Based on the number of words per sentence and syllables per word, she calculates what reading grade level a patient would have to be to understand the document. If the grade level is too high, she eliminates complex words, usually aiming for between a fifth- and eighth-grade level.
A recent wave of software has emerged to automate the process, quickly identifying complex words and lengthy sentences, and suggesting simpler alternatives. Health Literacy Innovations, a small Bethesda firm, is one of the companies offering the software.
Its Health Literacy Advisor is now being used by Uryasz. Other programs on the market include the Oleander Software Readability studio, and various medical plain-language dictionaries.
A doctor recently gave Uryasz a document describing internal radiation therapy for patients.
“Your radiation oncologist has planned a radioactive implant as part of your treatment,” it said originally. Uryasz used Health Literacy Advisor to analyze the section, and changed it to say,“your radiation cancer doctor, also known as a radiation oncologist, has planned a radioactive implant as part of your treatment.”
It’s very common for doctors to use technical terms on documents intended for patients, Uryasz said. “We have to provide patients with information they can literally understand, read and act on ... In order for them to understand their disease process, we [need to] consider this like ‘Dick and Jane’ would.”
Hospitals and medical centers in the United States are recently paying increased attention to health literacy, according to Penny Glassman, head of technology initiatives at the University of Massachusetts Medical School in Worcester, Mass.
More than half of the U.S. population today has difficulty understanding health material, she said — not just non-native English speakers or the elderly, but even for those who are highly literate. “In the whole situation of when you’re dealing with health issues, you all of a sudden can’t think straight,” Glassman said.
How it works
Health Literacy Innovations, a three-person company offering consulting in health literacy, released the Health Literacy Advisor in 2010, and has since been refining the product, which is available in English and Spanish.
Its Microsoft Word add-on scans and searches documents for difficult-to-understand language — words with three or more syllables, sentences with 15 or more words, and paragraphs of 25 or more words, for instance — and suggests plain-language alternatives. The user can calculate the reading level based on various standard indices.
A nurse might type “hyperlipidemia” in a word document meant for patients with the condition — the Health Literacy Advisor would suggest using “high cholesterol” or a definition (“when the levels of fat in the blood are too high”) to simplify the document.
Founder Aileen Kantor said she started the company seven years ago when, after working in health care administration and communication, she noticed a lack of health care literacy solutions. Since then, she’s noticed increased emphasis in hospitals on patient engagement, because of health insurance requirements that terms like “co-pay” and “deductible” be defined more clearly in documents.
Health Literacy Innovations sells the product to clients, issuing a licensing fee per user. A single license costs $399 a year, but large corporations can often get discounts for licenses in bulk. Clients include the agencies at the Center for Disease Control and the National Institute of Health, Howard University Hospital and the National Library of Medicine. The core technology is developed by the Health Literacy Innovations team itself, supported by a few virtual contractors, Kantor said.
Since licensing fees are charged per user and development cost is mostly fixed, Kantor said, the company and the product are currently profitable. The product can be customized to highlight or ignore certain terms — proper nouns, for example — but for the most part, “the belly of it is its lexicon of thousands of words.”
While it might be cheaper for doctors to write more simply in the first place instead of paying for automated tool, it’s often a challenge, Glassman said — partly because they “think in bigger words”, but also because “they feel if they make it simple they’re talking down to people,” she said.