inability to evaluate. A final rating on a 1-5 scale is given to the me-dia, with 3 (satisfactory) being the minimum score considered for addi-tion to the collection.


REFERENCE STATISTICS

The PFLC has an ongoing program to track and monitor referencestatistics. Patients can initiate a reference request either by e-mail,phone, or in person at the reference desk. An information request form(Appendix 2) is used for all reference inquiries to assist in documentingthe patron’s request and for categorizing the request into a medical subjectgroup. The completed information request form is kept in a confidentialfolder. A staff member assigns a medical subject to each request weeklyand a PFLC volunteer enters the data onto an Excel spreadsheet. Using thissystem, for FY04, the top ten subjects for reference requests were:

1. Delivery of Health Care (requests about a physician, health careorganization, navigating/accessing the health care system, etc.)

2. Cardiovascular System3. Drug Therapy4. Digestive System5. Orthopaedics6. Internal Medicine7. Nervous System8. Respiratory System9. Diet and Nutrition

10. Psychiatry

DISCLAIMER

Disclaimer statements are found throughout the PFLC on small 4 ¥ 6note cards mounted on card stands. The disclaimer is also included incover letters sent with all materials delivered to patient floors or mailedto an individual’s home. The disclaimer states: “The MGH Patient &Family Learning Center is here to provide health-related information toyou so that you may be better informed. Some material may reflect theopinion of the author and not necessarily that of your doctor or the Mas-sachusetts General Hospital. If you want medical advice, diagnosis, ortreatment, you should consult your doctor” (2).

CONFIDENTIALITY AND HIPAA COMPLIANCE

The PFLC respects its patrons’ right to confidentiality. Upon request,patrons are provided privacy during the reference interview and may


choose to withhold their names. Staff may not discuss patron informa-tion needs in public, where conversations may be overheard.

Information request forms and any other materials that may divulgethe nature of a patron’s request are kept inside a folder at all times.

Furthermore, signs are posted at all printers and at the fax and copy-ing machine reminding patrons not to leave any materials or documentswith personal information, to use a folder to keep materials protectedand private, and to verify all fax numbers before sending personal infor-mation. A fax cover sheet, which includes both the PFLC disclaimerand its confidentiality statements, must be used for all patrons request-ing fax services. A locked recycling bin is available for documents con-taining personal information. The bin is emptied and shredded on aregular basis.

COMPUTER TECHNOLOGY AND PFLC WEB SITE

There are twelve desktop computers available for patrons as well asone children’s computer. All computers have Deep Freeze software in-stalled; it instantly protects and preserves the original computer config-urations. It makes the computer virtually invulnerable to hacking, andeach restart erases all changes and resets the computer to its originalstate. This software has been very helpful, greatly reducing calls placedto the Information Systems department.

The hospital Information Systems department set up the computerswith a generic username and password allowing users to have full ac-cess to the Internet and intranet. The username and password are postedon the monitor at each workstation. The computer programs availableare: Internet Explorer®, Microsoft Office® (which includes Access®),Excel®, PowerPoint®, and Word®. (For PFLC’s Computer Use Pol-icy, see Appendix 3.)

The PFLC Web site (http://www.massgeneral.org/pflc) contains awealth of consumer health information. Appropriate Web sites were se-lected using a media evaluation tool and clinician input. Web site linksare checked monthly and needed changes are reported to the Web devel-oper for updating. WebTrends analytic software records the number ofunique visits to the site, with 22,000 visits recorded in the span of oneyear.

The PFLC boasts a multitude of health Web sites and databases avail-able for patrons to search. One subscription Web service offered isWell-Connected®, a library of reports on common diseases and wellness


issues. Each report provides an in-depth discussion of the latest treat-ments, risk factors, causes, diagnostic tests, and preventative measures.Another subscription service is HealthGate®, a comprehensive data-base to more than 250 health and medical conditions, including refer-ence materials such as the Merriam-Webster Medical Dictionary©. Athird is NORD, the National Organization for Rare Disorders, whosedatabase contains descriptions of over 6,000 rare or “orphan” diseases.

PFLC’s Web site also provides links to numerous free online re-sources. First is PubMed®, a service of the National Library of Medi-cine, providing access to over twelve million MEDLINE® researchcitations in life-science journals dating back to the mid-1960s. PubMedincludes links to many sites providing full-text articles and other relatedresources. Next is MedlinePlus, a gold mine of good health informationfrom the world’s largest medical library, the National Library of Medi-cine. The PFLC also links to hundreds of health Web sites, througheasy-to-understand medical subject headings. For example, the Ameri-can Heart Association link is found under the subject heading “Heart,”while the National Osteoporosis Foundation link is in the “Women’sHealth” section. Multidisciplinary clinicians use the media evaluationtool to review all potential Web sites before they are incorporated as alink.

