Our content standards

Whether it's a HealthSheet™ in Krames on FHIR®, articles in the Consumer Health Library, or printed booklets and brochures from Krames Store—all Krames content undergoes the same rigorous process to ensure accurate, accessible content for your audience.


Meet the in-house team

Our team includes:

  • Clinicians with advanced degrees
  • Medical librarians
  • Certified medical illustrators
  • Medical editors
  • Medical writers
  • Designers

Content development and sourcing

Editorial content is written for reading levels from 4th to 8th grade—with a general target level between 6th and 8th grade—depending on audience and topic requirements. The level is measured with commonly used readability scales (Gunning Fog, Flesch-Kincaid, and FK Reading Ease). Beyond grade-level assessment, content is developed with a focus on health literacy using tools such as Centers for Medicare & Medicaid Services (CMS) Toolkit and Plain Language and Training Resources from the National Institutes of Health.


Medical and instructional images are developed to:

  • Bridge learning barriers, speaking across languages and literacy levels.
  • Convey key messages, reinforcing priority content, such as anatomy and surgical solutions.
  • Tie content and audience together with real-life solutions, including how to do exercises and perform self-care.


To ensure all content meets accuracy and accessibility requirements, we evaluate during development:

  • Clarity of technical content in text and visuals (instructional art, medical illustrations, photographs, and graphics)
  • Appropriateness of content in text and art
  • Instructional design standards for typography and layout
  • Learning stimulation motivation
  • Literacy demand
Clinical subject matter experts review all new content in development, as well as active content in print and digital collections.

Standards for sourcing and guidelines

All content is sourced when initially written and when revised and updated. The research department has access to the latest clinical resources supporting medical specialties that form the foundation of our patient education content. These resources function as evidence-based clinical decision support tools, providing a synthesis of the latest information on evaluation, diagnosis, clinical management, prognosis, and prevention. Research methods also include consultations with medical experts and information gathered at health care association events.

Acceptable sources

  • Proprietary and open access databases that pull content from journals, textbooks, guidelines, drug directories, and clinical review articles such as ClinicalKey and UpToDate
  • Associations and organizations that set standards of care for their respective fields
  • Medical journals–600+ titles
  • Clinical textbooks–1,000+ titles
  • U.S. government sources such as the NIH, CDC, FDA, NCHS, and NIOSH
  • Pharmaceutical drug information (i.e., dosage, administration, and drug interactions)

Unacceptable sources

  • Broad-based Google searches

  • Content from commercial and for-profit organizations

  • Non-U.S.-based sources

  • Private research (i.e., not vetted/published by a recognized organization)

Krames patient education is grounded in the most recent evidence-based medicine available, ensuring relevancy, accuracy, and reliability.

Our process: Reviews and updates


We monitor more than 150 associations and organizations for guideline updates, and we incorporate current practice guidelines and standards of care when creating or updating content. See appendix for a detailed list.


Copyright and contractual agreements limit how source content can be utilized. Only citations (AMA style) can be legally retained and distributed to entities outside the name of the subscribing organization.

Content review

All new content is reviewed during initial development by a minimum of two licensed clinicians, often including a physician. Active health content is reviewed on a 24-month cycle by a minimum of two licensed clinicians. All reviewers are chosen for their topic knowledge.

In addition to undergoing regularly scheduled reviews, all health content is routinely evaluated in response to:

  • Revisions in guidelines or standards of care
  • Ongoing clinical input from our subject matter experts
  • Feedback from customers and end users


All health materials are reviewed and revised to reflect the most recent medical knowledge, standards of care, and guidelines. We’re committed to the ongoing maintenance of our print and digital health content including multimedia, calculators, condition-related risk assessments, and quizzes on specific health topics.

We maintain a database of current and former independent contractors who clinically review health/clinical content in their specialties or areas of expertise—ensuring stated facts and recommendations are evidence-based, medically accurate, and reflect current best practices. In addition, a select team of independent contractor clinicians stands ready to answer questions, offer firsthand experience and clinical insight, and review content in the required area of expertise.

Content integrations and translations


Krames patient education can be retrieved and integrated into health care delivery workflows at the point of care, through integration with problem lists and other parts of the patient’s electronic medical record. We achieve this intelligent integration of content by applying industry standard billing and clinical-coding terminologies to each online asset—presenting content dynamically and automatically at an appropriate point of care.



Translations of Krames patient education are produced by a select vendor. Both a translator and an editor work on the document. Once the translated manuscript is compiled into the desired format, it’s checked by a proofreader who’s a speaker of the target language, and whose English fluency encompasses both formal written and conversational English. This helps ensure that the desired literacy level and tone of our materials are conveyed accurately in the target language.

