For preventive care and chronic diseases, nurse management is essential. However, current reimbursement limits the time available for preventive services. Today's technology, such as telemedicine, has the potential to improve the efficiency of nursing care delivery while enhancing patient satisfaction. To improve access to health information for community members around Temple University, we developed a twice-weekly e-mail health message service. The design criterion was for a system that would be inexpensive and easy to use and would facilitate rapid changes to the information content. Most healthcare providers cannot set up a Web site or telemedicine system and, thus, must hire a company to develop the system and maintain the site. Because cost is a major factor in prevention, this approach has the obvious disadvantage of upfront costs. Furthermore, working through a company tends to be inflexible; that is, it is slow and hard to make changes to messages and information content. After carefully considering various options, we found that we could meet our design criterion by using a relatively simple programming language, Visual Basic for Excel. This is an easy-to-use programming language that supports the transmission of e-mail messages. It also has the advantage that all the normal Excel functions are available. Thus, changes to the information content can be made directly by the healthcare provider simply by typing in the new message into an Excel spreadsheet.
A brief summary of our development is as follows. Through previous studies, a library of hundreds of health tips and messages had already been established on hypertension, cholesterol, diabetes, smoking cessation, exercise, and nutrition. Messages on cancer, asthma, and dental care were added to this library. After the initial message sets were completed, the messages were further refined to ensure that the messages were culturally sensitive and medically correct. The messages were modified by a behavioral psychologist and were converted to an e-mail format. Community members provided their e-mail address and preferences about the kinds of health-related information they were interested in obtaining. Over the past 6 months, the Telemedicine Light application sent e-mails twice weekly to every subscriber. Some messages also contained links to other Web-based material, where interested users could find additional information about each topic. Based on the feedback received, community members found these e-mail health message helpful, and less than 1% of the participants cancelled this e-mail health message service.
We believe that this telemedicine tool can extend the reach of the nurse and help to increase health literacy and improve healthcare. It is an inexpensive and easy-to-use approach. Finding someone who can program in Visual Basic for Excel should not be difficult, and most nurses either know or can quickly learn how to use Excel. Changes/modifications/additions to the information content can be made quickly and, maybe most importantly, under the nurse's control. Lastly, text messages can also be sent out through this approach.
We would like to share this system, free of charge, with interested groups. Contact us for further information.
Sincerely,
William P. Santamore, PhD
Letitia Holloway-Owens, PhD, MPH
Suni Petersen, PhD
Ellen M. Tedaldi, MD