services involves a whole separate language: co-pays, deductibles, usual and allowable fees, covered and non-covered services. This is language that few other than those who use it every day in their work understand.

Over the years the practice has struggled with employees who are frustrated by patients who did not understand their benefits or the terms of their health plans. “Making health care plans and insurance products more transparent and comprehensible”—one of the attributes mentioned in the paper—is a huge priority for the practice as it would save significant time and energy for both patients and the practice.

Another important attribute is “Foster an augmented and prepared workforce to promote health literacy.” The health literacy of the staff can be a barrier to having a health literate practice. The practice started conducting interviews with staff members, asking simple questions. Discussions were held and then the staff was asked to write down what the message of the discussion was. One finding was that many of the staff could not triage a telephone call. Also, while many employees are sympathetic to patients’ needs, they may not have an understanding of what patients are asking. Therefore, the policy of this practice is that no front-desk office staff member can take messages with clinical content. The front office staff asks what the call is regarding, so that if there is an emergency or if the patient is ill and needs more than an appointment, a nurse or a doctor handles it right away. The practice has also looked at the health literacy of its medical assistants. Because the term “medical” is in the name of their position, patients often assume that they are able to perform at a higher level, but these are really entry level jobs with minimal training. It is important to make sure the medical assistants have the knowledge to function appropriately.

Many patients are computer literate, but a large number do not feel comfortable with the Internet as a source of information or do not have easy access to the Internet. Many patients are unable to conduct reliable searches for disease information. Those who are slightly more computer literate tend to conduct a broad search and then have trouble separating information that is evidence-based from that which is not. The practice uses MedlinePlus.gov as well as specialty society websites and disease-specific sites run by related associations (e.g., the American Diabetes Association and the American Cancer Society) as information sources for patients. The practice could do a better job of providing patients with a broader list of useful Internet sites that provide reliable information.

While being able to access one’s own health records via computer is attractive, it is difficult to imagine that this will occur widely in the near future, Hoverman said. Most electronic health records (EHRs) in the medical community are in a format to satisfy CPT coding guidelines and thus justify billing. Often important and useful information about why



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