To provide quality control and consistency across the broad range of our Spanish offerings, translations of our patient education are developed using glossaries, terminology, and style guides shared among the translation team. We translate into universal, or broadcast, Spanish with roots in the Spanish spoken in the Western Hemisphere.

List of Krames employees and independent contractors

Pat F. Bass III, MD, MPH, MS Dr. Bass is a board-certified physician who specializes in both pediatrics and internal medicine.

Trina Bellendir, MSPT, CLT Trina is a certified physical therapist.

Anne N. Clayton, BA, MPH, APRN-BC Anne is an advanced practice registered nurse (APRN) whose specialty areas include: cardiology, cardiovascular, and public health.

Tennille Dozier, RN, BSN, RDMS
Tennille is a registered nurse whose specialty areas include: pediatrics, pregnancy, childbirth, high-risk pregnancy, and high-risk newborn.

Anne Fetterman, RN, BSN
Anne is a registered nurse whose specialty areas include critical care, neurology, and cardiology. She is currently a nurse consultant for the Thomas Law Firm in Columbia, SC. Anne earned bachelor’s degrees in biology and in nursing from Baker University in Baldwin City, KS.

Amy Myers Finke, RN, BSN
Amy is a registered nurse who specialty areas include: pediatrics, childbirth, normal newborn, high-risk newborn, and high-risk pregnancy.

Marianne Fraser, MSN, RN
Marianne has expertise in public health, gerontology, hospice, health promotion, and chronic disease management.  She also has extensive clinical experience in case management, patient education with high risk populations, health care disparities, gerontology, hospice, and health care policy.  As an educator, Marianne taught community health nursing courses in university settings and implemented both national and international public health clinical experiences in geographic areas at high risk for health problems.  In addition to her bachelor's degree in nursing, she has a master's degree in community health and cultural anthropology, and doctoral work in health policy, American national government, and biomedical ethics.

Donna Freeborn, PhD, CNM, FNP
Donna is an assistant professor in the College of Nursing at Brigham Young University. She is a board-certified nurse midwife and family nurse practitioner. In 2008, Donna received her Doctor of Philosophy in Nursing and has 35+ years of professional experience in health care.

Paula Goode, RN, BSN, MSN
Paula is an Application Analyst-Certified Epic ClinDoc and Stork at WellStar Health System. She has 17+ years of experience as a registered nurse in the areas of HealthcareIT, clinical informatics, labor & deliver, intensive care, and acute care nursing.

Jessica Gotwals, RN, BSN, MPH
Jessica is a Krames employee and her title is Coordinator, Clinical Content (PES-Digital). Jessica is a registered nurse with experience in cardiac care, oncology, diabetes education, care coordination, population health, and nursing management. She has a Bachelor of Science in Nursing from Goshen College and a Master of Public Health from Oregon Health & Science University. 

Ronald J. Karlin, MD Dr. Karlin is currently an attending emergency physician at Ascension Sacred Heart on the Gulf, Port St. Joe, FL. He is board certified in Emergency Medicine by the American Board of Emergency Medicine.

He graduated from the University of Kansas with a bachelor’s degree and earned his doctor of medicine degree from the University of Kansas Medical School. He did his residency at the University of Missouri School of Medicine at Kansas City.

He has been published in this journal: Annals of Emergency Medicine, Vol. 13, Issue 6, pp. 449-55, June 1, 1984; “Septic Cavernous Sinus Thrombosis, Collective Review.

Cristina Lucuski, BA
Cristina is a Krames employee and her title is Senior Medical Editor (PES-Digital). As editor, Cristina managed the editorial production of publications for more than a dozen healthcare clients, including multiple-versioned publications of Spanish language versions. Cristina also served as program manager for MediMedia Managed Markets, a Krames sister company. Before joining Krames, Cristina worked for NJN Public Television. She holds a Bachelor of Arts degree in Communications and a minor in Spanish from West Chester University in West Chester, PA.

Alex Lupella Alex is a Krames employee and his title is Associate Content Manager. He has a background in writing, editing and project management. He holds a Bachelor of Arts in creative writing from the University of Wisconsin-Milwaukee.

