ExitCare Editorial Process Guidelines

June 12, 2006

Purpose and Scope

The ExitCare editorial review process reflects the EXITCARE commitment to excellence in cultivating health literacy. In order to meet the editorial goal of providing peer-reviewed, evidence-based, and lay-person understandable content that is consistent with current medical guidelines, the EXITCARE professional staff includes a Chief Medical Officer (CMO), Editors-in-Chief, and a number of Medical Reviewers, medical professionals including ED, primary care and specialty physicians and Allied Healthcare Reviewers, nurses, NP, PT, as well as Medical Literacy Editors, Document Specialists, medical illustrators, translators, and programmers.

EXITCARE employs a proprietary Document Management System (DMS) application that was developed specifically for EXITCARE in order to meet its unique needs. The DMS is at the core for managing thousands of medical topics in multiple languages, and includes an extensive repository of color illustrations and photos. EXITCARE releases quarterly updates of new and recently edited topics for ExitCare Complete and ExitCareED. E.P.I.C. Instructions are updated annually. All documents are maintained in a proprietary format. For partners needing other formats, a conversion program (OEM Content Exporter) has been created. This makes documents available in other file formats including HTML, RTF, PDF, and plain text.

EXITCARE is committed to providing an enterprise-wide solution that addresses the needs of the emergency department, ambulatory care, and in-patient services. EXITCARE content is specifically designed for integration with Electronic Medical and Health Records. Therefore, the individual topics have been tagged with ICD-9 and CPT codes.

Objective

  • To create patient education content that will be easy to read and understand.
  • To use evidence-based healthcare guidelines when available.
  • To use best practice guidelines when evidence-based guidelines are not available.

Guidelines

Standards
  • Health Literacy Standards: Content must be easy to read and understand. Content must be at a 6th to 8th grade reading level when possible, based on Flesch-Kincaid Scale. Criteria include:
    • Placing special emphasis on easy reading for the “Home Care Instructions” and “Seek Immediate Medical Care If” sections.
    • Using a consistent format to improve readability. Format includes:
      • Section headings
      • Bullet points
      • Color graphics
      • Standardized titles, phrases, and nomenclature
  • Review Frequency Standards: The Editors-in-Chief and the Medical Reviewers assess the topics either annually, or once every 2 to 3 years. The criteria for annual review include:
    • Reviewing the 100 most frequently used patient instructions as defined by the CMO, Editors-in-Chief and the customers of ExitCare.
    • Considering topics of special interest to the CMO, Editors-in-Chief or end users.
    • Incorporating new practice guidelines.
    • Reviewing topics containing time-sensitive materials.
    • Applying new JCAHO or other regulatory organization guidelines or suggestions.
  • Editorial Panel Standards: Both specialist and primary care physicians and other allied healthcare professionals serve on the editorial panel. The appointments, qualifications, and responsibilities of the EXITCARE team include:
    • CMO (Appointed by the EXITCARE board.)
      • Oversees development of all phases of medical content.
      • Selects new topics from recommendations of end users and reviewers.
      • Coordinates DMS and editorial review and translation selections.
    • Editor-in-Chief ED: (Appointed by CMO. Board certified emergency physician.)
      • Reviews and edits topics for ExitCareED content to meet current best-practice guidelines
      • Works with CMO and Document Specialist to assign review topics to other medical specialists and healthcare professionals.
      • Performs periodic comprehensive review of ExitCareED instruction content.
    • Editor-in-Chief In-Patient and Editor-in-Chief Ambulatory Care: (Appointed by CMO.) Board certified in family practice and/or internal medicine.
      • Reviews and edits ambulatory care and in-patient topics content to meet current best-practice guidelines in ExitCare Complete.
      • Works with CMO and Document Specialist to select topics.
      • Reviews content.
  • Medical Specialty and PCP Reviewers: (Appointed by CMO or Editors-in Chief.) Board certified physicians in Emergency Medicine, Internal Medicine, Cardiology, Gastroenterology, Infectious Disease, Orthopedics, Surgery, ENT & and Oral Surgery, Ophthalmology, Urology, Pediatrics, Psychiatry, Obstetrics & Gynecology, Dermatology, Radiology, Clinical Pathology, PCP’s and OB/GYN’s.
    • Conducts assigned periodic reviews of all relevant topic content to meet current best-practice guidelines.
    • EXITCARE CMO, Editor-in-Chief, and Document Specialist assign topics.
    • Document Specialist coordinates this process.
  • Allied Healthcare Reviewers: (Appointed by Editors-in-Chief.) These will include Nutritionists, Physical Therapists, Pharmacists, Nurse Practitioners, and Medical Educators.
    • Reviews assigned document content as required by Medical Specialty and PCP Reviewers.
    • Medical Reviewers coordinate this process.
  • Peer Review Standards:
    • No fewer than two physicians will review medical content.
    • The EXITCARE team will use evidence-based guidelines when available.
    • Primary resources will include peer-reviewed professional journals and textbooks, CME conference materials, medical software, certified websites, The Medical Letter Treatment Guidelines™, and Gold Standard Multimedia™ (or current drug information vendor).
    • The EXITCARE team will maintain a database of references used while reviewing existing and new topics.
  • Medical Illustrations Standards:
    • Seif and Associates, a Strategic Partner of EXITCARE, provides high-resolution medical illustrations.
    • Medical Illustrators with a Master’s Degree from an accredited Medical Illustration College perform the Seif work.
    • The CMO or Editors-in-Chief are responsible for assigning appropriate graphics and appropriate labels to new or revised documents.
    • The CMO, Editors-in-Chief, and current EXITCARE customers provide the DMS administrator with requests for graphics so illustrations can be included correctly in the document.

