This is the fourth in a series of articles examining how NIH, among other government agencies, is infusing innovation into the federal workplace.

When a patient is told he has high blood pressure at an Indian Health Service (IHS) healthcare center, the doctor no longer simply provides him a prescription for medicine, but also an individualized handout from MedlinePlus Connect.

MedlinePlus Connect, which has evolved in NIH over more than a decade, offers an increasingly valuable way for medical professionals to educate patients on a wide range of information about their conditions and the drugs that can help address them.

The doctor gives the patient a handout from MedlinePlus Connect spelling out everything they need to know about the blood pressure drug and reviews it with him before he leaves, Christopher Lamer, CDR U.S. Public Health Service, IHS told Breaking Gov.

That in turn is helping agencies such as the Indian Health Service (IHS) provide a more comprehensive health service delivery system care to nearly 2 million American Indians and Alaska natives who belong to 564 federally recognized tribes in 35 states.

MedlinePlus is NIH’s health information website geared towards everyday consumers and providers. Online since 1998 MedlinePlus is currently available in English and Spanish, but has select information in about 40 other languages about conditions and disorders, medications, and health and wellness.

MedlinePlus Connect is a free service that allows any electronic health record (EHR) system (e.g. the Indian Health Service) to easily link users to MedlinePlus. “The software was released as part of our EHR system and implemented across IHS between April and October 2011,” said CDR Lamer.

“What MedlinePlus Connect does is take code in a health IT system related to a diagnosis or a problem; the service processes that code and then returns the targeted relevant information from MedlinePlus,” explained Loren Frant, head of NLM’s Health Information Product Unit (pictured above). Frant said MedlinePlus Connect has over 900 health topic pages; each is in English and Spanish.

This is in addition to publishing health news, a medical encyclopedia, interactive tutorials and information about medications, herbs and supplements licensed from different content providers.

“Where MedlinePlus takes the whole Internet and says ‘here’s the authoritative best stuff’, MedlinePlus Connect drills it down one level further and says ‘here’s the thing from MedlinePlus that’s related to your specific information need. So it’s a really targeted response for the users of whatever system plugs into it.”

The result of this effort is MedlinePlus Connect is now the most frequently consulted scientific/medical database in the world, according to Frant.

CDR Lamer explained the IHS was working on a patient education handout website to provide patient handouts that align with their medical record and which takes advantage of the NIH’s National Library of Medicine (NLM).

“But we also realized there are too many medications, labs, and problems for us to be able to keep up with,” CDR Lamer added.

“The NLM solution came at a great time and supplemented a large part of what we were hoping to achieve with this project while helping us to achieve the requirements for a meaningful use certificate of the Resource and Patient Management System (RPMS) EHR.”

CDR Lamer explained how they integrated the problem list and medications list found in the patient’s medical record with the NLM handouts.

“The provider (e.g. doctor, nurse, pharmacist) can highlight a medication then click on an ‘info button’ to retrieve a patient handout. After printing the handout, the EHR will prompt the provider to document an education code indicating that a handout was provided and reviewed with the patient.”

The education provided to the IHS by MedlinePlus Connect is considered priceless, given that the service itself is free.

MedlinePlus Connect: Problem Solver

Loren Frant has been working on MedlinePlus since 2005 and her role has grown over time. Now she leads the MedlinePlus team putting MedlinePlus Connect under her leadership.

MedlinePlus Connect, a 2011 HHSinnovates Award winner, grew from a request to link NIH’s MedlinePlus portal to the Institute for Family Health according to Frant.

“The resulting pilot turned into MedlinePlus Connect,” Frant told Breaking Gov.

“We worked with them in 2009 and 2010 to create a pilot of MedlinePlus, what is now MedlinePlus Connect, working with the particular patient portal that they had purchased and were using. And then out of that grew a service that really is available to any health IT system that wants to link into targeted information from”

Topics cover diseases, illnesses, health conditions and wellness issues which are regularly reviewed. Links are updated daily.

“What we do on those pages is link out to the best health information that we can find for consumers that’s available for free online on that topic,” Frant added.

Rigorous Guidelines

Maintaining a body of health information that is changing daily is no easy task.

“We here at the NLM have expert medical librarians who are reviewing and selecting the content on MedlinePlus and everything that is on MedlinePlus is selected based on our rigorous quality guidelines,” Frant said.

“You can find it on our website. We have a link in the center of every page to our quality guidelines and that goes for whatever language the information is in.”

Frant emphasized that MedlinePlus Connect is totally free of advertising “because it’s a service of NLM and NIH and the Federal government, so our content decisions are just totally based on what we think is the highest quality, most authoritative consumer level information. It’s not based on what we need to sell advertising around, or anything like that.”

“We are organizing those links based on categories such as treatment information, financial information, prevention and screening,” she continued.

“So rather than a user going and doing a Google search and getting millions of results, they can come to MedlinePlus and they know that everything that they link to has been vetted by somebody on our team,” Frant said. “We’ve read it, we’ve determined that the organization that produces it is authoritative and it’s of high quality.”

Because the service is produced by NLM, it’s totally available for free.

“There’s no registration or licensing required to use it; it is totally free and open,” Frank said.

“We did that intentionally because we didn’t want to set up any barriers to people being able to adopt this. We want this to be open for people to use in production, for them to leverage in their patients. If somebody wants to do experimentations with it, we want it open and free to everybody to make use of.”

IHS’s CDR Lamer is happy to leverage the power of MedlinePlus Connect.

“MedlinePlus Connect is a fantastic resource that contains a wealth of patient focused information that is clearly written,” he said.

“It was easily implemented within our EHR and addressed many of our needs for providing a resource that is well maintained and updated. Patients and clinicians have the potential of accessing this information directly (though use of the info button) or by searching the site for more information.”