Geri K. Metzger, BS
Geri is a Krames employee and her title is Senior Content Manager and Medical Editor (PES-Digital). Geri has 25+ years of experience in writing and editing health information for consumers. She joined Krames in 2012, and has experience in plain language, evidence-based medicine, and consumer engagement. Before joining Krames, Geri worked at Healthwise, Inc., Mayo Clinic, OptumHealth, and WebMD. Geri holds a Bachelor of Science degree in biomedical communications from Ohio State University.

Tara Novick, RN, BSN
Tara is a Krames employee and her title is Coordinator, Clinical Content (PES-Digital). She has five (5) years of experience as a registered nurse in the following nursing fields: medical, surgery, pain management, patient education, and informatics. 

Daphne Pierce-Smith, MSN-FNC/P, CCRC, RN
Daphne is a Krames employee and her title is Manager, Quality, Regulatory and Accreditation. Daphne manages the accreditation and quality assurance processes for Krames and serves as the chairperson for the Quality Oversight Committee. Daphne has 30+ years of professional experience in healthcare and has held several leadership and educator positions – Clinical Nurse Manager, Research Manager & Educator, Change-Agent, Research Chairperson, Pediatric Nursing Instructor, and Adjunct Faculty. In 1989, she received a Master of Science in Nursing - Family Nurse Practitioner/Clinician track - and was certified as a Clinical Research Coordinator (CCRC) by the Association of Clinical Research Professionals (ACRP) for almost 20 years. In 2008, she completed a two-year certification program in healthcare management, and in 2013, she completed a federally funded program based on the Health Information Technology for Economic and Clinical Health Act of 2009 and received a certificate as a Health Information Technology Pro-Clinician/Practitioner Consultant. Daphne was a guest researcher at the Centers of Disease Control and Prevention (CDC) and co-authored numerous abstracts, manuscripts, and medical and nursing articles while employed at Emory University School of Medicine (EUSOM). She sat on several regulatory, academic, state, and national boards, as well as EUSOM Institutional Review Board. For several years, Daphne sat on the Commission for Nursing Practice for Georgia Nurses Association (GNA) and wrote articles for their official publication. She is published and has been a contributing author in gastroenterology (GI) textbooks and clinical GI handbooks for 20 years.

Brittany Poulson, BS, RD
Brittany is a registered dietitian.

Rita Sather, RN
Rita is a registered nurse who has specialized in surgical services and ambulatory care. Rita has been a registered nurse for 35+ years and is currently working as a Legal Nurse Consultant. 

Laura Semko, MA
Laura is a Krames employee and her title is Senior Medical Writer, Digital. As editor, Laura helped hospitals and other clients in the healthcare field produce engaging print publications. As a senior medical writer at Krames, Laura specializes in creating health content that is accessible to everyone. She also has over 5+ years’ worth of technical and scientific editing experience. She has a master’s degree in writing from DePaul University in Chicago, IL.

Dianna Sinovic, MA
Dianna is a Krames Employee and her title is Director, Editorial Project (PES-Digital). Dianna oversees PES-Digital clinicians and a team of writers, editors, and contractors who create new digital patient education/content and ensure the editorial quality of existing content. She is involved in all editorial aspects of digital content, from the style guide to the technical aspects of metadata, crucial for digital content delivery. Dianna and her team troubleshoot client issues, assess content for readability and plain language, and work closely with clinicians on medical review of digital content. She began her editorial career as a print journalist. Dianna has been an editor and reporter for newspapers in California, Kansas, Georgia, and Pennsylvania, including the Philadelphia Inquirer. She has a Bachelor of Arts in English Literature from the University of Missouri-Kansas City and a Master of Arts with an emphasis in science writing from the University of Missouri-Columbia School of Journalism.

Mandy L. Snyder, MSN, ACNP-BC
Mandy is an Acute Care Nurse Practitioner who works in a Clinic/Structural Heart Program. Her specialty areas include: cardiovascular disease, cardiology, stroke, acute and chronic respiratory failure, complex wound management, thoracic critical care, pathophysiology, emergency care, and post-op care to critically ill cardiovascular patients.

Kimberly A. Stump-Sutliff, RN, MSN
Kimberly is certified as a clinical nurse specialist (CNS) in Oncology. Kimberly is an associate medical editor for the American Cancer Society (ACS), Health Promotion Department in metro Atlanta. She also publishes booklets, pamphlets, and medical information for ACS.

Wanda L. Gomez Taylor, RN, PhD
Wanda has a Doctor of Philosophy in Nursing and specializes in geriatrics and hospice care.

Callie Tayrien, RN, MSN, CCRN
Callie is a registered nurse  who specializes in critical care, trauma, interventional radiology, and nursing education. She has over ten years of nursing experience. Callie has a Master of Science in Nursing from Walden University and is certified by the American Association of Critical Care Nurses as a critical care nurse.

