Patients who are well informed about their medical conditions and treatment plans fare better than those who are not. The literature suggests that knowledge-empowered patients are able to participate in health care decisions and in their own treatment, thereby improving their health outcome. Greenfield et al. [1
] and Beisecker and Beisecker [2
], for example, find that diabetic patients with active involvement in decisions regarding their medical treatment demonstrate improved control of their conditions.
Health care practitioners also benefit from having well-informed patients. Notkin [3
] suggests that when patients are provided with information about their care and treatment, physicians' tort liability may be limited, because many malpractice suits arise due to patients' misunderstanding of recommended courses of treatment. In a survey of cost-benefit studies for patient education in managed care and other settings, Bartlett reports that an average of three to four dollars is saved for each dollar spent on patient education [4
]. Savings are attributed to the confidence with which patients manage their own symptoms, thereby experiencing complications or exacerbations less frequently.
Recognition of the benefits that accrue when consumers are well informed about their medical care, as well as the increasing public interest in health care information, has prompted the development of patient- or consumer-oriented health information centers throughout the United States. Hospitals are forming resource centers for their patients; medical centers are opening their libraries' doors to patients [5, 6
]; and consumer health organizations are developing health resource centers [7
In addition to physical centers for health information, the quantity of health information available and the number of people accessing it via the Web has exploded. Tyson, for example, notes that eighteen million adults used the Web in 1998 to search for medical information [8
]. Web-based information stems from a wide variety of sources, including not only academic medical centers [9
] but government information sources such as the National Library of Medicine's MEDLINEplus
and PubMed systems. In fact, 30% of searches of the PubMed MEDLINE database are performed by the general public [10
Availability, however, does not ensure that those most in need of patient-oriented medical information actually receive it. Because many patients who need information about a disease or treatment are suffering from a life-threatening or chronic illness, emotional and psychological factors may constitute a barrier to accessing information. Frequently, patients are provided with so much new information, often of a traumatic nature, that they find it almost impossible to recall or understand more than a small amount [11
]. To such patients, making the decision to search for information may be very difficult. Even if patients locate a library, they may not be able to transmit accurate information about their specific condition to librarians, who then cannot make appropriate information recommendations. In addition, depending upon the setting, the librarian may have limited knowledge of appropriate resources for what may be a very rare or specific disorder. Although a wealth of information is available through the Internet, many patients lack the physical resources or the knowledge necessary to obtain materials through this route.
The provision of accurate, specific, and timely information to all members of the clinical care team, as well as to the patients themselves, is essential to providing optimum patient care. The Clinical Informatics Consult Service (CICS)*
at the Annette and Irwin Eskind Biomedical Library (EBL) has arranged this provision in the clinical setting by placing librarians directly with the team on rounds where they provide critically evaluated, just-in-time information [12, 13
]. Drawing on the successful CICS experience, and in keeping with Vanderbilt University Medical Center's (VUMC) effort to improve service to patients and their families, the EBL has embarked on a program to improve access to information using an information prescription mechanism that effectively and efficiently links patients and families with vital medical information.