Through its HealthGate® subscription, the Web site offers interac-tive learning tools such as Anatomy Explorer, where clicking on a spe-cific part of the body enables one to view the human skeletal andmuscular systems, and Condition Explorer, where clicking on a bodypart results in a display of related health conditions affecting that area.A Self-Assessment Tools section is provided, containing valuable healthcalculators, such as ones for body mass index or target heart rate.

PAMPHLETS AND BROCHURES

The PFLC offers more than 300 pamphlets and brochures on varioushealth topics, from prescriptions for mental health to healthful foodshopping. They are displayed in racks around the perimeter of the learn-ing center, arranged by their medical subject heading.

Staff use a Microsoft Access database to streamline the pamphlet in-ventory and ordering processes, track the number of pamphlets on dis-play, and the cost of providing each pamphlet. Pamphlets are stored in aseparate office and arranged on shelves in alphabetical order according


to body system. In fiscal year 2004, $11,500 was spent on pamphletsand brochures.

The PFLC has an ongoing pamphlet project with the Pre-AdmissionTest Area (PATA). This project supplies PATA with educational mate-rials to support patient teaching on a variety of pre-operative proceduresand topics. Examples of pamphlet topics include anesthesia; crutches;canes and walkers; and hip replacement surgery. In its third year(FY04), this successful, well-received project supplied $5,000 of pam-phlets and brochures.

PATIENT EDUCATION VIDEOS AND TELEVISION SERVICES

The PFLC has over 250 English and Spanish language patient educa-tion videos, which are also available on the hospital’s on-demand TVsystem. Each video received appropriate clinician review and licensingagreements and contracts were signed allowing the videos to be digi-tized and broadcast over the on-demand TV system. Patients call fromtheir bedside phones to request and view desired videos.

The MGH in-house TV system also offers a Health and WellnessChannel which continuously plays a loop of forty-five videos on vari-ous health and wellness topics. Usage and tracking data show this chan-nel’s widespread use and continued growth.

CLINICAL COLLABORATION

The PFLC’s reputation as a valued resource within the organizationis based, in part, on its collaborative programs and projects with diverseclinical departments. The PFLC partners with the Orthopaedic Arthro-plasty department to offer pre-operative education for total hip and kneepatients. As previously described, a solid partnership exists with thePre-Admission Test Area, providing pre-operative patient educationmaterials to enhance patients’ understanding of their operative procedure.Other projects include working with the Clinical Research department tofield clinical trial questions and calls from patients, and partnering withthe Stoeckle Center for Primary Care Innovation to provide patientswith important health information prior to an annual physical exam, in-cluding post-visit access to decision support tools and videos.


EVALUATION

A variety of tools and data are used to evaluate PFLC operations andservices. Every six months, a customer satisfaction survey is distributedto a sample of patients and visitors. The survey uses a Likert scale toevaluate: whether staff is helpful and service oriented, whether informa-tion provided is useful and pertinent, whether information was used fordecision-making; and if the PFLC is a welcoming, culturally sensitiveenvironment. Demographic data on the survey determines gender, agegroup and user status (Appendix 4).

Other evaluative data include tracking daily volume (currently140-150 per day), reference statistics, Web site visits, requests for infor-mation from staff on patient care units, decision support videos used,and feedback from clinical staff.

CONCLUSION

The PFLC consistently strives to provide quality services to patientsand families at MGH. Through its state-of-the-art technologies, anddedicated, well-trained staff and volunteers, it fulfills its important mis-sion and vision. The PFLC experience is shared as a successful model ofproviding patient and consumer health information in a vibrant, urbanhospital setting.

REFERENCES

1. Pittman T, O’Connor MD, Millar S, Erickson JI. Patient education: Designing astate-of-the-art consumer health information library. JONA 2001 Jun;31(6):316-23.

2. Massachusetts General Hospital, Patient and Family Learning Center OperationsManual 2003.



APPENDIX 1

MASSACHUSETTS GENERAL HOSPITALPATIENT CARE SERVICES

BLUM PATIENT AND FAMILY LEARNING CENTER

MEDIA EVALUATION FORM

MEDIA TITLE: WEB SITE ADDRESS (if appropriate):

In order to assess and assure the quality and relevanceof information to which the Blum Patient and FamilyLearning Center provides, please rate the materials youare evaluating in the following areas.

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valu

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CONTENT

The information appears accurate 5 4 3 2 1 U

The information appears comprehensive 5 4 3 2 1 U

The information appears to be targeted toward patients 5 4 3 2 1 U

The reading level is targeted toward patients(under 8th grade)

5 4 3 2 1 U

The information has a logical layout and sequence 5 4 3 2 1 U

The use of illustrations/graphics is relevant 5 4 3 2 1 U

Additional comments:

