Patient Education Materials

Many universities and institutions are now expressing an interest in a standardized drug database.    They are in search of a high quality, dependable database that helps their academic department build a reliable model to determine pharmaceutical outcomes.  Lexicomp is often the preferred choice.

Whether the researcher is in need of  a drug reference database for clinical decision support, for dosage administration,  patient education material,  drug classifications (brand or generic), adverse drug events,  drug-drug interaction,  drug-allergy interaction,  more and more academics are coming to Lexicomp to secure their drug database information.  Check out this page for more information. 

It might seem like an easy question, but the answer is neither obvious nor unimportant.  Both pediatric and neonatal dose range calculators are receiving more focus and attention.  This is serious business, with serious consequences.    Last week, Matt Bennardo wrote a blog posting where he cited a study by Practice Fusion,  where it has been shown that EHR's are having a real impact on the decrease in infant mortality.  This is great news for those EHR's that have elected to use better dose range checking calculators.  

As I said in a post last week. "All pediatric dosage calculators are not created equally.   As Matt goes on to say, "But luckily there are drug information vendors like Lexicomp that understand there is a vast world of difference between adults and children -- and often between older children and neonates. Lexicomp's drug information is trusted by dozens of EHR vendors to guide clinicians in prescribing, fulfilling, and administering drugs to patients of all types -- including children."

Lexicomp provides both "machine readable" transactional information (geared towards specific populations) for use in clinical decision support, as well as "human readable" reference materials for clinicians and patients. Even Lexicomp's patient education leaflets are written with either adult or pediatric patients in mind.

If you are developing an EMR or looking to improve an EHR or HIS system, I would suggest reaching out to Lexicomp for some suggestions.  Lexicomp is known for its pediatric and neonatal drug information.

Matt Bennardo had a great blog post last week where he wrote about the positive benefits of Meaningful Use on the development of EHRs and their impact on patient safety.  He cites a study by Practice Fusion,  where it has been shown that EHR's are having a real impact on the decrease in infant mortality.  This is great news!

As Matt wrote, "Of course, to get these kinds of results, the information in the EHR needs to be accurate, timely, complete, actionable, and specific to the patient. With respect to pediatric and neonatal patients, that last point is especially important. An EHR that is only set up to perform dose range checking and interaction checking on adults won't be nearly as helpful when it comes to children."

All pediatric dosage calculators are not created equally.   As Matt goes on to say, "But luckily there are drug information vendors like Lexicomp that understand there is a vast world of difference between adults and children -- and often between older children and neonates. Lexicomp's drug information is trusted by dozens of EHR vendors to guide clinicians in prescribing, fulfilling, and administering drugs to patients of all types -- including children.

Lexicomp provides both "machine readable" transactional information (geared towards specific populations) for use in clinical decision support, as well as "human readable" reference materials for clinicians and patients. Even Lexicomp's patient education leaflets are written with either adult or pediatric patients in mind.

If you are developing an EMR or looking to improve an EHR or HIS system, I would suggest reaching out to Lexicomp for some suggestions.

Reports are circulating that spending on healthcare IT is set to grow at an annual rate of 24% over the next several years. This is phenomenal growth, and it's tempting to think that rising tides are going to raise everybody's boat. But with the proliferation of EHR vendors we've seen in the past couple of years, that conventional wisdom isn't likely to hold true. How do you make sure that you're one of the rising boats, and not one of the swamped ones?

Development talent is the scarcest resource right now
Among other things, this boom in healthcare IT means more competition for talented developers with healthcare-specific experience. And the influx of cash means that a few well-funded or well-positioned EHR vendors are going to reap early rewards -- and then will likely start poaching even more top talent from other vendors by offering bigger salaries and more benefits.

Your best move is to protect your IT resources by having them focus only on the most crucial parts of your system -- the parts that will differentiate you in the marketplace. Use a drug information provider with robust APIs, an intuitive data structure, and superior customer service to take the burden off your own development team so they can focus on more important tasks. One such vendor is Lexicomp, who has helped many customers get to market faster after less-than-positive experiences with other medication list vendors.

Another tactic is to forgo building your own eprescribing tool (which can take months to certify anyway), and instead use a standalone module like DoseSpot.

Meaningful Use still rules the day -- but look ahead to Stage 2 and beyond
With the government incentives now beginning to pay out, more and more practices and hospitals are pursuing Meaningful Use certification. To compete, your system will need to meet the Stage 1 requirements like drug-drug interaction checking, drug-allergy interaction checking, and distribution of patient education materials.

