Philly health info: the college of physicians of Philadelphia's regional community health information project.

ABSTRACT

THE COLLEGE OF PHYSICIANS OF PHILADELPHIA has created Philly Health Info (PHI), a regional community health information model. PHI objectives are, first, to provide as many citizens of greater Philadelphia as possible with accurate, current, and understandable health information they can use to their benefit; and second, to test the feasibility of reaching a substantial proportion of people who are underserved through community sites such as library branches, community health centers, physician offices, and other convenient locations. The centerpiece of PHI is its Internet portal. This consumer-oriented portal focuses on regional health issues and offers a virtual directory of regional health resources and services. A pilot project was launched in the spring of 2004 to test the feasibility of bridging the digital divide by placing trained volunteers at Internet access sites in community locations. The first PHI site is located at the Northeast Branch of the Free Library.

INTRODUCTION

A new initiative designed to empower consumers and reduce the risks that accompany seeking health information on the Internet was officially launched by The College of Physicians of Philadelphia on Wednesday, April 21, 2004, at the Northeast Regional Library. Philly Health Info (PHI) is both a community health information system and a user-friendly Internet portal (www.phillyhealthinfo.org) created for the delivery of regional health information resources and services. Philly Health Info's core objectives are first, to provide as many citizens of greater Philadelphia as possible with accurate, current, and understandable health information they can use to their benefit and, second, to test the feasibility of reaching a substantial proportion of people who are underserved by providing access to health information at neighborhood sites such as public library branches, community health centers, physician offices, senior centers, and other convenient community locations. The College has developed a network of community-based partnerships throughout the region that offer access and assistance for consumers seeking health information, as well as serving as a conduit for recruitment and training of volunteers to aid the public in accessing health information resources and services.

BACKGROUND

The College of Physicians of Philadelphia was founded as a private medical society in 1787 by the city's leading physicians, including Dr. Benjamin Rush, a signer of the Declaration of Independence, and Dr. John Morgan, the founder of the nation's first medical school. Today, The College is a nonprofit educational and cultural institution dedicated to promoting a better understanding of medicine and the roles of the physician in society. It has an honorary fellowship of some 1,500 physicians, other health professionals, and distinguished members of the laity. It is also home to one of the foremost historical medical libraries in the world and to the renowned Mutter Museum for the history of medicine. From its inception, The College has been dedicated to serving the health and medical needs of the public. An early by-law refers to "contributing in all ways to the health of the community."

The College's Division of Public Services has been optimally positioned to implement a regional health information network. In a city that hosts five medical schools and numerous health care systems, The College prides itself on its neutrality. It has nothing to sell and is committed to improving the health of the public. In 1983 The College developed Pennsylvania's first coordinated effort to share the resources of health science libraries with public libraries and other agencies through the Consumer Health Information Network (CHINET), a consortium of public libraries, medical libraries, health libraries, health agencies, health care professionals, and consumers in Philadelphia, Bucks, Chester, Delaware, and Montgomery counties. Two years later, with funding from the Commonwealth of Pennsylvania, The College was able to expand its provision of these information services to state-supported institutions throughout Pennsylvania. The resulting program was called the Health Information Services for Pennsylvania Residents Program and focused on education and reference support services for nonmedical librarians.

The C. Everett Koop Community Health Information Center, created in 1995 with funding from the Connelly Foundation, provides access to reliable and current health and wellness information. The Koop Center provides print material and Internet access free to the public and is open seven days a week, 10 A.M. to 5 P.M. The Centers for Disease Control (CDC) commissioned a formal evaluation that was highly laudatory of the Koop Center and its achievements. The College is now expanding the work of the Koop Center through the development of Philly Health Info.

The Philly Health Info Project has evolved under the leadership of Thomas W. Langfitt, M.D., the president of The College of Physicians and the former head of the Pew Charitable Trusts. In addition to Dr. Langfitt, the other members of The College's PHI team are the Director of Public Services and PHI Project Director Andrea Kenyon, Consumer Health Information Specialist and PHI Web Manager Eric Darley, Outreach Coordinator Ellen Freda, and PHI Content Manager Susan Underkoffler.

PHILLY HEALTH INFO NETWORK COMPONENTS

Philly Health Info Portal

The centerpiece of Philly Health Info is a free, multifaceted, consumer-friendly Web portal that provides a comprehensive online Philadelphia regional health information directory to assist Philadelphia-area consumers in accessing health care services. The PHI portal has been designed to benefit everyone but provides specific resources for targeted segments of the population including seniors, women, minorities, children, and youth.

The home page features a health periodical that highlights a different health topic on a quarterly basis. The lead article is written by college fellows and other area health care professionals. A feature story highlights the activities, programs, and services of an area organization addressing the same topic as the lead article.

