Computer-based patient education.

Most physicians rely on computers to help manage their practices. Computerized billing, automated laboratory results, printouts of radiographic results, and centralized appointments are common examples of this. Unfortunately, as a profession, we have yet to fully tap into the power of digital information for educating our patients regarding disease processes, diagnostic modalities, and therapeutic options. Part of the reason for this is that the technology only recently arrived at the point where it is mature enough to warrant our investment. With the rapid growth of the Internet, and the availability of fast, inexpensive computers, computer-based patient education is now a viable option. Clearly, the time honored methods for educating patients, such as one-on-one counseling, brochures, and take-home videos, are here to stay. The number of computer-based programs available for patient education is increasing rapidly; however, compared with offerings for continuing medical education training, this area is still in its infancy. Computer-based patient education generally falls into one of two categories: noninteractive (passive) programs and interactive programs. An example of noninteractive programs would be computer-generated patient education handouts, which could either be documents prepared by the individual provider or commercially available handouts. These handouts usually function as more of a reminder to help reinforce information that we give to patients. The most common uses for this type of handout are instructions for the pre- and postoperative period, wound care, and the use of medications. Interactive programs can follow a preprogrammed script or actively respond to feedback from the patient by instantaneously altering the delivery of information. This makes interactive programs much better suited to educational settings where patients are required to process and retain new information. Interactive computer programs possess some qualities that are simply not available when using brochures or videotape. Patients can follow multiple pathways to get the information they need. This accommodates individual variations in learning strategies. It also helps to maintain a high level of patient involvement, as they are literally directing their own progress through the program. Even programs that are hard wired to follow a specific sequence can provide options for the inclusion of interactive questions. These questions allow the provider to track patients' performance as an indicator of their true understanding of the subject matter. Videotapes are essentially passive learning media. Unless you or your staff are sitting through it with patients, you really have no idea how much of it they actually listened to and even less idea as to how much they truly understood and retained. If something comes up on the tape that makes the patient feel uncomfortable, such as a live video of a surgical procedure, they may fast forward the tape and miss other important information. Interactive programs may include options for patients to print out take-home information at the end of the program, such as the risks and benefits of a procedure, postoperative instructions, or explanations of diagnostic modalities. They also may be used to generate permanent records for inclusion in the patients' chart. This is literally the gold standard for issues of informed consent. An example might be a one page printout that shows that a family went through the interactive program on a specific day and answered 12 out of 12 interactive questions correctly on the first try. With that kind of documentation you should be well-protected regarding the adequacy of your informed consent (although malpractice is a completely separate issue). The Internet actually possesses characteristics from both categories. Internet websites are interactive in the sense that patients actively direct their own exploration by reading those pages in which they are interested and following links to other related pages. They are also somewhat passive, because patients are generally limited to viewing selected text and photographs. The opportunity for a significant two-way flow of material between the patient and source through the Internet is currently somewhat limited.