But it's not enough to simply check off the existing boxes. Every other EHR vendor is rushing to do the same. Instead, you need to provide value above and beyond the others. Again, a drug information vendor like Lexicomp can help you exceed Stage 1 requirements and put yourself where you need to be for Stage 2 and 3. They offer functionality like dosage range checking for both adults and pediatric patients, detailed patient education pamphlets in multiple languages, and links to some of the best drug and clinical reference services available.
 
Deploying extra features like these in your system can help make it more likely that you'll be a rising boat when the money starts pouring in.

• Pediatric Dosage Calculations in both transactional information for the clinical decision support systems and reference materials designed for clinicians.
• Pediatric focused patient education materials

All the buzz about Meaningful Use sometimes makes us forget what EHR implementation is really supposed to be about -- improving patient care.  But this article from Practice Fusion's blog reminds us that EHR use can reduce errors, save lives, and makes it easier to serve patients better. That's what the real objective is!

The study in the article highlights the benefits of EHR use when pediatric patients are concerned. The researchers were able to link the use of electronic health records and associated clinical decision support systems to a quantifiable decrease in infant mortality -- especially among neonatal patients.

Of course, to get these kinds of results, the information in the EHR needs to be accurate, timely, complete, actionable, and specific to the patient. With respect to pediatric and neonatal patients, that last point is especially important. An EHR that is only set up to perform dose range checking and interaction checking on adults won't be nearly as helpful when it comes to children.

But luckily there are drug information vendors like Lexicomp that understand there is a vast world of difference between adults and children -- and often between older children and neonates. Lexicomp's drug information is trusted by dozens of EHR vendors to guide clinicians in prescribing, fulfilling, and administering drugs to patients of all types -- including children.

Lexicomp provides both "machine readable" transactional information (geared towards specific populations) for use in clinical decision support, as well as "human readable" reference materials for clinicians and patients. Even Lexicomp's patient education leaflets are written with either adult or pediatric patients in mind.

Last week I posted an entry that dealt with the reported upcoming changes in Stage II  Meaningful Use requirements as it relates to providing the patient drug education leaflets in their native tongues.  There has been  interest in that posting and its implications,  so I am reposting it for those who might have missed it.

My colleague,  Matt Bennardo,  wrote a wonderful blog posting about the potential upcoming changes in stage two Meaningful Use guidelines as it relates to Patient Education.  This could be a very big deal.

 Patient education will become more and more important over time,  because there is a strong belief that better patient outcomes will result if patients know  more about their condition, treatment program,  and drug regimen.   On the drug side,  this could mean  dose administration regimen,  dosage precautions, drug interactions,  drug-allergy interactions, adverse drug events and more.

What EMR vendors (and institutions)  need to start thinking about today,  are the implications that requirements to supply Patient Education Leaflets,  likely will not just mean English. 

In his posting,   Matt,  states:  "The workgroups are additionally talking about  better and more relevant patient education. One point of discussion has  been providing the materials in "common primary languages" for every  metropolitan statistical area. This would require providers to have  patient education available in any language that is spoken by 5% of the  population they serve, or at least 1000 people in the same population --  whichever is lower. This is a big deal, and not every information  vendor is in a position to deliver on this!

He goes on to say:

Lexicomp can help bridge the gap
Luckily, some vendors are. Lexicomp has long had patient education materials in many languages. At last count, they could provide up to 19 different languages commonly spoken in the United States and Canada. This is just one example of how a forward-thinking drug information vendor was able to anticipate and meet advanced requirements before they were even formulated. So when evaluating vendor partnerships for your EMR or HIS system, it's not enough to find one who can check off boxes. Instead, you need to find a vendor with the same commitment to improving patient care that ONC and CMS are seeking."

Please take note now,  early in the integration of your drug module into your EMR system.

A recent study found that 59% of all Americans now use the Internet to research health topics. With all the misinformation prevalent online, it's increasingly important to make sure that there are also good sources that can accurately and completely answer patient questions.

Lexicomp is one of the best sources for drug information that can be easily integrated into patient portals, reference sites, and other consumer health websites. Information is available covering adverse drug events, potential allergies, interactions, and more -- both for pediatrics and adults. Furthermore, Lexicomp has some of the best and most comprehensive patient education materials and pamphlets in the industry.

