Nursing 3240 Consumer Health-Related Web Site Evaluation Form Student Name: Date of Search: The purpose of this assignment is to analyze and evaluate health related website for credibility, usability and accuracy for your practice with patients who are consumers in the information age. It is critical that nurses are able to guide patients (consumers) in their use of the internet when they are seeking healthrelated information. • Please use this form and type in your complete answers. • Use complete sentences for each response. • Two scholarly references are required. Your text may be one of the references. The selected web site does not count as one of the references. • Use your own words and avoid direct quotes. • Please turn this assignment into the Drop Box in D2L Brightspace and to Taskstream. Completion of this assignment contributes to meeting course objective five. Basic Web Site Search Instruction • Select a health care issue that a consumer or patient would be interested in, NOT one you are interested in. Avoid WebMD, CDC, and Mayo Clinic as we know these are reputable sites. The goal is to evaluate a website for credibility, usability and accuracy. It is okay to choose one that may not be, you may learn more from one that isn’t reputable as one that is. • Conduct an internet search using one of the commonly used search engines (Google, Bing, Yahoo, AskGeeves ) 1. ENTER THE KEY WORDS you use for that issue used in internet search here: 2. How many listings were on the search? 3. Please specify the search engine used: 4. What was your thought process for the topic you selected? 5. Select a site that is listed AFTER the SIXTH one on your search results for this review. What is the title of site and what number on the list was your selection – be specific: 6. What was your reason for choosing this website: 7. Subject of site (be brief - a sentence or two): 8. Web site address (URL). Be sure to double check that the link works: 9. Date site was last updated. What might be an inference/conclusion on this criteria? Nursing 3240 10. Who do you think is the intended audience? Discuss why. 11. What do you think is the objective/purpose for this site? Describe how the contents of the site relate to the intended objective. Check the answer that best represents the site. If “no,” provide brief comments in Comments column. Content: 1. The purpose of the site is clearly stated or may be clearly inferred. 2. The information does not appear to be an “infomercial” (an advertisement disguised as health education). 3. There is no bias evident. 4. If the site is opinionated, the author discusses all sides of the issue, giving each due respect. 5. All aspects of the subject(s) are covered adequately 6. External links are provided to fully cover the subject (if not needed, circle N/A) Comments: Yes No N/A Comments Accuracy: 7. The information is accurate (if not sure, circle N/A) Yes No N/A Comments Yes No N/A Comments 8. There is a reference list, bibliography, or citations that can be used for comparing or verifying information. 9. There are links to citations that are available online. 10. There are no mechanical errors (grammatical errors, typos, etc.) in the text. 11. The web site follows or subscribes to the Health On the Net (HON) Code. Where is the icon located? If the Code is not easily identified, visit the HON website (Link is in D2L Content Week 11) to check the Url to ascertain if it is subscribes to the code principles. Comments: Authorship: 12. The site is sponsored by or is associated with an institution or organization. 13. For sites created by an individual, the author/editor’s name(s), credentials (educational Nursing 3240 background, professional affiliations, certifications, past writings, experiences) are clearly stated. 14. Contact information (email, address, and/or phone) for the author/ editor or webmaster is included. Comments: Audience: 15. The type of audience the author is addressing is evident (academic, youth, minority, general, etc.) 16. The level of detail is appropriate for the audience. Yes No N/A Comments Navigation: 19. Internal links add to the usefulness of the site. 20. Information can be retrieved in a timely manner. 21. The site is organized in a logical manner, facilitating the location of information. 22. Any software necessary to use the page has links to download software from the Internet. Comments Yes No N/A Comments External Links: 23. Links are relevant and appropriate for this site. 24. Links are operable. 25. Links are current enough to account for changes in the field. Yes No N/A Comments 17. The reading level is appropriate for the audience. Check the reading level of the website, provide the grade, site used, and comment. You may need to turn on this feature. 1. Go to File and use drop down to find Word Options. Select Proofing, then find and select “show readability statistics.” 2. Then copy and paste a few paragraphs from the web site to a new Word document. 3. In Review, click on the Spelling and Grammar tool. A box will open with the reading level. OR 4. Use read-able.com or what the text suggests in the chapter. 18. Technical terms are appropriate for the audience. Comments: Nursing 3240 26. Links are appropriate for the audience (e.g., sites for the general public do not include links to highly technical sites). 27. Links connect to reliable information from reliable sources. 28. Links are provided to organizations that should be represented. Comments: 29. 30. 31. 