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.
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.
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
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.
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
button appears next to the medication (figure 2).
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.
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.
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
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.
Polyglot Systems, Inc.
2000 Aerial Center Parkway, Suite 101
Morrisville, NC 27560
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
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®.