These patient education leaflets put complex clinical information into words that patients understand, and are used in hundreds of hospitals worldwide. Lexicomp patient education is available in up to 19 different languages, which makes it valuable for sites serving diverse populations. Make sure that patients searching for healthcare information find what they need at your site or portal -- and in the language they speak!

My colleague,  Matt Bennardo,  wrote a wonderful blog posting about the potential upcoming changes in stage two Meaningful Use guidelines as it relates to Patient Education.  This could be a very big deal.

 Patient education will become more and more important over time,  because there is a strong belief that better patient outcomes will result if patients know  more about their condition, treatment program,  and drug regimen.   On the drug side,  this could mean  dose administration regimen,  dosage precautions, drug interactions,  drug-allergy interactions, adverse drug events and more.

What EMR vendors (and institutions)  need to start thinking about today,  are the implications that requirements to supply Patient Education Leaflets,  likely will not just mean English. 

In his posting,   Matt,  states:  "The workgroups are additionally talking about  better and more relevant patient education. One point of discussion has  been providing the materials in "common primary languages" for every  metropolitan statistical area. This would require providers to have  patient education available in any language that is spoken by 5% of the  population they serve, or at least 1000 people in the same population --  whichever is lower. This is a big deal, and not every information  vendor is in a position to deliver on this!

He goes on to say:

Lexicomp can help bridge the gap
Luckily, some vendors are. Lexicomp has long had patient education materials in many languages. At last count, they could provide up to 19 different languages commonly spoken in the United States and Canada. This is just one example of how a forward-thinking drug information vendor was able to anticipate and meet advanced requirements before they were even formulated. So when evaluating vendor partnerships for your EMR or HIS system, it's not enough to find one who can check off boxes. Instead, you need to find a vendor with the same commitment to improving patient care that ONC and CMS are seeking."

Please take note now,  early in the integration of your drug module into your EMR system.

Stage 1 of Meaningful Use has been criticized by some as simply encouraging EMR vendors, hospitals, and physicians to "check off boxes" in order to be eligible for government incentives. These critics look at Stage 1 and ask how the hodge-podge of "requirements" (many of which are still very optional) will really lead to better patient outcomes. By all accounts, CMS and ONC intend to use Stage 2 and Stage 3 to correct that perception.

Patient education -- just one small example
One simple example of this is in patient education leaflets that are mentioned in Stage 1. These pamphlets are intended to give important information to patients to help them better manage their own health and be more informed when they visit healthcare providers. Some of the most commonly distributed patient education materials are those related to prescription drugs, and they include information on dosage precautions and administration, potential adverse drug events, allergy symptoms and so on.

It's not even required to supply patient education materials to qualify for Stage 1 -- instead, it's an optional item in a menu set. Even if providers do choose the patient education menu option, the bar is very low. Providers need only supply patient-specific materials to 10% of patients. It's easy to see how critics may find fault with this.

But beefed up requirements are on the way!
Workgroups have been hashing out details of what will be required in Stage 2, and their proposed requirements are expected later this summer. Patient education is one area they've been discussing. Published minutes and transcripts from the workgroup meetings reveal that patient education will now be required for everybody, and that the percentage of patients who receive it will be drastically increased -- up to 80%. The Stage 1 requirement was clearly just to develop the functionality. Stage 2 is where the rubber meets the road.

But that's not all yet! The workgroups are additionally talking about better and more relevant patient education. One point of discussion has been providing the materials in "common primary languages" for every metropolitan statistical area. This would require providers to have patient education available in any language that is spoken by 5% of the population they serve, or at least 1000 people in the same population -- whichever is lower. This is a big deal, and not every information vendor is in a position to deliver on this!

Lexicomp can help bridge the gap
Luckily, some vendors are. Lexicomp has long had patient education materials in many languages. At last count, they could provide up to 19 different languages commonly spoken in the United States and Canada. This is just one example of how a forward-thinking drug information vendor was able to anticipate and meet advanced requirements before they were even formulated. So when evaluating vendor partnerships for your EMR or HIS system, it's not enough to find one who can check off boxes. Instead, you need to find a vendor with the same commitment to improving patient care that ONC and CMS are seeking.

When EMR vendors talk about Stage 2 of Meaningful Use, they too often suggest it's just "more of the same" of the Stage 1 requirements. Optional menu choices become requirements, measurements become tougher, but overall -- not much of a change. The truth is that anybody who really believes that is in for a rude surprise when the proposed rule comes out later this summer.

