Medical Futures Lab

Guest posting by Kylie Balotin

In my Medical Media Arts Lab course, I have been assigned to a team in order to design a campaign that will encourage primary care physicians in the Harris County Public Health System to offer HIV testing to their patients more regularly. As the semester has progressed, we have come up with a few solutions to our problem including designing a poster to put in every patient examination room. We hope that this poster will act as an icebreaker to stimulate a dialogue between the physician and patient and as a reminder for the physician. Currently, we are beginning to think about what this poster could potentially look like.

I began by looking up past and current HIV poster campaigns, but I noticed that most of these campaigns were focused on the patient rather than the physician. While posters like the one below give examples of what information is usually displayed and interesting examples of how to display information, I’m not sure if these posters are completely what we want. These posters might be interesting to patients, but I don’t think they’ll be enough to catch a physician’s attention and, even further, change their behavior. This poster is interesting to look at initially, but I don’t think it would catch the physician’s attention after the first time he or she sees it. It might blend in with the other posters and even into the walls. This is called “campaign fatigue.” This campaign will not be effective if the physician forgets about the poster after seeing it a couple of times.

(“We Can Stop HIV – One Conversation at a Time”)

As a result, I began to look up health campaigns that sought to change physician behavior. I became especially interested in an antismoking campaign in New York called “Don’t’ Be Silent About Smoking.” This campaign has many of the same ideas as our campaign including opening a dialogue between a physician and his patient about a preventable health issue. I was especially interested in the images that the campaign used for some of its posters and think that these would be interesting to implement in our campaign.

The 2008 Media Campaign Posters (“Media Campaign”)

The first version of the “Don’t Be Silent About Smoking” poster that came out in 2008 featured a physician with his or her mouth sewn shut of taped over (shown below). I like how provocative this poster is; it is really shocking to look at when you see it for the first time. If we chose to go with a poster design that is similar to this one, even if the physician gets used to seeing the poster, the patient will probably ask about it. I also really like the text that was included in the poster. It doesn’t state facts or statistics about smoking and deaths caused by diseases related smoking. Instead, the posters emphasize the physician-patient relationship and how patients look to their physicians for health advice. This design is also interesting because we want to get the physicians at the Harris County Public Health system involved with the campaign too. We want to try to feature a physician on our posters, and a design like this one would allow us to do just that.

One of the biggest challenges that we foresee to a successful poster campaign is campaign fatigue. We are worried that the physician will forget about our poster after a couple of weeks, and we are trying to find a design that will delay this from occurring. A provocative poster such as the ones above could possibly be a solution to our problem.

References
“Media Campaign.” Don’t Be Silent About Smoking. N.p., n.d. Web. 26 Feb. 2015. <http://talktoyourpatients.org/media/2010.php>.
“We Can Stop HIV – One Conversation at a Time.” We Can Stop HIV – One Conversation at a Time. N.p., n.d. Web. 26 Feb. 2015.

Guest posting by Kylie Balotin

As I stated in my previous post, I am part of a team trying to design a poster for an HIV campaign. In addition to deciding on what images we want displayed, we are trying to figure out what text on the poster should be. Throughout this process, we have been asking the question, “What makes text on a poster effective?”

According to an article by Seth Noar, we must create a clear message for the audience first. Next, we can use different communication and persuasion theories to frame our message and create credibility with the audience. (Noar) The message should precisely explain what we are asking our audience to do, but we can still trying to use “creative and unconventional messaging” to get the attention of our audience.(Noar) Since we are trying to design a poster, we should also try to make our message as concise as possible.

Even with this information, I was still not sure how to design an effective message for a poster campaign. As a result, I began to search for examples of other campaign posters. For example, I found a physician-targeted poster from a C-diff campaign, which is pictured below. This poster caught my eye because of the text, which says, “Dispense less [pills] and more [soap].” (“DFWHC Foundation | Non Profit Advertising Case Study”) This text is clever and creative, which should help catch the audience’s attention according to Noar’s article. However, I did more research about the campaign’s message and realized that the text did not seem to match the message. This poster was designed to remind physicians to prescribe antibiotics sparingly, but I thought it was a poster that reminds physicians to wash their hands. (“DFWHC Foundation | Non Profit Advertising Case Study”) The campaign could have worded their message better so the campaign’s actual message was understood.

