Tools to assist clinicians document health education and health literacy related information into the RPMS Electronic Health Record used at all Federal and most Tribal IHS programs.

1. Health Literacy Resources
In the Indian Health System
June 17, 2013
CDR Christopher Lamer, PharmD, MHS, BCPS, CDE
Office of Information Technology/Health Education

2. • Provides a comprehensive health service delivery
system for approximately 1.9 million American
Indians and Alaska Natives.
• Serves members of 566 federally recognized
Tribes.

3. Agenda
• Health Literacy Assessment
Tools
• Health Factors
• Patient Education
• Patient Goals
• Handouts

4. 9
91
Adequate Health Literacy
Low Health Literacy
88
12
Adequate Health Literacy
Low Health Literacy
REALM
Results
(word recognition)
Newest Vital Sign
Results
(numeracy/food labels)
The patient does not demonstrate the ability to obtain, process, and understand basic
health information.
Assessment is made by a low score on a health literacy screening tool or observation.
Tools for Assessing Low Health Literacy

5. Interpreter needed
FineMotorSkills Deficit
Dementia
Values or Beliefs
Stressors
Low Health Literacy
Cognitive Impairment
No Barriers
Visually Impaired
Blind
Hard of Hearing
Deaf
Does Not Read English
Speaks English as a second language
Health Factors: Barriers to Learning

6. Patient Education
Topic Sub-topic Code+ =
Heart Failure
Hypertension
ICD9 (250.03)
Exercise
Nutrition
Medications
Prevention
Home Management
Self-Management
Literature

7. SubtopicsActivities of Daily Living
Anatomy & Physiology
Behavioral and Emotional Health
Complications
Cultural/Spiritual Aspects of Health
Disease Process
Equipment
Exercise
Follow-up
Help Line
Home Management
Health Promotion Disease Prevention
Hygiene
Infection Control
Literature
Lifestyle Adaptations
Medications
Medical Nutrition Therapy
Nutrition
Pain Management
Preconception Care
Prevention
Procedures
Safety
Second/Third Hand Smoke
Self Management Plan
Stress Management
Tests
Tobacco
Treatment
Wound Care
MEDICATIONS
STANDARDS:
1. Describe the name, strength, purpose, dosing
directions, and storage of the medication.
2. Discuss the benefits and common or important side
effects of the medication and follow up as appropriate.
3. Discuss any significant drug/drug, drug/food, and
alcohol interactions, as appropriate.
4. Discuss the importance of full participation with the
medication plan and that this is the patient’s
responsibility. Discuss any barriers to full participation.
5. Discuss the importance of keeping a list of all current
prescriptions and over-the- counter medicines, vitamins,
herbs, traditional remedies, and supplements. Encourage
the patient to bring this list and pill bottles to
appointments for medication reconciliation.

8. Patient Education Data Captured
• Education Topic
• Level of Understanding
• Readiness to learn
• Free text comment field
• Time

9. Patient Education and Measures
• Use of the codes
• Use in quality measures
• Tobacco cessation
• Comprehensive CVD (GPRAMA measure)
• Health Education reports
• Diabetes measures
2010
2011
2012
0 2000000 4000000 6000000 8000000
7,541,324
6,198,609
5,822,930
57.8%
55.9%

10. Patient Education Plans
Exercise
Nutrition
Medications
Prevention
Home Management
Self-Management
Literature...
Create SNOMED subset
ProblemSub-topic Optional
Pointer

11. Proposed Documentation Process
Integrated Problem List
Diagnosis (SNOMED) Narrative Status Date added [] Add Education
Diagnosis (SNOMED) Narrative Status Date added [] Add Education
Wellness [] Add Education
General Eduction Codes
[] Exercise [] Complications
[] Nutrition [] Medications
[] Lifestyle Adaptation [] Nutrition [] Special Initiatives
Associate with condition: [__________________]
Special Initiative Eduction Codes
Diabetes
Baby Friendly
Prenatal
Administration
Admission to Hospital
[] hypoglycemia
[] insulin
[] exercise

12. Patient Goals
• Captures patient selected goals
• Compatible with personal action plan or
motivational interviewing
• Enables followup and captures notes related to
the goal over time

