* Background and Significance: 3 million people a year require lower extremity amputations (LEA) related to complications from diabetes. This number has decreased since the 1980s because of health promotion initiatives. However, multiple electronic education sources may be written above recommended reading and comprehension levels. Lack of comprehension of health information can directly impact the ability of patients with diabetes to take action on foot care recommendations to prevent LEA.
* Framework: Malcom Knowles theory of adult learning, or Androgogy, introduced the idea that adults learn differently than children and learning must meet the learner where their needs are. This framework outlines the transaction of learning by focusing on the knowledge to be attained and addresses the learner’s needs.
* Objective: The purpose of this study was to compare the reading level, understandability and actionability, or comprehension , of diabetic foot care patient education materials available from five electronic health records (EHRs). These five EHRs include NextGen, eClinicalWorks, Cerner, Epic, and MEDITECH.
* Methods: Five registered nurses, independently assessed the reading level, understandability and actionability (or comprehension) of diabetic foot care patient education materials available from five popular EHRs using the Patient Education Materials Assessment Tool (PEMAT) and the Simple Measure of Gobbledygook (SMOG). Each registered nurse was blinded from one another's scores. The scores were combined and analysis using SPSS technology.
* Results: PEMAT and SMOG tools have established reliability and validity, verified with Cronbach’s alpha from .98-.99. Repeated measures ANOVA with Tukey's LSD post hoc comparisons determined differences (p<.05) existed in reading level, understandability and actionability among the five sets of patient education materials. The actionability scores of MEDITECH were significantly higher (70 +/-3.33) than NextGen (60 +/- .00) and eClinicalWorks (64 +/- 4.00).
* Conclusion: Among the five EHRs appraised, there were differences between the reading level, understandability, and actionability. MEDITECH scored highest in actionability and within an acceptable reading level rendering it most favorable for patient education.
* Discussion: Providers should be aware EHR generated education may not coincide with patient and/or caregiver abilities to comprehend and act. Providers may be required by a facility to utilize EHR generated educational materials to meet meaningful use standards but, may need to augment with supplemental sources of patient education.
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