When it opened in 2003, The Indiana Heart Hospital was considered to be the "hospital of the future" because of its technology advancements and innovative focus on patients.

TIHH became the first hospital to integrate HealthClips, a new digital video product featuring short three minute clips, into their delivery of care through the GetWellNetwork’s interactive patient care system. HealthClips was developed by Milner-Fenwick for the delivery of patient education through in-facility CCTV systems and via the internet for home viewing.

TIHH’s Director of Education in Advanced Practice, Shelly Strong, MA, BS, RN, CNOR (right in photo) and Discharge Coordinator, Jan Miller, BSN, RN talked to Patient Education Update about the impact this has had at their facility.

We feel that that one of the benefits to HealthClips is that they are very respectful of time.

Patient Education Update: How long have you been using HealthClips?

Miller: Officially, we rolled it out December 11, 2007.

PEU: How are they organized on your CCTV system?

Strong: We’ve bundled the clips into categories that we want patients to view during their stay at TIHH. We’ve tried to keep the groupings, the bundles, less than 20 minutes each and several of them are only about 10 minutes. All the videos are also available for patients to pick and choose what they’d like to watch.

PEU: HealthClips features 2-4 minute videos. How do you see this shorter length affecting the delivery of patient education?

Miller: I think because they are short, it allows the patient a chance to view a few of them, and come back later and watch some more. It’s more convenient for them. They can pick at their own choosing, so it doesn’t interfere with say, their dinner.

PEU: How else does the shorter length help?

Strong: Many of our patients are very tired and some of them are sedated. I know from past personal experience as a patient, there are times that you can’t focus. The thought of trying to watch a video for an hour is just unbelievably hard and difficult.

PEU: Our traditional videos aren’t an hour, but even at 10- 15 minutes, I can see what you’re saying.

Strong: We feel that that one of the benefits to HealthClips is that they are very respectful of time. When we bundled them, we actually put the amount of time required to watch that bundle on the outside to help patients make good choices. If they have a favorite TV program coming on that they want to watch, they can see when they get the prompt for education on the GetWell Network that this is a six minute program. “Oh, I can do that easily. My visitors will be here and maybe my wife can watch it with me.”

PEU: Has the new technology increased patient viewings?

Miller: Percentage wise, it’s real hard to say because we haven’t done any recent data collection on that. But it definitely has increased. Before we got GetWellNetwork and HealthClips, we had to push a TV set around and plug it in. You are constantly searching and hunting and all of that, so very few videos got shown.

And now most of the patients are very willing to watch the clips. Obviously, you always have repeaters. They’ve been there and done that and they feel like they know what they need to know. But for people that are new to heart disease, they are like, “Can I show that to my wife when she gets here?”

PEU: Do you feel comfortable with the content in these programs?

Strong: When patients are watching these videos, if you’re outside the room listening, it’s almost sounds like it’s one of us talking to the patient. The videos say the same things we do. And that was a big, big selling point for us. Plus you’ve got such beautiful illustrations, they are so easily understood. That’s what Jan and I, who sat in this very office and reviewed them and went, “WOW, these are terrific, look at this!” We were so struck by your videos, it was wonderful.

PEU: How did you get HealthClips to fit into your care paths?

Strong: From her experience working on the floor, Jan was able to re-categorized them to the way we practice here at TIHH. We re-bundled them into categories that made sense to our nurses. Some clips were re-named as to the activity and their purpose.

PEU: With the basics in place, what changes are you making now?

Strong: One of the things that we’re in the process of doing now is getting to roll it in our day bed area. We just had a meeting a couple of weeks ago with our pre-op coordinators. At that point, Jan reviewed what we had done. “Is there anything we need to add to this bundle?” “Should we make a special pre-op bundle?” “What should be included as far as what the pre-op nurses teach?” It’s very customizable and it’s very easy to change things. It’s great!

PEU: Do you have different bundles for different situations?

Miller: One thing we’ve done is a CHF bundle for new CHF patients and a bundle for recurring patients, getting those things we need to hit on for each re-admission whether it is weighing, diet, no salt, etc.

PEU: It sounds challenging.

Miller: One of the other obstacles to this is that hospitalizations are becoming shorter and shorter. We don’t have a lot of time with patients to get that education in there. So it’s real important to start it at the door and continue working with them as the patient progresses through the continuum of care.

When patients are watching these videos, if you’re outside the room listening, it’s almost sounds like it’s one of us talking to the patient.

PEU: Are you using HealthClips prescriptively yet?

Strong: We are prescribing for patients on the on-demand GetWellNetwork through our computer system. We pull the patient list and then we go to a list of patient videos and video bundles that are available. We look at what the patient needs and then we prescribe them.

PEU: Do you prescribe an entire bundle or do you pick and choose from the bundle?

Strong: When you prescribe the bundle, you are prescribing the whole bundle. I have a lot of step patients and heart failure patients, so I generally go ahead and prescribe that bundle. But underneath the bundles are all the videos listed, so I can still pick and choose. If there is something that I specifically want them to see or if they have a question, I can go into it and pick that video. I can do that either at the computer station or at their bedside using their pillow speaker.

PEU: Can the patient pick and choose themselves?

Miller: Yes, the patients can use their pillow speaker also to go through and pick videos. But they are not in bundles. They have a list of videos and they can choose from that.

