Health Information for Patients, Physicians, and the Public

Health Information for Patients, Physicians, and the Public

Director Newton N. Minow's Hemphill lecture marked the beginning not only of the Program's work on end-of-life decision-making, but also its focus on the provision of medical information to patients, physicians, and the public. High quality communication is a prerequisite for high quality health care. Effective communication is vital to the physician-patient relationship. Moreover, the media and powerful new information technologies facilitate swift access to health information, greater responsibility by individuals for their own health, and more efficient and cost-effective delivery of advanced health serv-ices to people without regard for their geographical location. Public information about health and the health care system is also essential to meaningful public debate about the need for reform.

In 1992, the Program first addressed public health communications when it cosponsored its second Medicine for the 21st Century conference with the American Medical Association and the Annenberg Center for Health Sciences at the Eisenhower Medical Center. With the support of the W.K. Kellogg Foundation and the U.S. Environmental Protection Agency, this conference addressed Challenges in Personal and Public Health Promotion. This three-day meeting examined legal and ethical issues in public health promotion, methods for developing community-based participation in health campaigns, strategies for reaching target audiences, incentives for health promotion and particularly preventive care, and ways to make health communications distinctive in an era of information overload. The proceedings from the conference were published in the May/June 1994 issue of the American Journal of Preventive Medicine. An article by Director Newton N. Minow and Annenberg Senior Fellow Fred H. Cate, "The Media and Health Policy," in Health Management Quarterly, addressed the role of the media in the debate over health care reform.

The Program expanded the examination of physician-patient communications begun by Minow's Hemphill lecture, when it joined The Program in Communication & Medicine at Northwestern University Medical School in 1993 to create the Annenberg Health Communication Forum. Under the leadership of Annenberg Senior Fellow Gregory Makoul, the Forum reflects an effort to supplement Northwestern's innovative medical curriculum and to challenge traditional perspectives about the relationships between physicians and patients.

The first forum, Increasing the Supply of Generalist Physicians: Theory vs. Practice, held in January 1994, featured panelists from the White House, national medical associations, and academia debating the meaning of the term "generalist" and the role that communications technologies play in training and supporting "generalist" physicians. Another forum, Shared Decision-Making Programs: Interactive Video for Patients, examined the use of interactive video to deliver tailored information to individual patients. In the forum Primary Care, Health and the Community, Oxford physician and lecturer Theo Schofield challenged the perception that community health problems require medical solutions.

Talking About Social Problems in Medical Encounters featured physician-sociologist Howard Waitzkin. In many primary care encounters, patients raise social problems relating to work, family, gender roles, aging, and the conditions that foster self-destructive behavior. However, physicians' focus on physical symptoms can fail to address patients' underlying concerns about these issues--a communication pattern that can reinforce the very societal problems that cause or aggravate patient maladies. Dr. Waitzkin argued that physicians, patients, payers, and policymakers should take seriously the growing body of evidence that shows that addressing social problems can improve therapeutic outcomes, increase satisfaction, and decrease use of scarce health care resources.

A new forum, Teaching About Communication in Medicine, will be held in Oxford in July 1996. Recognizing that the best way to improve physician-patient interaction is to train medical students in effective communi cation, a growing number of medical schools in North America, the United Kingdom, and other countries are including communications skills training in their curricula. This international forum will bring together teachers and re searchers to share ideas, innovations, and current practice in an effort to facili tate the development of high quality, effective teaching that will enable physi cians to better meet the needs of their patients.

The Annenberg Health Communication Forum has also addressed the use of information technologies to extend the reach of health care services. This practice, known as telemedicine, raises important issues concerning technology, interpersonal communication, and the impact of law and public policy. The variety of these issues was clearly highlighted in the March 1994 forum, Telemedicine and Access to Care: A Demonstration, during which physicians and patients at Northwestern University Medical School consulted with physi cians at the Mayo Clinic in Rochester, Minnesota. Cameras, monitors, comput ers, and medical diagnostic equipment in the two locations were linked through the existing telephone network, so that physicians in Rochester could talk with patients and physicians in Chicago, conduct physical examinations, and access x-rays and other test results.

Subsequently, the Forum sponsored Telemedicine: Barriers and Possibilities in Washington D.C., to examine further the policy issues that telemedicine poses. Cosponsored by the Mayo Clinic, this policy roundtable linked three panelists at The Annenberg Washington Program by satellite to three panelists at the Mayo Clinic. Annenberg Senior Fellow Dale Hatfield moderated the discussion, which identified key issues policymakers, health care providers, and payers must address if telemedicine is to achieve its enormous potential. The Annenberg Health Communication Forum has not only enriched the curricu lum at Northwestern University Medical School, it has also contributed to the national debate on health care policy and reform, and set the stage for improv ing communication training at medical centers throughout the world.

In addition to supporting the Annenberg Health Communication Forum, the Program expanded its work on public health communications by participating in the Department of Health and Human Services Office of Disease Prevention and Health Promotion's (ODPHP) broad-based examination of the role of information networks and other interactive communication technologies in promoting health and wise health-related consumer behavior. The Program and ODPHP cosponsored a roundtable in December 1994 on Intellectual Property Issues in Networked Health Information. The roundtable, moderated by Annenberg Senior Fellow Fred H. Cate and Mary Jo Deering, Director of ODPHP's Health Communication Staff, sought to identify the range of intellectual property issues presented by networked health information and to articulate important principles that should guide the resolution of those issues.

In May 1995, the roundtable's conclusions served as the basis for a panel on intellectual property issues at the Partnerships for Networked Health Infor mation for the Public conference, in Rancho Mirage, California, cosponsored by the Department of Health and Human Services, the Annenberg Center for Health Sciences at the Eisenhower Medical Center, and other organizations. Annenberg Senior Fellow Cate's report based on the roundtable and the Rancho Mirage panel, "Intellectual Property and Networked Health Infor mation: A Statement of Issues and Principles," is forthcoming in the Bulletin of the Medical Library Association. According to that report:

Information networks offer enormous potential for improving the delivery of health care services, facilitating health-care decision- making, and contributing to better health. In addition, advanced information technologies offer important opportunities for new markets, targeted information products and services, greater acces sibility, lower costs and prices, and more rapid and efficient distri bution. Realizing the full potential of those information resourc es, however, requires the resolution of significant intellectual prop erty issues.

As the participants at both the roundtable and the subsequent conference panel stressed, the intellectual property issues in networked health information may be particularly acute both because of the technological context and because of special features of networked health information. For example, the government funds and originates a significant amount of health-related information. In addition, much of that information is of great importance to the population and benefits not only individual users, but also employers, insurance companies, the government, and society as a whole. Because of these and other considerations, the report recommends that the government continue to provide particularly important health information to the public, and facilitate that information's accessibility and reliability, while avoiding unnecessary competition with pri vate information providers.

The Annenberg Health Communication Forum and the Program's other work on the provision of health information to physicians, patients, and the public is helping health professionals and policymakers better understand the relation ship between effective communication and improved health, and the role that new technologies may play in providing essential information. Moreover, this is an area where the Program draws not only on its expertise in the emerging field of health communications, but also on 13 years of experience in traditional communications policy issues--for example, mass media, telecommunications, and information networks. Through this unique combination, and its partner ships with other organizations, the Program has sought--and continues to seek--to contribute to the debate over telemedicine, public health promotion, the use of the Internet to deliver health information, among other issues. The goal is a simple one: to facilitate the affordable availability of relevant, accurate health information to people everywhere.