Early in the development of Philly Health Info the Philly Health Info Project Team decided to focus our efforts on locating, listing, and maintaining links to health resources in greater Philadelphia. At the same time, we understood, and continue to understand, the value of nonregional Web sites in providing comprehensive, general health information about a wide variety of health and medical topics. We selected ten of these "national" Web sites to serve as referral sources in the event that someone cannot locate information within Philly Health Info on a specific topic. Most of these national Web sites appear on the General Health Web sites page of the Consumer and Patient Health Information Section (CAPHIS) of the Medical Library Association. The "Top 10" list of national health information Web sites include Centers for Disease Control and Prevention, Hardin Medical Directory of Internet Health Sources, Healthfinder, Medem, MedHelp, MedlinePlus, MedWeb, National Organization for Rare Disorders, NOAH, and Mayo Clinic.

Philly Health Info currently provides an alphabetical list of links to information on eighty-five diseases and disorders and health and wellness issues. The College supplements information provided by the "Top Ten" national sites with easy-to-understand health information from ADAM (medical encyclopedia) and Wired.MD (streaming videos).

The most unique feature of the PHI Portal is a directory of over 500 regional health and medical services and resources covering the 85 disease and wellness topics. The initial focus for the directory was on northeast Philadelphia in order to support the dissemination of neighborhood health resources and services at the computer kiosk located at the Northeast Regional Library. In early 2004 The College hired a full-time content manager, who provided the necessary person power to expand Philly Health Info's geographic coverage to include the entire city of Philadelphia. In addition to pointing to regional resources and services Web sites, PHI works hard to identify and enter regional resources and services, support groups, agencies, and health-related events that do not have a Web presence. A template system was created to enter PHI content. The content manager scans local newspapers, and PHI staff is routinely picking up flyers, checking bulletin boards at supermarkets, and talking with community organizations. Future plans include expanding the regional services directory to include the four contiguous suburban Pennsylvania counties (Bucks, Chester, Delaware, and Montgomery).

The PHI Portal continues to be an evolving entity striving to provide a user-friendly interface for Philadelphians to access health information. The challenge is to expand the portal to meet these needs in an effective and efficient manner.

Visits to the portal are registered using a serverlog tracking product titled Index Tools. The PHI Portal offers multiple feedback options, including an online user survey, to solicit comments from users. Suggestions are also solicited from the PHI Portal Advisory Committee, which meets quarterly and is composed of librarians, public health professionals, health care providers, and medical informatics experts.

Pilot Project

In the spring of 2002 The College began plans for the launch of a pilot project in partnership with the Free Library of Philadelphia and the Philadelphia Department of Public Health to test the feasibility of bridging the digital divide through the intermediation of Internet access sites in neighborhood locations. After discussion with our outreach partners, a computer kiosk was installed in the Northeast Branch of the Free Library, which is adjacent to Community Health Center #10. Situated at the busy junction of Cottman and Bustleton Avenues, they are the busiest facilities of their kind in the city.

In preparation for the Northeast Pilot, the PHI staff team determined that a community assessment of the demographic characteristics, health status, and health information needs of Philadelphia citizens was necessary to assist in the implementation of the PHI project. The College contracted with the Philadelphia Health Management Corporation (PHMC) to include five health information questions in their Community Health Database 2002 Southeastern Pennsylvania Household Health Survey. The questions asked were

* When you want information about health, where do you primarily get it from?

* What type of health information do you primarily look for?

* What type of health information is the most difficult for you to find?

* How do you prefer to get information about health?

* Where do you primarily use the Internet?

In addition, PHMC conducted six focus group discussions with northeast Philadelphia residents. Numerous key informant interviews with northeast Philadelphia community leaders were also conducted during the spring of 2003. The findings from this community assessment showed that chronic conditions affected three out of ten people in northeast Philadelphia and that these findings presented an opportunity for Philly Health Info to provide an important public service to the community. The PHMC Household Health Survey indicated that younger adults are more likely to obtain health information from the Internet than other age groups. Certain groups also are more likely to obtain health information through the Internet; for instance, more Asian adults get information this way compared to white, African American, and Latino adults. Among adults who use the Internet, the majority access the Internet from home, followed by work. African American adults are much more likely to access the Internet at the library compared to other racial groups. The poor and uninsured are also more likely to access the Internet through the library than the nonpoor and the insured. The final PHMC report acknowledged that making Internet access available to diverse groups will present many challenges, such as the need to understand various methods of communication among population subgroups as well as issues concerning access to the Internet. In addition the report stated that copromotion with other social service agencies that are catering to the need for increased computer literacy training would be advantageous.

