11/11/96
The mother registers her 9-month old baby at the desk and is given a magnetic visit card which she swipes the through the terminal located at her seat in the waiting room. She completes the screening interview (spoken through her earphone) on a touchpad. This expert assessment system uses complicated branching logic to elicit the health supervision medical history relevant to that visit. It is programmed for all the questions suggested at the 9-month well-child checkup by the AAP Guidelines for Health Supervision and Bright Futures, and also updates specific problem areas known about the baby from the prior 6-month visit interview. The mother then watches an anticipatory guidance video for 9-months (with personalized introduction by the MD) on her terminal with the earphone. She is called by the nurse from the waiting room by an announcement through her video terminal. They are directed into an exam room where the card is swiped at door for patient relocation within the office, and mom finishes her health education video program (or screening interview) on the exam room monitor.
Before entering the exam room, the pediatrician reviews the list of video programs presented to the mother and the automated assessment and prioritized concerns obtained from her, and knows exactly which problem areas to emphasize and the anticipatory guidance needed most. After the exam and counseling, the doctor selects other patient education materials for her, including a specific colic-related video clip, and 4 other handouts which are personalized for the child when printed. Additional video spots are shown in the education room, and the entire set of 9-month video programs and the problem-related video instruction are recorded on videotape to take home and share with father and other caregivers. Or - the mother can take home a floppy disk to program her home computer to show those specific segments off her home copy of the AAP's compact disk "Multimedia Guide to Child Care, Birth to Age Five."
The software exists for the 16 well-child visits though age 10. The video programs could be available soon.
Alternatively, the baby has the usual 9-month exam, but afterwards, the pediatrician has the mother spend a few minutes watching these specific videos for the 9-month visit: a 2-minute spot on general anticipatory guidance, a 2-minute spot on nutrition, a 3-minute spot on safety, and a 1-minute program to help with colic. This seamless, tailor-made, 8-minute long presentation is programmed by the pediatrician by only pressing 4 buttons on a remote control of the office Digital Video-Disk player. A videotape copy is also made for dad to view at home.
Alternatively, the baby could have the 9-month exam, but afterwards, the mother watches those 4 video spots on the usual VCR from the office video library of endless loop tapes which require no searching or rewinding. Each separate "repeating loop" tape contains one topic that is repeated many times, so that at the end of each segment, the same topic segment can restart.
Though medical schools and the businesses use interactive video for training and education, why should we use it for patient education? Video makes patient education at a well-child visit more comprehensive and thorough, and save clinical time. Interactive video produces strong reinforcement that helps parents learn faster with 25% more retention (1,2). The combination of visual presentation with audio explanation makes information more quickly and easily understandable. Immediate, interactive feedback provides reinforcement which motivates the learner to focus attention. Many studies show such video technology reduces learning time by 50% -- which implies we can deliver twice as much health promotion.
Pediatricians repeat standardized health guidance to parents and patients countless times every day, but few use video regularly. We depend primarily on the spoken word to communicate health guidance, but understanding and retention varies widely, as does patient compliance. Though written instructions and printed brochures are commonly used, changing demands requiring us to do more -- in less time. Since we need to use more effective and efficient patient education techniques, increasingly, some pediatricians are turning to video.
Video-enhanced patient education may be one of the best ways to facilitate communication. Surveys suggest that videos for patient education are desired by both pediatricians and patients at 80% of office visits (3). But according to some AAP surveys, less than 20% of pediatricians use patient education videos during office visits. While the benefits of using video are many, there has been a delay in use in the pediatric office because most existing videotape programs are too long and inefficient, and they are not deliverable in a format which is feasible for office patient flow and space limitations. A video is often rejected by a physician because of disagreement with one small part of the content. For practical office use, a video presentation must be succinct, customizable, and be able to be instantly administered by the clinician. Only videos for patients to take home can be encyclopedic.
With the current requirements toward more efficient use of professional time and meeting expected educational standards and guidelines, health education video technology can be the primary tool to teach health care basics, thereby allowing more focused use of physician time. Direct video reinforcement of our pediatric guidance is a powerful adjunct to enhance patient understanding and retention, and improve child care. Video can enable clinicians to more easily demonstrate home management techniques. Scripts represent medico-legal documentation, and such educational adjuncts can visually dramatize the danger signs and child safety issues that parents should know (4). Compliance with otitis media treatment improved 50% when medical advice was followed by video viewing (5).
Existing digital video-CD technology eliminates the problems of cumbersome videotapes which wear out and require rewinding and searching for topics. Similar to audio-CD, it can provide up to 99 subject tracks of different video topics on one disk (6). With no searching or rewinding, there is instant access to all topics which can be programmed in any order. The remote control selects the subjects the way songs are programmed on an audio-CD player. The cost of a video-CD player is little more than that of a VCR, and the cost of one disk of pediatric health supervision subjects will be far less than that of a collection of videotapes.
Vignettes from anticipatory guidance published from AAP Guidelines for Health Supervision and Bright Futures on videodisk will enhance health promotion at well child exams. These can be administered by the clinician, or be determined by EXPERT ASSESSMENT SOFTWARE which will automatically administer needed educational selections (7).
Based on experience with well-child pilot videos edited from the Johnson & Johnson Infant Health Care video, useful topics for office use would be Anticipatory Guidance for the 16 well child exams at 1week, 1mo, 2m, 4m, 6m, 9m, 12m, 15m, 18m, 24m, 36m, 48m, 60m, 72m, 96m, and 120months. Well-child visit spots should be separate segments for infants, toddlers, preschool, and schoolage children on topics such as: physicals, immunizations, development and child care; breast feeding pointers and solutions; newborn/ infant stimulation, care and feeding for first year; safety, accidents, poisons, baby-sitters, and day care; foods, nutrition, and snacks; toilet training; behavior, discipline, punishment, and child rearing.
Since child care health outcomes can be enhanced, we will better serve patients by routinely educating them using the media with which they are most familiar -- TV and video -- in conjunction with one-on-one counseling. Since both patients and pediatricians desire the video approach, and managed care organizations require increased efficiency, video reinforcement of health guidance will certainly become a common adjunct in the modern pediatric office.