PEU: Are you using post-viewing quizzes to test understanding or to direct patients to a specific video?

Strong: No, we are not doing that yet, but we’ve have talked about it.

PEU:. How did you get your nurses to buy into the new system since most people don’t like change?

Strong: We had the RNs and LPNs advanced trained in many areas and we flow-charted their workload. The main reason was to show them that there is time to do things and have consistency. “This is when you play the video, when you are introducing them to the room and getting them all settled in. This is the time to teach them about the GetWellNetwork system. This is the time that you prescribe and get these videos started.” We are in the process of doing this now in the day bed area. Because that shows the nurses that, yes, there are a lot of things that you need to accomplish with your patients, but here is the time when we consistently need the education to be done.

PEU: HealthClips was originally designed as a web product for patients to use at home. What’s your view of patients being able to go onto the hospital website to watch these videos?

Miller: I think it would be fantastic. We would love our patients to have the ability through the web to have a password and be able to view from home.

PEU: So where does Internet use fit into your future plans?

Strong: Well, it won’t be in 2008, the budget is set. But it’s on the wish list for 2009. We’re going to request that we have Milner-Fenwick videos available to our patients, so they can go home and continue their education. With all of the regulatory agencies and insurance, hospitalizations are getting shorter and shorter. With the amount of time that we have them, they are being educated from the moment they get here until they leave. It would be so great for them to be able to access it from home.

PEU: So you see this as something that will be widely accepted and used?

Miller and Strong: Yes

PEU: What other ideas do you have for the future?

Miller: We have quite a few. It hasn’t been approved, but because it’s so important, we’d really like to have videos bundled so they can be seen in our waiting areas, emergency department, and in our atrium. By touch screen from a kiosk, someone who’s loved one is in there with a heart attack can touch the word “heart attack” and a video will come on. They can sit there and watch it and the beauty is the videos are so short. So if they get called away, it’s not like its 15 minutes long. It’s just such a great thing that they are so concise and short.

PEU: How did the decision process work for setting up your on-demand system?

Strong: There were several meetings to choose which television system and educational medium we would use. We chose GetWellNetwork at those meetings. We then set up some meetings with Heather Boyle-Townsend (Director of Patient Education at GWN) to get different vendors like yourself to show us their products. Each week she’d bring us a couple of different ones for us to look at.

PEU: Who was involved?

Strong: Our IT people, surgical critical care educators, the diabetes educator, the discharge coordinator, our project champion, a patient representative, and the account managers from GetWellNetwork. We kind of just watched the videos and decided which ones we were going to purchase. Heather told us we were the first to watch your HealthClips videos. It was unanimous as soon as we saw them that that is what we wanted. The good thing was that we were able to make a decision. Now we just had to come up with the money.

PEU: How did you do that?

Miller: I think it was beg, borrow and steal! But it worked! Our chief officer here, Tom, is very, very active in making sure that the GetWellNetwork is getting utilized. It was purchased for education and that allowed us to get some videos.

By giving patients access to videos at home, I believe will allay many fears and help their families understand…

PEU: Would you say that the interactive patient care system has had a big impact on the delivery of care?

Strong: We are incorporating it into our culture now. It really marries very well with the HealthClips videos and with the flow charting. This improves the utilization path rather than dragging around TV sets and those kinds of things. I believe we will become very, very dependant on it when we get day beds up and going.

PEU: What are the main subject areas that you’ve been using the most?

Miller: I’m showing videos everyday on stenting and congestive heart failure. Obviously it’s a growing population.

PEU: Is that the biggest?

Strong: It probably is although we do a lot of open hearts here. We do utilize the pre-op videos a lot.

PEU: In the future, do you think you would have patients watch the pre-op videos at home once they are available on the web?

Strong: Oh yes

PEU: What other subject areas are important?

Strong: I’ve put risk factors in almost all of the bundles. That helps patients start to realize what their risk factors are and what they can change.

PEU: With your focus on cardiology, are there any other areas you are interested in?

Miller: We are real anxious to see the diabetes clips when they come out.

PEU: Are you doing much with diabetes education?

Strong: Yes, we are huge on diabetes. We have a diabetes champion, a diabetes educator, and we practically test everyone who walks in the door.

PEU: Do people know they have diabetes when they come into the hospital?

Strong: We do find a fair amount of people that are diabetic and have no clue about it. If they come back for some reason after their stay, they tell us we created their diabetes. They don’t understand the disease process.

PEU: So what can you really do for them just to get them started?

Miller: We do try to make sure that they leave here with a meter and understand how to use it. Our diabetic champion sees them all and explains to them that this is something that we found while they were here and that it’s very important to get it under control. We send them off with educational materials and we let their family physicians know.

PEU: Anything else you’d like to say about your experience so far?

Strong: My thought is just keep on doing what you’re doing with the videos because you are really on the right track. They are so needed. It’s very, very exciting and there’s so much you can do with that and for people to be able to access that at home, I know because a big part of my background has been in surgery for 20 of the 40 years I’ve been a nurse. People are so frightened. By giving patients access to videos at home, I believe will allay many fears and help their families understand what’s going to happen before they get here.

PEU: So how long will you be fine tuning things?

Miller: I think we will be fine tuning forever.