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Liability is a big factor
Question: "What do you do when you are asked to share your patient education materials with other hospitals, physicians’ offices, and outpatient clinics? Do you have a policy in place for such requests and what does it include? For example, how do you handle revisions when clinical information changes?"
Answer: Although there is no formal policy at The Ohio State University (OSU) Medical Center, all patient education materials are available to affiliates via the Intranet. Agencies outside the OSU system are asked to submit a request in writing.
"Our informal policy’ is to inform the person requesting the material that it can be obtained off our Internet site (www.osumedcenter.edu), and they can use it with our name without copyright infringement," says Sandra Cornett, RN, PhD, program manager for consumer health education at the medical center in Columbus.
If the facility requesting the material wishes to use its own logo on a handout, it can do so for $25; however, the copyright remains in Ohio State’s name. If the content is modified, the changes must be sent to the patient education office for review. "I determine if the handout was changed enough to no longer be ours, or if they should write modified with permission’ at the bottom," says Cornett.
Great Plains Regional Medical Center in North Platte, NE, has no written policy either, yet facilities that refer patients generally are given educational handouts upon request. "I feel it’s just all part of the continuum of care," says Barb Petersen, RN, patient education coordinator. Requests coming from facilities that do not refer patients are frequently given the materials if they are researching and/or updating their own publication and looking to other facilities for examples, she says.
As a publicly funded health system, the 1,100 written materials inventoried at the University of Miami Medical Center are available to any facility that wants them. The material is copyrighted so credit must be given if handouts are republished.
Over 40 low-literacy educational pieces are available on the health system’s Web site listed under the "Plain English Library of Medical Information." "The site is very heavily used because there is not much low-literacy information on the Web," says Sharon Sweeting, MS, RD, LD, CDE, patient and family education coordinator at Jackson Health System/University of Miami Medical Center.
All materials developed at Fairview-University Medical Center in Minneapolis are shared with any of the hospitals or clinics within its health system, says Nancy Goldstein, MPH, manger of patient education at Masonic Cancer Center’s Front Door, also in Minneapolis. Also, clean, original copies are provided to any facility that refers patients. "They are welcome to make as many copies as needed for the patients who will be coming to our hospital."
For facilities outside its system, there is a catalogue listing materials that are available. There is a charge for materials to help recoup the printing and shipping cost, which ranges from 10 cents per copy for simple one-page instruction sheets to $15 for extensive manuals such as those for organ transplant patients.
If the organization wants to make changes in the content, a contract is signed in which Fairview withdraws permission to use its name in the booklet. "We don’t want to be held responsible for or associated with a protocol that is not used or recommended by our facility," says Goldstein. In those instances, the medical center negotiates a one-time fee and provides a clean, original copy.
People who purchase a handout from The Ohio State University Medical Center must sign a paper with a disclaimer that states that OSU is not liable for the content. A disclaimer is on the Web site to cover any material that might be downloaded, says Cornett.
The drawback to allowing other facilities to use your materials is that they might alter them in a way that is not suitable, says Linda Kocent, RN, MSN, coordinator, patient-family education at Children’s Hospital of Philadelphia. "Families might think the revised document is endorsed by Children’s Hospital."
There are other drawbacks in addition to liability. It often takes weeks and even months to create a pamphlet and it is difficult to just hand the material to someone at another facility. Yet in the long run, it generally pays off. "I had a request for some patient education multidisciplinary forms from another facility. As I had taken a lot of time to gather this information, it was very tough to just hand it off. However, I did. A few months later, I was in need of some examples of materials and they were more than willing to return the favor," says Petersen.
Also, it is difficult to recoup the cost for developing materials, says Cornett. She estimated how much it costs to develop materials at OSU Medical Center including the author’s time, review time, formatting, illustrations, and of course her time and it came to over $70 per page.
It is difficult to recoup the cost, but OSU does insist on credit for both copy and illustrations, even if the illustrations are the only part of the pamphlet that is used. "I want credit for the illustration at the bottom," says Cornett. A drawback of sharing materials via the World Wide Web is that agencies can download material from the Web and put their name on it without permission or paying the $25 fee requested by OSU, which is copyright infringement.
Once material is obtained by another facility it is up to them to make sure they keep the information current, says Kocent. "We change our materials often to keep up with changes in practice and research. We could not possibly keep up with who was given what and whether they need the change."
Materials are frequently revised at OSU Medical Center as well, although the standard states that each piece will be revised every five years. The materials are updated on the Intranet and Internet as revisions are completed. "If an agency has modified or used a handout, I let them know that we are constantly updating the content of our materials and they need to take the responsibility to make the information current or take the most current revision from the Internet," says Cornett.
Materials at Fairview-University Medical Center are reviewed and updated annually, but organizations that purchase items from the health care system are not notified. It is each facility’s responsibility to check back for updates, says Goldstein. n
For more information about sharing educational materials with other facilities, contact:
• Sandra Cornett, RN, PhD, Program Manager, Consumer Health Education, Department of Consumer & Corporate Health Education and Wellness, 1375 Perry St., 5th FL, Room 522, Columbus, OH 43210. Telephone: (614) 293-3191. Fax: (614) 293-3690. E-mail: email@example.com.
• Nancy Goldstein, MPH, Manager, Patient Education and Masonic Cancer Center’s Front Door, Fairview-University Medical Center, Mayo Mail Room 603, 420 Delaware St. S.E., Minneapolis, MN 55455. Telephone: (612) 273-6356. Fax: (612) 273-3365. E-mail: firstname.lastname@example.org.
• Linda Kocent, RN, MSN, Coordinator, Patient-Family Education, Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104. Telephone: (215) 590-3661. Fax: (215) 590-6093. E-mail: email@example.com.
• Barb Petersen, RN, Patient Education Coordinator, Great Plains Regional Medical Center, 601 W. Leota, North Platte, NE, 69101. Telephone: (308) 535-8640. Fax: (308) 535-7473. E-mail: firstname.lastname@example.org.
• Sharon Sweeting, MS, RD, LD, CDE, Patient and Family Education Coordinator, Department of Education and Development, Jackson Health System, University of Miami Medical Center, Jackson Medical Towers-7th Floor East, 1500 N.W. 12 Ave., Miami, FL 33136. Telephone: (305) 585-8168. Fax: (305) 326-7982. E-mail: SSweetin@med.miami.edu.