Meaningful Use workgroups are hard at work behind the scenes -- and they aren't just debating what percentage of prescriptions need to be electronically ordered. There are some shifts in the overall focus of the incentive program -- such as this article noting that patient engagement is going to be a lot more present in Stage 2.

What are EMRs doing to ensure positive patient engagement?
If I were an EMR vendor, this is where I'd really start hoping that my team had done their homework in creating strategic partnerships. If they didn't then I could easily be stuck with a drug information provider that was "good enough" for Stage 1, but which doesn't have what it takes to drive patient engagement in Stage 2.

And for physicians, this is where the rubber meets the road. "Patient engagement" is another name for "customer service" in healthcare. If docs can't provide good service, they'll lose business. And if the gap in service was a result of sub-par patient education materials provided by your system -- well, then you'll lose business too.

Lexicomp has some of the most well regarded patient facing materials available. Not only is dosing information divided into separate pediatric and adult documents, but they offer several languages as well. Patient education is worthless if the patient can't understand it. Now that we know what's top-of-mind at CMS regarding patient engagement, isn't it better to try to get in front of the upcoming requirements than scramble to catch up when Stage 2 and Stage 3 come around?

As hospitals and EMR vendors scramble to prepare for Stage I Meaningful Use criteria, the Stage II criteria are already being prepared.  The Stage II requirements will require hospitals to continue with and advance the use of CPOE, and the use of clinical decision support elements including drug interaction and drug allergy screening.  Additionally, patient education materials must be offered to at least 80% of patients at discharge.

Although most of these requirements are simply advancing a requirement from Stage I, the ultimate goal of requiring the use of clinical decision support tools is to improve patient care, especially as it relates to high priority health conditions.  In order to accomplish this, CDS should have specific attributes:  authenticated, credible, evidenced-based and patient-context sensitive.  This can only be accomplished by using a drug reference database that can provide information that meets this criteria. 

Lexicomp provides clinical information that can be used to perform key CDS functions such as drug interaction, drug allergy, duplicate therapy and dosage range screening.  This content is derived from our well established drug reference information that is evidenced-based, peer-reviewed and up-to-date.  If you are a clinician working in health care, you most likely have relied on this content to help you make patient care decisions for many years.  If CDS is going to accomplish its goal of improving patient care, it is going to require a strong, evidenced based library of clinical information.  Something Lexicomp has been doing for over 30 years.

Compatability can easily make or break drug database decisions when choosing information for an EMR, EHR, or HIS.  Lexicomp's data is not only compatable with Oracle, SQL Server, MySQL, and Access, but also provides so much more.

• A top of the line IT team that treats customers as partners
• Specific clinical decision support functions, including drug-drug and drug-allergy interaction checking
• Consumer-facing patient education materials
• Compliancy with the RxNorm 

Regardless of how you refer to them, patient education pamphlets or patient education leaflets, there are soon to be some new requirements on these types of patient education materials when the new Meaningful Use Stage II requirements are released.  There is some specific language along the lines of, "Patient education materials are to be provided to the patient in their native language."  Granted, this is pretty vague, but in order to provide the best treatment and the ensure the best outcome for each patient, this makes sense.

One of our primary goals at Lexicomp is to improve patient outcomes.  From providing clinicians the tools they need to make decisions on drug therapy and treatment at the point-of-care to educating patients on the medications they are taking. This all rolls up into better outcomes and decreased costs. 

Specific to the new patient education requirements, Lexicomp is one of the only resources that provides high end patient education materials in multiple languages, 19 of the most common languages in the U.S. and Canada in fact.  These materials can be integrated into your Health Information System (Epic, for example) and can be used in your hospital's patient portal.  They are very versatile and delivered in the appropriate formats to meet multiple needs.

Congress is often compared to a sausage factory, and its laws to sausages. Anyone who sits down to read federal regulations on almost any topic would be sure to agree. Rarely do you come across a regulation that looks like a piece of steak -- simple, unadorned, and exactly what it appears to be at first glance. No, federal regulations are much more like sausages -- a mish-mash of ingredients of unidentifiable origin, all encased in an opaque shell that makes it impossible to tell if their label is accurate until you take a bite.

Now consider the sausage called "Meaningful Use". Clinicians, patients, and EHR vendors are just now getting their first nibbles of that sausage, and ONC and CMS are watching their faces closely to see how they react. In fact, it's public knowledge that the Meaningful Use sausage recipe is subject to change -- that's what Stage 2 and Stage 3 are all about.

