Meducation: Improving Medication Safety through Patient-Centered Multi-Language Instructions
Meducation SMART App

The Meducation SMART app processes medication lists from the patient record and then enables viewing and printing of simplified medication instructions in any of a dozen languages (figure 1). These instructions include patient-specific dosing information and medication information to complement traditional forms of Consumer Medication Information (CMI), with the goal of providing easy-to-understand, concise, and easily translated information that can be given to patients during the medical or pharmacy encounter. Additionally, Meducation provides video demonstrations of complex medication devices (e.g., inhalers) that can be shown to the patient in the clinic or pharmacy, or reviewed by the patient at home. By combining plain language instructions, accurate translations thereof, and video demonstrations in the patient’s own preferred language, Meducation is able to reduce health disparities that arise from low health literacy and limited English proficiency.


Figure 1. Sample printouts from Meducation

The foundation of the Meducation SMART app is a drug information database (developed in-house under a grant from the National Institutes of Health, National Center on Minority Health and Health Disparities, R44MD001212), which was designed from the outset to facilitate the authoring and generation of medication instructions that support low health literacy and the language needs of patients. The database currently supports over 1700 prescription medications and 12 languages.

Unlike most other sources of CMI, the Meducation system

  • generates a printable CMI sheet containing both the SIG (instructions for use) and a medication-specific drug monograph for each medicine;
  • provides such information at a 5-6th grade reading level with particular consideration for low health literacy;
  • supports printouts with ample white space and multiple font sizes to increase comprehension and to improve readability for elderly and visually impaired patients;
  • provides animated, visual demonstrations of complex medication techniques for viewing at any time over the web and in multiple languages;
  • utilizes the Universal Medication Schedule, a research-based visual aid shown to reduce medication errors and improve adherence;
  • and supports efficient, cost-effective, and verifiable translation into other languages.
Background and Significance

Health Information Technology (HIT) holds great promise for the delivery of cost-effective and equitable care for all Americans. In recognition, the Institute of Medicine (IOM) has emphasized how information technology can play a critical role in providing "safe, effective, patient-centered, timely, efficient, and equitable" care with the potential to reduce health disparities. The HITECH Act (The Health Information Technology for Economic and Clinical Health Act) signed into law on February 17, 2009, offered promise to fulfill IOM’s vision through establishment of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information.

Prior to HITECH’s enactment, advocates for communities of color and other underserved populations, aware that historically advances in health and health care had often benefited other communities disproportionately, raised concerns that racial and ethnic health disparities, which have persisted for decades, could be exacerbated if people of color and other underserved groups did not participate fully in HIT advances. In response to these concerns, the Office of the National Coordinator (ONC) was charged in the Purpose section of its charter to perform duties in a manner that: “improves health care quality, reduces health disparities, and advances the delivery of patient-centered medical care”; and “improves efforts to reduce health disparities.”

There is now growing evidence that health information technology is being adopted disproportionately and that further widening of existing health disparities may result. Polyglot’s goal is to develop technologies that address the needs of underserved populations – particularly to overcome low health literacy and language barriers. To date, very few health IT projects have considered the importance of these issues, despite the recognition that the economic impact on public health and potential health outcomes is significant. A third of the US population is considered low health literate and 1 of every 12 individuals does not speak or understand spoken and written English well. Current cost estimates for the impact of low health literacy is as high as $238 billion each year and racial inequities account for $57 billion each year.

Technical Details

Our app reads the RXCUI drug identifier and the instructions for use (SIG) for each medicine in the SMART EMR patient record. The Meducation drug information database is cross-referenced to RxNorm, and is designed to provide a drug monograph for each recognized RXCUI by associating it with a set of pre-determined phrases (e.g., general instructions for use and storage, cautions, side effects, etc.). The instructions for use are similarly constructed by a mapping from the recognized SIG to a set of instruction phrases. For example, “1 qd” for a medicine in oral tablet form maps to the phrases “Take the medicine by mouth once a day” and “Take one(1) pill each time”. Each of these phrase sets are then assembled into a structured and formatted document and rendered as printable PDF files inside the Meducation SMART app container. Unicode character sets are embedded in the PDF documents, obviating the need for the client computer to have particular fonts installed.

