Do patients understand the aftercare instructions generated by your electronic health record, or the educational material you post on your Web site? If they don't, you're not only running afoul of regulatory demands for good communication, but also imperiling quality of care, which can hurt both patients and the bottom line.

An estimated 14 percent of Americans are "health-illiterate," and another 20 percent have only basic health literacy, according to the National Center for Education Statistics. "The average American reads at a 5th grade level, and the average health care information is written at a 10th grade level," says Aileen Kantor of Health Literacy Innovations, Bethesda, Md., which sells software that analyzes documents for comprehensibility and suggests changes to render them to an appropriate reading level. "If people can't understand their health care information, they're going to make mistakes."

In one study of caregivers for young children, almost half made dosing errors when they were given standard medication counseling, and fewer than 10 percent followed instructions to the letter. When they were instructed using plain language and pictograms, the dosing error rate plummeted to 5.4 percent, and almost 40 percent adhered to all the directions.

Kantor, whose company was founded specifically to address a growing interest in improving communication with patients, says health literacy has gone from a "cool thing" to a must-have, due to increased attention from regulators and liability concerns when patients don't understand their instructions.

As payers move to value-based purchasing, it will be even more important for providers to make sure patients understand exactly what they need to do.

Kantor says providers often aren't aware that their patients might have problems understanding the material they receive. "I use our software tool on information from the world's best clinics, and it's written at a college reading level," she says. "It's all medical jargon and long sentences."

A feature story in the July issue of Health Data Management explores how plain language communications is becoming a way of life for some provider organizations.

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