Processes

  • English Content Review Process:
    • DMS administrator will track documents that the Medical Reviewers and Literacy Editors need to review and will provide appropriate electronic or hardcopy content to these reviewers.
    • Editors-in-Chief and Medical Reviewers will review each topic to ensure that the content meets current evidence-based or best-practice guidelines.
    • The Document Specialist and the ExitCare Team will ensure the Last Reviewed and Last Revised dates are listed in the document footer.
    • Literacy Medical Editors will be responsible for user readability to comply with the company’s guidelines. Literacy editors are non-physicians who are professional technical and scientific communicators with experience in document usability and the healthcare industry. They work closely with the CMO, Editors-in-Chief, and Medical Reviewers to maintain the integrity of the clinical content. As a team, the literacy medical editors will help to create a document that is clinically correct and meets our literacy standards. Their duties include:
      • Using the Flesch-Kincaid Scale analysis as a guide to achieve appropriate reading levels.
      • Maintaining consistent document formatting.
      • Editing document copy.
      • Testing and confirming document usability.
  • Foreign Language Content Review Process:
      • Medical Reviewers will consider and update substantive topic changes in approved languages.
        • A substantive change to a document is defined as a major change in the diagnostic evaluation, treatment guidelines, or specific warnings described in the content.
      • The CMO and Editors-in-Chief will be responsible for determining when the revisions or new content are substantive and require translation.
      • Translation services employed by EXITCARE must have medical professionals on staff to review the translated work. At least two different translators will translate and proof the document.
      • Translators will use SDL TRADOS™ or similar translation memory software to insure that the phrases and sentences are translated in a consistent manner.
      • After the translation is complete, EXITCARE may spot check the work using independent physicians, nurses, or language specialists to determine the quality of the work.
      • We will consider translation requests from customers.
      • “For You” questions (an end-of-document patient quiz) will be translated into Spanish in September 2006.
  • New Topics Selection Process:
    • EXITCARE adds new topics each quarter to ExitCare Complete and ED.
    • EXITCARE will select new topics for E.P.I.C. Instructions from the ExitCare documents annually for 2006 and 2007.
    • The selection of the new topics is primarily driven by:
      • Requests from the EXITCARE customers.
      • Recommendations of CMO, Editors-in-Chief, or Medical Reviewers.
      • New diseases, vaccines, medical research and treatments.

Conclusion

ExitCare has developed a Proprietary DMS program and procedure for implementing an editorial process to ensure the goal of providing understandable, evidence-based, and well-illustrated patient educational information. These are patient education and aftercare instructions for the enterprise-wide needs of the entire medical profession.

 

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