Meducation instruction sheets can be personalized with the street address of the Organization or Pharmacy to which the EMR user (provider or pharmacist) belongs (this feature is not activated in the demo).

The Meducation database also contains translations of each of these individual phrases into 11 other languages (translation is done by qualified medical translators and is verified by independent medical translators), so that the phrase sets which comprise an instruction sheet can easily be swapped to provide the instruction sheet in other languages. When the patient’s preferred language becomes part of the patient record, as required by the ONC’s EHR meaningful use criteria, then the Meducation SMART app will be able to automatically generate the instructions in the appropriate language.

All of the information provided by Meducation is accessible within the Meducation SMART app through a RESTful API. Hence, it would be possible to update the patient medication record with RDF links to both Meducation instructions and demonstrations.

Usage Notes

Select the Meducation icon from the SMART app panel. The Meducation SMART app initializes in the SMART app container with the screen in “Med List” mode and the patient’s medication list, if one exists, is displayed. If a given medication in the list is found in the Meducation database, a button appears next to the medication (figure 2).


Figure 2. Medication list in SMART app Meducation container

Clicking on this button switches the screen context to "CMI" and displays a PDF document containing "how to take" instructions along with other medication-specific CMI (figure 3). Select a language and a font size from the drop-down boxes to change the language and font size of the document.




Figure 3. CMI in English (top), X-Large font (middle), Mandarin-simplified (bottom)

To print out multiple medication information sheets, click on the "Med List" tab and place a checkmark in the column marked "Select" for each medicine you wish to include and click on the button labeled "CMI Selected".

If a medicine contains an FDA MedGuide, a button appears next to the medicine. Clicking on this button will open a new window containing the MedGuide pulled directly from the FDA website.

If a medicine has an associated video demonstration, a button appears next to the medicine. Clicking on this button switches the screen context to "Demos" where the video can be viewed by the provider and patient (figure 4). Select a language from the drop-down box to play the video in that language.



Figure 4. Medication with an available demo (top). Demo playback in English with subtitles (bottom).

The following patients have medications with video demonstrations:

  • Jessica Jackson (Spiriva)
  • Lisa West (ProAir HFA)
  • Mary Smith (Nasonex)
  • Patricia White (Lumigan)
  • Patrick Parker (ProAir HFA)
  • Paul Gracia (Spiriva)
  • Richard Brooks (ProAir HFA)
  • Richard Reed (Vigamox and ProAir HFA)
  • Rebecca Thompson (Nasonex)

This SMART app was designed and tested on Internet Explorer 9.0. Meducation requires both Adobe Reader (for PDF display) and Adobe Flash (for Demo playback) browser plugins.

About Polyglot Systems, Inc.

Polyglot Systems, Inc. (www.pgsi.com) is a health information technology company with a focus on improving care and access for underserved patient populations - particularly those with low health literacy and limited English proficiency. Polyglot has received several SBIR NIH grants from the National Center on Minority Health and Health Disparities.

Contact us at info@pgsi.com for more information.

Polyglot Systems, Inc.
2000 Aerial Center Parkway, Suite 101
Morrisville, NC 27560
email: info@pgsi.com
website: www.pgsi.com
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Founded in 2001, Polyglot Systems is organized around two insights. First, that healthcare improves and costs decline as the quality of patient-provider communications improve. Second, that technology can improve such communications quickly, dramatically and affordably.

The need for such technology is severe. Nearly 30 million Americans are considered "limited English proficient" - unable to communicate effectively in English. More than 90 million Americans are deemed “low health literate” – so impaired in their ability to understand health information that their ability to make appropriate healthcare decisions is compromised.

Our mission is to deliver solutions that overcome these communication challenges at every stage of the healthcare encounter.

Visit www.pgsi.com to learn more about Polyglot and our suite of products, including Meducation®, AVA™ and ProLingua®.