Kimberly Tchang, BA
Kimberly is a Krames employee and her title is Medical Editor (PES-Digital).  Kimberly also served as an editor with Krames Integrated Content Marketing Division. There she developed and managed custom publications for hospitals and health plans. Kimberly has an extensive trade and consumer magazine background and has written widely on health and wellness issues for national publications. She has a Bachelor of Arts in English/Writing from Manhattanville College in Purchase, NY.

Heather Trevino, BSN, RNC-MNN
Heather is a Krames employee and her title is Coordinator, Clinical Content (PES-Digital). Heather is a certified registered nurse who manages the medical review schedule of Krames digital health content. She is certified in Maternal Newborn Nursing, LEAN and EPIC. Heather has been a registered nurse for 15+ years.

Raymond K. Turley, SR, RN, MSN
Ray Sr. is a Krames employee and his title is Coordinator, Clinical Content (PES-Digital). Ray Sr. has been a registered nurse for 10+ years specializing in neurology and neurosurgery. He has a Master of Science in Nursing Informatics from the University of Utah. Ray Sr. has also successfully completed a Diabetes Educator Certification Course. He manages neurology, diabetes, orthopedics, arthritis, rehabilitation, vascular, and genitourinary digital health content (for Krames).

Raymond K. Turley, JR, PA-C
Ray Jr. (a.k.a.Kenny) is a certified Physician Assistant (PA). Ray Jr. has been working as a PA for 3+ years. He is currently working in general surgery and assists with surgical cases in OB/GYN. Ray Jr. also has experience in orthopedics. He attended Des Moines University in Iowa and received a master's degree in Physician Assistant studies. Ray Jr. received a Bachelor of Science at Utah State University in human movement science.

Renée Watson, MSN, RN
Renée is a Krames employee and her title is Coordinator, Clinical Content (PES-Digital). Renée has been a registered nurse for over 35 years, specializing in oncology, hospice and palliative care, triage nursing, ambulatory care, healthcare quality, and medical writing. She holds an Associate of Science and a Bachelor of Science in Nursing from Boise State University and a Master of Science in Nursing and Health Leadership from Gonzaga University.  Renée previously sat on the Idaho Medical Board's Dietetics Licensure Board. She currently is serving her second term as a Board Member for the Idaho State Board of Nursing.

Brooke C. Wheeler
Brooke is a Krames employee and her title is Senior Medical Writer (PES-Digital). Brooke has been a writer and editor of consumer health, technology, and education content for over 20+inda years. Brooke has written hundreds of patient education articles, patient consent sheets, video scripts, and other materials, for consumer-level and low-literacy readers. Before joining Krames, Brooke held senior editor posts at publications including BabyCenter.com, Americanbaby.com, AOL UK Health, and iVillagehealth.com. She attended the University of Massachusetts at Amherst.

Kristin Whitehair, MLIS, MPA Kristin is a Krames employee and her title is Senior Research Analyst. She is a librarian with experience in hospital libraries focusing on patient education and clinical care support. She has a Bachelor or Arts in History from Kansas State University, a Master of Library Science from Louisiana State University, and a Master of Public Administration from the University of Kansas.

Stacey Wojcik, MBA, BSN, RN
Stacey is a Krames employee and her title is Coordinator, Clinical Content (PES-Digital). Stacey is a Registered Nurse, specializing in ambulatory care, telehealth, and neonatal intensive care.  She has a Master of Business Administration in Healthcare Management and a Bachelor of Science in Nursing. Stacey manages cardiovascular, orthopaedic, radiology, pathology, ophthalmology, oral health, speech, physical medicine, and exercise rehabilitation digital content (for Krames).

Derek Wu, MA
Derek is a Krames employee and his title is Medical Illustrator. Derek has experience with both traditional illustration and 3D computer animation and modeling. He graduated from University of California, Berkeley with a Bachelor of Science Degree in Molecular Environmental Biology, and from the University of Texas Southwestern at Dallas with a Master of Arts in Biomedical Communications. He is a professional member of the Association of Medical Illustrators. 

Mary Ann Zapalac, MA
Mary Ann is a Krames employee and her title is Medical Illustrator. Mary Ann has 25+ years of experience as an illustrator, specializing in instructional and medical art. She holds a Bachelor of Arts Degree in Art from The University of Texas in Austin and a Master of Arts in Medical Illustration from The University of Texas Southwestern Medical Center in Dallas.  


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