13. Goal
Step
Follow Up

14. Patient Handouts
http://www.ihs.gov/healthcommunications

17. Logic
Patient Wellness Handout (PWH)

18. My Wellness Handout Report Date: Aug 13, 2010
------------------------------------------------------------------------------
********** CONFIDENTIAL PATIENT INFORMATION [CCL] Aug 13, 2010 **********
DOE,JANIE HRN: 3 CHEROKEE INDIAN HOSPITAL
1 MAIN STREET CHEROKEE, NC 28734
CHEROKEE, NORTH CAROLINA 28719 SMITH, DOCTOR
555-555-5555 828-497-9163
Thank you for choosing CHEROKEE INDIAN HOSPITAL.
This handout is a new way for you and your doctor to look at your health.
______________________________________________________________________
HEIGHT/WEIGHT/BMI - Weight and Body Mass Index are good measures of your
health. Determining a healthy weight and Body Mass Index also depends on
how tall you are.
You are 5 feet and 10 inches tall.
Your last weight was 220 pounds on Aug 03, 2010.
You should have your weight rechecked at your next visit.
______________________________________________________________________
MEDICATIONS - This is a list of medications and other items you are
taking including non-prescription medications, herbal, dietary, and
traditional supplements. Please let us know if this list is not
complete. If you have other medications at home or are not sure if
you should be taking them, call your health care provider to be safe.
1. ALBUTEROL MDI (HFA) 6.7GM Rx#: 1234567 Refills left: 5
Directions: INHALE 2 PUFFS BY MOUTH EVERY 4 HOURS IF NEEDED FOR
BREATHING; **SHAKE WELL BEFORE USING**
2. FLUTICASONE PROP 11O MCG (12GM) Rx#: 1234568 Refills left: 11
Directions: INHALE 1 PUFF 110MCG/INHL BY MOUTH TWICE A DAY

19. Controlling your cholesterol can keep your heart and blood vessels healthy.
Your total cholesterol result was 150 mg/dL on Aug 10, 2010.
Your last LDL (bad cholesterol) result was 70 on Aug 10, 2010.
Your last HDL (good cholesterol) result was 40 on Aug 10, 2010.
Your last triglyceride result was 120 on Aug 10, 2010.
LDL (bad cholesterol) should be under 100 mg/dL. Your LDL cholesterol
is good! You should have your cholesterol checked every year.
______________________________________________________________________
DIABETES CARE
HEMOGLOBIN A1c
Hemoglobin A1c is a test that measures your blood sugar control over a
3-month period. You should have this test done every 3-6 months.
Your last A1c test on file was 8.0 done on Aug 10, 2010.
Ask your health care provider how you can keep lowering your A1c.
DIABETES KIDNEY ASSESSMENT
Diabetes can cause kidney damage. There are tests that can see how well your
kidneys are working. Getting these tests at least once a year can help your
health care provider protect your kidneys and lower your risk of getting
kidney damage and dialysis.
Your kidneys were tested on Aug 10, 2010. You will need to have your
kidneys tested again on Aug 10, 2011.
DIABETES EYE EXAM
Diabetes can affect your eyes and vision. Early detection of eye problems
can help you to get the treatment you need to lower your chances of having
problems such as blurred vision or blindness.
Your last diabetes eye exam was done on Aug 10, 2010. You will need to
have another eye exam by Aug 10, 2011.

20. Clinical Summary and PHR
RPMS
EHR
California
Area Office
Area Office
GPRA
ONM
IHS
Health Information
Exchange
CCD
External
Healthcare
Facility
Health Information
Exchange
Transition
of Care
Summary
Clinical
Summary
Personal
Health
Record
PHR
Server
Secure email
client on the EHR

21. Personal Health Record
Indian Health Service Personal Health Record
Register to use PHR
How to Register
To begin using the Personal Health
Record, click the link below to create an
account and apply to view your Indian
Helath System medical record
User Login
Username
Password
Login
Forgot Username or Password
What is the Personal Health Record?
You can use the Indian Health Service Personal Health
Record (PHR) to view your health information. You can
track medications, lab results, and other helath
infomration from the privacy of your personal computer
or mobile device.
Who can use the Personal Health Record?
Only an Indian Health System patient who registers to
use the Personal Health Recordand verifies their
identity at an Indian Health Service, Tribal, or urban
health care facility can view their medical records.
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22. Conclusion