32. Structure: Educational graphics and art add to the usefulness of the site. Text-only option is available for text-only Web browsers. Options are available for people with disabilities (large print, audio). If audio and video are components of the site and cannot be accessed, the information on the site is still complete. Comments: Yes No N/A Comments Summary and Recommendation: Summarize your findings in six to seven sentences. Based on your evaluation, would you recommend this site to healthcare consumers? Why or why not? Scoring Rubric for Website Evaluation Description of location, title, url of website Description of intended audience and objective/purpose Completion of representation of accuracy, content, authorship, external links, and structure. Comments are included. Summary and recommendation to consumer with justification Writing: compete sentences, appropriate grammar and spelling, neatness Scholarly references are included (website does not count as a reference) TOTAL Possible Points 3 3 6 5 3 5 25 In this lesson we will be looking at how electronic health records benefit the consumer. After completing reading the two chapters being covered in these lessons, listening to the recorded lectures on the Consumer and the E H R and the Empowered Consumer, looking at the associated links in Content, you should be able to complete the website evaluation assignment. Remember do not choose an already known reputable website like Web MD or Mayo Clinic as we already know they are excellent sources of health information. The goal is not to find a reputable site but to choose one at random and determine if it is credible and reputable. It is perfectly fine if it is not. You may learn more from one that isn’t than from that is. 1 2 The statement the promise of the Internet in Health care really refers to a couple of items that we need to consider as we think about what the internet can do for health care and for consumers. First as patients we can obtain health information from the internet. And the other is the information from the National Health Information Network. This network acts as the basis for the secure exchange of information over the Internet. The vision is there would be a national network where health information on everyone in the US would be stored, meaning all electronic health records would talk to each other. For instance if you were in a car accident in Florida and Emergency staff were unable to get health information because you are unconscious. You do have identification and staff would be able to pull your health information from a national network and treat you appropriately. However there is the issue of privacy. HIPPA is difficult enough without the 3 added layer of a national network. Another issue is the development of the network. This effort is in process but has a ways to go in the US but other countries are further along. The NHIN is trying to get such a network up and running. It would provide an electronic record from birth to death and all pertinent information in between. In order for this to occur every health care provider and organization would need to use electronic records and we know this is not occurring everywhere in some areas of the US. All providers would need to have records that are accessible to those who are designated by the patient such as health care proxies. And would also allow patients to access their records. 3 There are differences in terminology when we talk about consumers and the electronic records. The electronic medical record (EMR) is the health care record created by the health care provider or agency such as a hospital. The agency owns the EMR. The electronic health record (E H R) is the health care record that can contain health data from multiple EMRs and PHRs. The personal health record (PHR) is one that the consumers uses to communicate with his/her provider and to keep their own health care information. An EMR must meet national standards for interoperability. Interoperability is sharing health information between the EMR and the E H R. If the PHR meets interoperability standards, it can communicate with the E H R but is controlled by the consumer. There are many advantages of electronic records – improved collaboration between caregivers, between caregiver and patient, empowerment of the consumer by keeping own record and with better access to one’s own health information, self care may improve. Care may become more personalized and improves communication between all members of the team. 4 5 6 Another type of record, as already mentioned, is the personal health record. One way to keep a PHR is portable such as by a software application like as a flash or jump drive, depicted in the figure in this chapter. A second type of PHR is one that the agency sets up that the patient can access by logging into a website. Clients have easier access to their health information when the agency adds health information to the PHR. I have registered for a PHR with my health care organization and I am able to go in and see lab results and other test results when they are complete. I get emails telling me when there is new information in my PHR and that I can check whenever I wish. I can also use it to send messages to my caregiver. The third type of PHR is a hybrid so that there is remote storage of information and also have on a personal computer or a portable drive. HIPAA is an issue as someone could login and access someone else’s information. So this is fairly new and some people are not comfortable with it. 7 PHRs can be certified to meet interoperabilty standards to be able to talk with the E H R. 7 What are the benefits of the PHR? Very similar to the advantages of the Electronic record. Enhanced collaborative care is one with all the information in the record it promotes a partnership between the members of the team with the patient on the plan of care. Explanations can be made by the physician to the patient based on the record information that both are able to review. Conditions may be better managed when the patient knows why the plan is what it is and follows the plan. In addition, communication will be improved because everyone has the same information to work from and no surprises, which in the end makes for higher quality of care. Barriers to PHR include the physician’s reluctance to use this with their patient, they feel that the information is not written in lay terms and therefore should only be reviewed WITH medical personnel. There is also a concern they may see something that may upset them or the patient wants the information for litigation reasons. There is also a need for a Unique Patient Identifier (UPI). While some places have medical record numbers that are unique, there are still other places that have different ways of identification for charts and may be based on more than one identifier. Such as name and birthdate. This in necessary as