Article addresses the e-patient phenomenon

By Jenny Carrick

A team of scholars from the Betty Irene Moore School of Nursing at UC Davis and the University of Maryland School of Nursing published the first article in academic nursing literature about the electronic-savvy patient, or e-patient. The article is also the first published by a group of doctoral students at the Betty Irene Moore School of Nursing.
The article, "Exploration of the E-Patient Phenomenon in Nursing Informatics," was published online Jan. 6 in Nursing Outlook — the official journal of the American Academy of Nursing — and will appear in an upcoming print edition of the journal. The article describes how health-care providers can collaborate with e-patients — individuals who use technology to become involved in their own health care — to increase "collective wisdom" about health.

"We wrote this article because we are interested in how the system may be able to generate greater knowledge, and better health outcomes, with the help of e-patients," said Perry M. Gee, the article's primary author. Gee, a registered nurse and clinical informatics specialist, is a doctoral student at the Betty Irene Moore School of Nursing.

E-patients use online tools and information to understand their condition, make treatment decisions, find support groups, manage their symptoms, challenge their diagnosis or locate providers, according to the article.

"When e-patients apply knowledge to self-manage health and solve problems for themselves and others, they may improve health outcomes that might not have been possible in a clinician-only controlled environment," the article states.

The article's authors are scholars from a variety of disciplines, which is characteristic of the School of Nursing's interprofessional approach to education and research. Three other doctoral students at the Betty Irene Moore School of Nursing co-authored the paper: Deborah A. Greenwood, a registered nurse with a master's degree in education who works as a diabetes clinical nurse specialist with Sutter Medical Foundation; Katherine Kim, a professor in residence at San Francisco State University's Health Equity Institute, who has master's degrees in public health and business administration; and Susan L. Perez, who has a master's degree in public health; Holli DeVon, an associate professor at the Betty Irene Moore School of Nursing, and Nancy Staggers, a nurse informaticist and professor at the University of Maryland School of Nursing, also are co-authors.

The student authors began their research for the article in January 2011 as part of their doctoral seminar, taught by DeVon.

"This collaborative, interprofessional model of education involving both students and faculty is student-centered and very progressive," DeVon said.

The student authors, some of whom have backgrounds in health informatics and technology, researched individuals who seek out health information on the Internet and they encountered individuals who were self-taught experts in their own care.

In the article, the authors update a framework used in the nursing informatics field that explains the relationship between data, information, knowledge and wisdom. The authors revised the model to include the e-patient. The new version indicates that nurse informaticists — professionals who serve as a bridge between health care and technology -- can foster collaboration between e-patients and clinicians, and that greater health care wisdom may result.

"We're now in a new era of health care, in which a patient can seek out and instantly access health care information on the Internet," DeVon said. "This changes what patients know, and it creates opportunities for strengthening the partnership between clinicians and the people they treat."

For example, individuals with health conditions have information and knowledge their clinicians may not have — such as information about their particular symptoms or pain levels. Nurse informaticists can design and develop tools that would facilitate information-sharing of this nature between clinicians and the individuals in their care, according to the authors.

"In these collaborations, e-patients would educate the health-care team on what data mean in their life context, health-care professionals would provide clinical guidance, and together they would create plans or engage in shared decision making using the collective wisdom from support groups, social networking sites, blogs, databases, and research," the authors write.

Regarding empowered, informed health-care consumers as a potential benefit to the health-care system will require a cultural shift within the health-care system, the authors note.

"Interpreting and sharing data, information, and knowledge requires a reexamination of preconceived notions to arrive at a shared wisdom between clinicians and e-patients," according to the article.

While articles about the e-patient were published in medical journals as well as in non-academic media, this is the first such article in an academic nursing journal.

Gee said this research impacted how he disseminates information on e-patients. Gee teaches nursing at Simpson University in Redding, Calif., and at the UC Davis Extension Informatics Certificate Program. Now, as a result of this research, Gee includes information on e-patients in the nursing informatics lectures he delivers in Northern California.

The article also points to future training needs for clinicians who will be working with e-patients.

"Many nurses and other clinicians have already encountered e-patients but these providers may lack the tools or training to effectively meet their particular needs," the authors write.

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