(“DFWHC Foundation | Non Profit Advertising Case Study”)

In contrast, the antismoking campaign’s posters, such as the one below, from my last post clearly convey the message of the campaign. Just from reading the largest text on the poster, I understand that the campaign’s message is physicians need to talk to their patients about smoking. The rest of the text works to support this idea by stating that the patients need physicians’ guidance and that physicians can save their patients’ lives by changing their behavior. This poster’s text, while not as creative as the last campaign’s poster, is clear and concise about the message of the campaign.

(“Media Campaign”)

            Finding the right text to put on a poster is critical to a poster campaign’s success due to the limited space to convey our campaign’s message; the text needs to be concise but still explain the campaign’s goal. Currently, my team has decided that the message of our campaign is that we need to end physician silence on HIV testing and remind physicians to ask their patients to get tested. As we decide on the text we want on our posters, we need to remember that the text needs to be clear about this message like the antismoking campaign poster and does not seem to imply a different message like the C-diff campaign poster.

References
“DFWHC Foundation | Non Profit Advertising Case Study.” Agency Creative. N.p., n.d. Web. 12 Mar. 2015.
“Media Campaign.” Don’t Be Silent About Smoking. N.p., n.d. Web. 26 Feb. 2015. <http://talktoyourpatients.org/media/2010.php>.
zNoar, Seth M. “An Audience-Channel-Message-Evaluation (ACME) Framework for Health Communication Campaigns.” Health Promotion Practice 13.4 (2012): 481–488. NCBI PubMed. Web.

Guest posting buy Pooja Kapadia

Electronic medical records have been touted in recent years as the ultimate method for keeping patient records. The case for the paperless option is compelling and isn’t a small surprise that the Obama administration heavily promoted this idea, with more than $27 billion in incentives given to doctors to convert. And this worked. From 2008 through 2013, the percentage of US doctors’ offices with EMRs rose from 17 to 48 percent and hospitals implementing EMRs increased from 13 to 70 percent.

Good:

More time
As any medical office staff member can attest, paper medical charts require a fair amount of physical labor. For example, when a patient comes in, their files need to be physically pulled from storage, transported, stamped and resorted, all in one visit. As one can imagine, all of this back and forth results in a greater possibility of human errors, as charts might go missing, papers might fall out or information might be out of order. I spent time shadowing a doctor who still uses paper records, and there were many instances where I was trying to locate lost papers from a patient’s file, or even find the missing file itself!  The nurses were in charge of this task. This was a huge waste of their time! Instead of talking to patients, they were stuck with moving papers. This led them to always be in a rush when talking to patients. This ultimately resulted in getting a less detailed history, and potentially reduced quality of care. EHR could have eliminated all of this.

And the Bad:

Crashes

Unlike technology, ink and paper never crash. A prolonged computer outage can impact both the physicians as well as the patients. The delay in access to medical records makes it difficult for physicians to try and treat patients who come in. The medical staff can try and compensate with fax and phone reports, but this is no substitute for a complete set of medical records.  They have to try and rely on patient memory, which is (at the least) slightly hazy, or (at worst) completely skewed. In addition, patients get frustrated as they cannot schedule surgeries or even get their own test results back.

For me, EMR systems seem like a good way to streamline the process of charting a patient’s history. This is a transformation that is happening before us. Yes there are flaws: it is a new system. When is anything new without flaws? However, there are so many benefits to be gained from this. I think that once EMR becomes standard practice, people will develop ways to tweak and improve the current systems. EMR allow medical staff to use their time talking to patients and seeing more of them, instead of physically moving papers. This leads to better care for the patient, as they get more attention from their providers. Better care: this is what we all want right?

Work Cited:

“As Patients’ Records Go Digital, Theft And Hacking Problems Grow.” Kaiser Health News As Patients Records Go Digital Theft And Hacking Problems Grow Comments. Kiaser, 03 June 2012. Web. 19 Feb. 2015http://kaiserhealthnews.org/news/electronic-health-records-theft-

Freudenheim, Milt. “The Ups and Downs of Electronic Medical Records.” The New York Times. The New York Times, 08 Oct. 2012. Web. 18 Feb. 2015.

Guest posting by Charles Ho

Educating patients to ensure they understand their treatments is a critical component in delivering effective healthcare. One study has indicated that hospital readmissions are significantly reduced when the clinical staff is actively involved in educating the patient in post-treatment tasks.¹ It can also be hypothesized that empowering patients with knowledge about their treatment plan can make them more engaged in managing their health.

 Traditional approaches to patient education can include printed handbooks that guide patients through a particular procedure. While this is a familiar medium of information, other types of media may deliver education to patients in a more effective manner. Putting patient education resources in a digital format and made available online is one such strategy. One potential advantage is the ability for clinicians to make more frequent updates to such materials². Also, similar to digital textbooks used by college students, digital forms of patient education materials allows patients to have a more interactive experience, such as performing an instant search for unfamiliar medical terms their doctor may have mentioned but the patient didn’t have time to ask about.