After a "soft launch" period during the winter months of 2003-2004, the PHI kiosk at the Northeast Regional Library was officially launched on Wednesday, April 21, 2004. The computer station, which consists of a desk with a computer, printer, and two chairs, is located on a landing in a highly visible location that still affords some privacy. Volunteers trained to assist patrons with health information questions are scheduled for two hour shifts on Monday, Tuesday, Wednesday, and Saturday from 10 A.M. to 2 P.M.

Visitation was slow at first but has increased due to media attention from local northeast newspapers and radio stations and referrals from the Health Clinic nearby. Volunteers are asked to complete a questionnaire after each visit that records the topic the visitor requested and the volunteer's search process. Visitors are requested to complete an anonymous survey to comment on their satisfaction with the service. Contact information is encouraged but optional. Contact information will be used for follow-up telephone interviews conducted by PHMC to determine how the information was used and if the PHI service was helpful.

Plans for expansion continue to surface as organizations learn about our project and want to participate. Agencies interested in hosting a kiosk or offering health information training using the PHI Portal include high-rise apartment houses called NORC's (naturally occurring retirement communities), senior centers, physician group practices, and health centers. Three PHI neighborhood kiosks were launched in June 2004. Two will be situated at senior centers in different parts of the city and the third will be at the nurse practitioner-operated Eleventh Street Family Health Clinic in north Philadelphia. The goal is to test out the model in different environments and adjust the model accordingly.

Trained Volunteers

A unique feature of the PHI project is the use of volunteers, termed Interactive Personal Assistants (IPAs), to staff the community kiosk locations. Trained IPA's are computer literate people from the community who help patrons access information using the Philly Health Info portal. The IPA serves as a community-based intermediary to assist in bridging the digital divide. A two-day hands-on training curriculum was developed in conjunction with the Drexel University Institute for Healthcare Informatics, under the direction of Russell Maulitz, M.D., Ph.D. The goals of the IPA training are to establish a comfort level for navigating the PHI Portal, to establish the role of the IPA and the parameters in which he or she will function, to identify probable, common difficulties that may be encountered and provide tools that may help overcome them, and to provide opportunities to role-play and work with the PHI site. There have been six training sessions with approximately seven volunteers in attendance at each session. A curriculum manual has been created, providing a copy of Powerpoint presentations from the class, guidelines for handling health information questions at the kiosk, practice exercises, and materials for further reading.

The recruitment and retention of volunteers has been a challenging aspect of the project. Initially there was some difficulty in recruiting volunteers. We subsequently posted IPA volunteer opportunities on the PHI Web site, www.opportunitynocs.org, and www.idealist.org. Additional volunteers have been recruited by community locations that want to offer PHI outreach. The challenge at the moment is screening new volunteers and keeping enthusiastic volunteers involved while kiosk locations are in their infancy stages, with slow patron traffic. Additional challenges involve matching volunteers with appropriate outreach locations based on geography and schedules.

Networking

Community outreach has been critical in creating awareness of Philly Health Info and soliciting community participation. The outreach coordinator spent some initial time creating a list of community organizations to contact. During the first year of this project the focus was on organizations located or working in northeast Philadelphia. This has now been expanded based on opportunity and referral. We are now meeting with organizations throughout the city to determine ways that we can complement their community health outreach activities. A sampling of organizations we have contacted include faith-based organizations, social service agencies, community hospitals, academic medical centers, senior centers, support groups, health associations, and community-based coalitions. We have more inquiries about collaboration than we have time to explore and must constantly reprioritize our outreach activities. We have developed criteria for determining "partner readiness," which includes stability of the organization and level of commitment to the PHI project on the part of the community organization, Internet connectivity and physical setting, visitor traffic and the nature of their needs, and the organization's willingness to help promote the PHI program to their constituency.

FUTURE PLANS

Experience, funding, and opportunity are the three elements that continue to direct the PHI project. Experience has taught us that, while there is great interest in disseminating health to the community, there is no consensus on the best method for accomplishing this task. There are many stakeholders and plenty of bureaucracy and turf issues to overcome. Experience has also taught us that everything takes more time than is allotted, and understanding each organization's culture, goals, and limitations are key to mutual understanding and trust. Finally, clear and routine communication between PHI and community partners is essential to prevent misunderstandings and provide reassurances of mutual commitment and cooperation. Opportunities to collaborate with community partners continue to grow. Future plans include placement of IPA-staffed computer terminals in clinical settings and expanding our neighborhood outreach to targeted locations in north and west Philadelphia. The challenge will be to secure the human and financial resources necessary to both respond to the opportunities for collaboration and to continually test and hone the PHI model.

Andrea Kenyon, Director of the Katherine A. Shaw Division of Public Services, College of Physicians of Philadelphia, 19 S. 22nd Street, Philadelphia, PA 19103