we know there may be more than a John Anderson in one locale. And it is even possible to have the same name and birthdate. This makes it difficult to set up records. Other issues are data security, lack of standardization of data and COST. Lastly the consumer needs to see themselves as active participant in their care. 8 Many PHRs are self-created whether a patient does it on paper or on the internet. The patient does put it together. There are fee based services that can help patients do this or there are some that institutions have. For instances, Children’s Hospital & Clinics of Minnesota has Children's PHR that the parents set up. Over time it has evolved and Childrens pulls in information based on clinic and hospital visits so parents do not have to do this. Keeping a PHR can be a time consuming for the patient to keep up with entering date and making decisions about what to enter. However the time invested is worthwhile as the PHR is an excellent resource especially for those who have chronic illness. Another type of PHR is a record that plugs into a USB port. The patient carries this with them and has the same responsibility to add in health information. There is a picture of one in the chapter, it looks like a jump drive. 9 Smart cards are another option. They are created by the health care organization along with the physician and given to the patient. They look like a credit card and has a small chip in them to hold the information. A password and PIN are required for secure access. 9 10 11 Back to smart cards, which we know are created by providers for patient use. Security is a big issue with them. They can easily be lost or stolen, HIPAA compliance requirement are such that there need to password and PIN tied to the card. They need to be programmed to be locked when they are reported as lost or stolen. Advantages to the smart card are listed in the feature box in the chapter and include things like: require used ID and authorization, require employee credentials for authentication to access, immediate access to lifesaving information, data portability, guard against fraud and abuse in health care, help with language issues, cut down on costs for administration, support of the NHIN standards. 12 Practitioner instituted access to health records for patients is up and coming. There are four categories for this type of electronic access. The first is vendor created and hosted by the clinic. Examples are MyChart (I have heard that CentreCare and Health East use this one, I did see Allina has one on a websearch). Self built provider hosted e records are available. MyActive Health and Health Profiler are examples I also found on a web search A self built research system that is agency neutral. Boston Children’s Hospital was mentioned in the text as a facility that has developed technology to allow patients to maintain copies of their records electronically whenever they choose. 13 The last category is a system that links the EMR with a PHR to import information from all the various providers and home monitoring devices too. 13 Now about E-encounters. This was something I wished for when I worked in home care twenty years ago. Cell phones had just been implemented for the home care nurses and computers were starting to be used more and more in our agency. I thought it would be great to be able to contact my home care patients care provider during the visit and complete my documentation before I got back to the office. I imagine that is the standard operation in home care now. What is an e-encounter? Typically they are sent by email so it is a two way messaging of health care information between the provider and patient. Which can be initiated by either one. It may be through the MyChart PHR. Benefits are the patient is able to follow up with the provider after a visit and doesn’t remember what was told to them at the visit so it can facilitate retention of instructions, compliance and visitation rates when reminders are sent to the patient. Not every illness needs a provider visit so a telephone follow up initiated by an email 14 can be effective in patient assistance on the minor health concern. Barriers include the privacy issue of email, liability although the email trail provides a documentation trail, there is some increased workload although some email encounters are billable. Some issues surrounding implementation of e Encounters include what should be included in posts and when. Please take a look at the table at the end of the chapter for a list of what tasks patients would like to do online. Some developers think a contract is needed that addresses how long one should wait for a reply, what are topics that are permissible, what to put in the subject line and using full name for identification. Triaging is much easier when patients are specific in the subject line. Lastly payment is an issue as to whether it be a billable service or annual fee and many patients are okay with this 14 Home monitoring has become very popular although payment is an issue. According to American Telehealth Association, Massachusetts became the 12th stated to approve Medicaid payment for home monitoring (2013). It only applies to home health agencies. Minnesota is one of the states that has public insurance reimbursement for remote patient monitoring and home visits (telehealth) 15 16 Final comments . The internet has the features to provide much greater access to personal health care information and is changing the relationship between the patient and the provider. This should improve outcomes for patients and improve the efficiency of health care. You should now have a better ability to talk about electronic records that a consumer may be involved with, whether it is an EMR, E H R or PHR. Even though there are barriers to the various types of electronic records, you will be seeing more and more use, especially as interoperability improves. I believe nurses are already working with e-encounters and home monitoring and this will be a growing area of nursing practice. If you aren’t familiar with PHRs be sure to look into your health care organization and see what they offer. 17
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