 These benefits are well-known by health policy makers. One of the criteria a physician must satisfy to demonstrate “meaningful use” of information technology, as outlined by the U.S. government, is to engage at least 10% of patients in education resources through the electronic medical record system.³ Interestingly, this seems to be a rather low threshold, which may indicate integrating health information technology with patient education is still in the development phase.  Certain obstacles, such as a difficult user interface and patient confidentiality, are just some of the reasons why a seemingly intuitive development can be hindered.

 Digital technology has the potential to enhance patient education. To supplement these advancements, we also need to address other areas that can affect the patient education experience. One such example would be to ensure that the culture and attitude of the clinical staff are conducive to allowing patients to understand and question their treatments⁴. Realizing that the patients’ firm understanding of the treatment process is important, improvements in patient education should be tackled aggressively.

 REFERENCES

[1] Jack, B.W.; et.al. “A reengineered hospital discharge program to decrease hospitalization: a randomized trial.” Annals of Internal Medicine (2009). 150 (3): 178-187

 [2] Modern Medicine Network. “Using technology to transform patient education” (2004)

<http://www.modernmedicine.com/modern-medicine/content/using-technology-transform-patient-education?page=full>

 [3] HealthIT.Gov. “Patient-specific education resources”

<http://www.healthit.gov/providers-professionals/achieve-meaningful-use/menu-measures/patient-education-resources>

 [4] Boston University. Reducing hospital readmissions with enhanced patient education.

<https://www.bu.edu/fammed/projectred/publications/news/krames_dec_final.pdf>

Guest posting by Charles Ho

When we go see a doctor, we expect a one-on-one conversation. However,  increased digitization of medical records and clinical tools has made physicians more and more attached to the computer, even during a patient visit. While it can be easier to access and share patient information electronically, we also need to think about how physician computer usage affects the patient’s experience.

A common complaint expressed by patients recently is that physicians are not paying attention to them as they are sifting through information on the computer during a visit.¹ As a student, I can get a sense of this frustration if I were to visit a professor during office hours and the professor would be reading notes off the computer when trying to explain a concept to me. I would not  find this to be the most effective way to communicate when the professor is positioned behind a computer screen.

 These situations have been studied objective and quantitatively. A recent study measured duration of eye contact during office visits between a patient and a physician.² Their findings, as one may expect, indicate that the amount of eye contact a physician makes with the patient is significantly less when the physician is using the computer during the meeting.

 However, an interesting observation in that study revealed that this decrease in eye contact duration was when the physician was sharing information from the computer to the patient in a passive fashion. If the physician were conveying the information and using the computer as an aid in an active manner, the eye contact duration was not significantly affected.

 So this brings about the following question: How can we make computers more conducive to an active two-way conversation between patients and physicians? Because physicians struggle to utilize their electronic medical record systems in their daily routine³, it is an even bigger obstacle for such computerized tools to be effective for both physicians and patients simultaneously.

 Thus, it is important to figure out how to incorporate computers as an aid, rather than an obstacle, to the one-on-one discussions between patients and doctors. Perhaps have the computer connected to a large screen that could be easily seen by the patient would be a start, as opposed to having the back of the computer facing the patient. In the long run, the user interface of computer software used in the clinical setting need to be revamped. We should make the interface less text-cluttered and have more visually appealing icons and diagrams, making it easier for patients to understand their health record. It is hardly useful to share information with patients from the computer if the content is incomprehensible to the patients.

 These are just a few ideas that I propose, and ultimately, I believe that developments in technology will be a great asset for clinicians. However, these benefits can only be realized when we also think about the implementation process and how technology affects medicine from the perspective of the most important stakeholders, the patients.

REFERENCES

 [1] Marte, J. “Why your doctor should put down the ipad.” MarketWatch. (2014)

http://www.marketwatch.com/story/why-your-doctor-should-put-down-the-ipad-2014-01-28

 [2] Asan, O. et.al. “How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care”. Patient Education and Counseling 98 (2015). 310-316

 [3] Verdon, D.R.. “Physician outcry HER functionality, cost will shake the health information technology sector”. Medical Economics (2014).

http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/ehr/physician-outcry-ehr-functionality-cost-will-shake-health-informa?page=full

 Image credit: http://images.wisegeek.com/doctor-with-tablet-and-patient.jpg