It's a safe bet that not everybody is going to like this sausage. And ONC and CMS are going to respond to complaints in one way: by trying to stuff more regulations into the sausage casing in an attempt to make everybody happy.

What will the next Meaningful Use sausage recipe look like?
Nobody knows, of course. But the safe bet is that there will be more of everything. There will be more (and more complex) clinical decision support. Drug-drug and drug-allergy checking may be joined by drug-food, drug-age, drug-disease, or drug-lab checking. Dose range checking can be expected at some point -- and then the logical step there is customized dose range checking for pediatrics and adults and others with special needs.

There are already conversations taking place about delivering patient education materials in common primary languages. According to the Office of Civil Rights, those are languages that are spoken by more than 5% of a population or more than 1000 people in a population, whichever is lower. Does your EHR system have any customers in New York or Los Angeles or Chicago? Imagine how many common primary languages you'll need to support.

How will your data vendor support you when the sausage recipe changes?
It's impossible to say which of these criteria will appear in Stage 2, which in Stage 3, and which in future regulations that aren't even planned yet. (What -- did you think that Stage 3 would be the end of it?) So it's crucial to have a drug information partner with high quality information who is able to support a wide range of clinical decision support needs and who is ahead of the curve in clinical information and patient education. Moreover, you need a partner who gives you superior customer service. It's a tall order and not easy to fill -- but Lexicomp is all of these things.

• Allows for specific clinical decision support functions, including drug-drug and drug-allergy interaction checking
• Has consumer-facing patient education materials
• Is compliant with the RxNorm 
• Include comprehensive reference information for the US including drug generic name, drug brand name, drug classifications, and eventually clinical dosage guidelines for calculating pediatric and adult doses

Over the past decade, the number of reports of adverse drug events has been on a dramatic rise.   The FDA currently uses an Adverse Event Reporting System (AERS) which has seen a large increase on the number of reports coming in.  In fact, researchers at the University of Maryland School of Pharmacy revealed in a new study of adverse events linked to medications─compiled by the FDA since 1969─that 55 percent have been reported to the agency in the past decade.


Drug makers are required by federal regulations to report possible health problems possibly linked to their products, but reporting by doctors, patients, and others is voluntary.  New safety warnings and technology making reporting easier could play a part in this increase in reports, but there may be other contributing factors.  With the current US populations aging, more and more people are taking multiple medications to treat multiple medical conditions.  This has been most apparent when I have spoken with a few nursing home and assisted living facilities who have relayed that a number of their patients currently have a medicine list of over 10 medications and some are as high as 20.  With all of these medication being taken together, it stands to reason that additional adverse drug events are reported.


There is drug information software available to help with checking medication lists for things like drug food interactions, drug-drug interactions, drug-allergy interactions, and drug-condition interactions that could potentially help reduce these adverse drug event reports.  In fact, software like Lexi-Data from Lexicomp has been included in a number of applications including EMRs, EHRs, analytic tools, and ePrescribing  solutions with the intent of screening in real time for adverse events while medication are being prescribed.  Also, new patient education materials that are easily understood by the patient can help reduce things like drug-food interactions by informing the patient of the potential.


While software systems generally rely on case studies or published information to screen for adverse drugs events, the increase in the number of reports to the FDA will hopefully help to identify additional adverse drug events that have yet to be identified, leading to better outcomes for patients in the future.

The HITECH Act (commonly known as "Meaningful Use") has some specific requirements for drug reference and drug interaction data which can be used to qualify for incentive money. There aren't many vendors that can provide such specific information, so it's important to shop around to every available seller. Lexicomp and Multum are two vendors that offer qualifying data.

Here are some of the qualifications that drug reference and drug interaction data must meet:
-- Must allow for specific clinical decision support functions, including drug-drug and drug-allergy interaction checking
-- Must have consumer-facing patient education materials
-- Must be compliant with the RxNorm (a medication list maintained by the National Library of Medicine)
-- Must include comprehensive reference information for the US including drug generic name, drug brand name, drug classifications, and eventually clinical dosage guidelines for calculating pediatric and adult doses

Both Lexicomp and Multum meet all of these criteria and more. Shopping around to different vendors may give you options that better fit your budget, development environment, support needs, or timeline. But always be sure to ask vendors if their information has been used yet by any EMR, EHR, or HIS vendors who have certified for Meaningful Use under the HITECH Act.