Patients Want Detailed After-Visit Summaries


WASHINGTON – Patients want more information about their medical visits than physicians think they need or can benefit from, according to a study of physician and patient perspectives on the after-visit summary generated by electronic health record systems.

“Doctors think patients should get one or two pages of information, no more, or it will be too much. Patients, on the other hand, were asking for more,” said Susan Nash, Ph.D., of Baylor College of Medicine, Houston, who added that the content areas requested by patients in their research “actually align very well with components of the meaningful use requirements.”

The content of the after-visit summary is currently being standardized as one of the 15 core requirements of meaningful use that is necessary for physicians and other providers to receive federal EHR incentive payments. All certified EHR systems will need to be capable of providing the patient with a summary of the topics and instructions that were discussed during each medical visit.

“As much as 40%-80% of information that patients get within an office visit is forgotten by the time they leave the clinic. Written information that supports the verbal information can be helpful for improving patient understanding and retention,” Dr. Nash said at the meeting. But “we really don't know, though, what the optimal content and format of the [summary] might be.”

The investigators conducted individual interviews with 12 family physicians and 48 of their adult patients regarding their experiences, attitudes, preferences, and recommendations for the content and format of the after-visit summary.

The physicians and patients were recruited from two private and two public primary care clinics serving diverse socioeconomic populations. All clinics were affiliated with Baylor College of Medicine, and all used EHRs that offer some type of electronically generated after-visit summary.

Physicians reported using the summaries in a number of ways. “Some routinely print and review the [summary] with their patients, essentially every time,” Dr. Nash said. “Others rarely even see or discuss it with their patients because these tasks are handled by someone else.”

The physicians almost uniformly view the after-visit summary as a potentially useful tool for patient education and continuity of care, but they also felt that it falls short in a number of ways, most notably with respect to its medication and problem lists, which some said mix the old and new, and the active and inactive.

Most physicians “reported a lot of confusion on the part of their patients,” said Dr. Nash, an instructor of family and community medicine at Baylor.

Mismatches between language and reading level also concerned physicians, as did privacy. “Some [physicians] were very concerned about showing potentially sensitive information on the patients' records if it would automatically appear on the summary,” Dr. Nash said.

Patients overall reported a high level of satisfaction with the after-visit summaries they received, but wanted even more information, Dr. Nash reported.

Patients wanted simplified medical terminology, but more explanation of diagnoses and medications, more specific health goals, and educational features such as personalized diet and exercise plans.

The desire for more detail on medications – as well as clearer lists that focus on newly prescribed medications – was a major theme.

Like physicians, patients also brought up issues of privacy, reading level, and language. Of the 48 patients, 18 were Spanish speakers but received the summary in English.

Based on their findings, the Baylor investigators have developed several experimental models of the after-visit summary and are testing them on patient satisfaction, recall, and use of health information, as well as adherence to treatment recommendations.

Dr. Nash reported that she had no disclosures to make.

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