CULTURAL APPROPRIATENESS

Concepts match the logic, language, experience of targetculture

5 4 3 2 1 U

Images and examples present culture in positive ways 5 4 3 2 1 U

The material is available in other languages, i.e.: Spanish Yes No

Portuguese Yes No

French Yes No

Other (list):________________

USABILITY

Internet

The site is easy to use and navigate through 5 4 3 2 1 U

The response time of the site is quick 5 4 3 2 1 U

CD ROM

The CD ROM is interactive 5 4 3 2 1 U

The CD ROM output can be customized for the user 5 4 3 2 1 U

Video

The video is close-captioned 5 4 3 2 1 U

The video picture quality is good 5 4 3 2 1 U

The video sound quality is good 5 4 3 2 1 U


AUTHORSHIP

The information is sponsored by a dependableorganization

5 4 3 2 1 U


The authors have expertise in the area 5 4 3 2 1 U

The material sources and references are furnished 5 4 3 2 1 U


CURRENCY

The information has been updated recently: 5 4 3 2 1 U


Excellent Satisfactory Poor

OVERALL EVALUATION OF THIS MEDIA 5 4 3 2 1 U

EVALUATOR’S NAME:_______________________________________

Pittman, T., O’Connor, M., and Millar, S.©The General Hospital Corporation, 1998


APPENDIX 2

Massachusetts General HospitalPatient Care Services

The Blum Patient & Family Learning CenterFax # (617) 724-3281

Information Request Form

Instructions: When there are requests for information, staff should complete this form. As much detail aboutthe request as possible should be provided, e.g., the title of the Book or Article, the Author, theCall Number (if known), the Subject, Keyword. Please print.

THIS INFORMATION IS FOR:

Name: ___________________________________________

Address/Unit: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Phone: (Home) ___________ (Work) ____________ Unit Ext:_______ Fax_______

Check One: Pick Up in PFLC____ Deliver to Unit ____ Mail _____ Fax_____

Need By: Date ______________ Time _________________

Requested (Check One): In Person ____ By Phone ____ Fax ____ Email ____

_____________________________________________________ ________________________________Name of Staff Completing the Form Date

APPENDIX 3


COMPUTER USE POLICY

TO OUR PATIENTS, FAMILIES, AND FRIENDS . . .

• There is a 30-MINUTE TIME LIMIT for computer use. Please stop by the main desk for an index card thatwill indicate your 30-minute time frame.

• Select any computer that is not being used and place your index card in the note holder on top of thecomputer monitor.

• Computer use can be extended by 30 minutes as long as no one else is waiting, with a ONE-HOURMAXIMUM on the computer.

• Computers are to be used for researching health information. Use for general information and email is atthe discretion of the staff.

• There is a PRINTING LIMIT of 50 pages for health related materials, and 10 pages for general topics.

• Please . . . NO FOOD OR DRINK in the Learning Center.

• No Cell Phone Use Please.

• Computers will be shut down 10 minutes prior to closing time.

The following activities on the computer are not allowed:

• Pornography• Chat Rooms• Games (except for Children’s computer)• Dating web sites• Hate, Racist, Satanic or Cult web sites• Gambling and/or other illegal activities defined by Massachusetts General Laws• Downloading software• Altering the Center’s desktop or homepage

Any person using a website that is not allowed will be asked to leave the Center and not return.

We Appreciate Your Cooperation


APPENDIX 4

Massachusetts General HospitalPatient and Family Learning Center

User Satisfaction Survey

Please complete this brief survey to help us improve our services. All information is confidential.

Check the appropriate boxes and add any comments that you have. On a scale of 1 to 4 where four (4) is excel-lent and one (1) is poor, please rate the following:

DID YOU FIND THAT THE INFORMATION . . .4

EXCELLENT3

GOOD2

FAIR1

POORNOT

APPLICABLE• helped answer your question(s)?

• was understandable?

• was useful?

• led you to other information sources?

• was provided in reasonable time?

DID YOU FIND THAT THE STAFF . . .4

EXCELLENT3

GOOD2

FAIR1

POORNOT

APPLICABLE• were friendly and helpful?

• provided accurate information?

• were efficient and customer focused?

DID YOU FIND THAT THE LEARNING CENTER . . .4

EXCELLENT3

GOOD2

FAIR1

POORNOT

APPLICABLE• was a warm and welcoming place?

• appeals to various ages and cultures?

HOW DID YOU HEAR ABOUT OUR SERVICE? IS THE INFORMATION BEING USED FOR:____Brochure ____Yourself____Doctor, Nurse or Other Health Professional ____Family and/or Friend____Friend or Family Member ____Health Professional____Walk-In ____Other (please specify) ____________________Other (please specify)_____________________

Will you use the information to help make a health care or lifestyle decision? _____Yes _____No

Comments/Suggestions:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please fill in the brief information about yourself . . .

____ Patient SEX: ____ Female____ Family/Friend of Patient ____ Male____ Health Professional____ Student AGE: ___ Under 20____ MGH/Partners Staff ____ 21-30____ Other: _______________________________ ____ 31-50

____ 51-70____ Over 70

THANK YOU FOR COMPLETING AND RETURNING THIS FORM.

Documents

Consumer Health Within an Academic Medical Center