Linking Health Education and Health Care Service Information via the WWW: The Health-aware Project

WWW: The HealthAware Project Lucila Ohno-Machado,’ Aziz Boxwala, ‘ Jeanne Guillemin,2 Kathy Keefe, ‘ Greg Sharp,’ Todd Rowland, 1 John Ehresman, ‘ Jeannie Tam, ‘ Luke Sato, ‘ Robert A. Greenes’ ‘Decision Systems Group, Brigham and Women’s Hospital, Harvard Medical School 2Department of Sociology, Boston College, Boston MA Background. Sophisticated health education and health service materials are increasingly available on the World-Wide-Web. However, the sources of information are usually not connected and not easily updatable. For example, users who make use of health education software to learn about health promotion and potential diseases cannot readily connect to health care services to select appropriate providers, post specific questions, get access to decision support on the appropriateness of a visit, and make necessary appointments. There is a missing link between general information on health matters and specific information on health services that are available for a certain population. One of the reasons for this gap is the lack of software tools that facilitate the maintenance of such dynamic information. The HealthAware Project developed by the Decision Systems Group (DSG) at the Brigham and Women’s Hospital and the Department of Sociology at Boston College (BC) has the goal of bridging this gap, by developing tools that facilitate the maintenance of educational and health service material, as well as the interaction between consumers and providers of health services. We are evaluating the impact of these tools in a controlled environment at the BC campus using five different domains: substance abuse, breast disease, sports injuries, cardiovascular disease, and prenatal care. Methods. Educational content consists of material developed in-house supplemented by extensive links to validated WWW sites. The content is maintained in a database from which up-todate WWW pages are generated periodically. We provide not only multimedia information on prevention, anatomical and physiological data pertinent to the condition, disease characteristics, and treatment options, but also links to support groups, chat groups, bulletin boards, email to health care providers, and referral directories. We are currently developing computer-based decision support tools for self-referrals and for referrals mediated by a primary care provider. In addition to quantitative evaluations on the impact of the system on (a) education on health topics, (b) change in health-related behavior, and (c) proper usage of health services, researchers at BC are conducting focus groups to assess the overall perception of the system in terms of userfriendliness, acceptability of technology, and overall satisfaction with the system. Results. We have developed educational modules for substance abuse, breast disease, and sports injuries. The modules have been implemented at the BC Intranet for selected users, and a control group has also been identified for evaluation. Data on the use of the substance abuse module are available for 311 undergraduates. Specific patterns of alcohol consumption have been identified. Preliminary comparisons of preand post-test surveys indicate that the module was effective in educating students, although analysis of focus groups interviews indicates that problem drinking is supported by college culture. Preliminary data on the use of the breast disease module are available for 161 BC staff members over 30 years of age, all with full health care coverage. These data indicate a great disparity between highly educated respondents who have computer skills and access and are well informed about breast cancer detection, and economically disadvantaged minority employees who have had little or no access and were uninformed. About thirty two percent of the surveyed group either has been diagnosed with breast cancer or had a family member with that diagnosis. Discussion. Although the WWW is an excellent conduit for disseminating health information, the lack of software tools that allow pertinent linkage between educational material and health services, and facilitate the maintenance of up-todate information, has shortchanged its full potential. The tools we have developed to fill this gap have been implemented in a limited domain; preliminary results indicate that they have a positive impact on health education. We also expect to verify significant differences in health-related behavior and proper use of health services. Acknowledgements. This work has been funded by NLM Contract NO1-LM-6-3539 and NLM training grant 2 T15 LM07092. We thank Drs. Yvedt Matory, James Zuckernan, Pierre D’Hemencourt, and Jonathan Schaffer for sharing their expertise in the domains of breast cancer and sports-related injuries.