Association of Patient Recall, Satisfaction, and Adherence to Content of an Electronic Health Record (EHR)-Generated After Visit Summary: A Randomized Clinical Trial

Abstract

Objective: Most electronic health record (EHR) systems have the capability of generating a printed after-visit summary (AVS), but there has been little research on optimal content. We conducted a qualitative study and a randomized trial to understand the effect of AVS content on patient recall and satisfaction.Methods: Adult primary care patients (n ‫؍‬ 272) with at least 1 chronic condition were randomly assigned to 4 AVS content conditions: minimum, intermediate, maximum, or standard AVS. Demographics and health literacy were measured at an index clinic visit. Recall and satisfaction were measured by telephone 2 days and 2 to 3 weeks after the clinic visit.Results: Average age was 52 years; 75% of patients were female, 61% were Hispanic, and 21% were African American, and 64% had adequate health literacy. Average medication recall accuracy was 53% at 2 days and 52% at 3 weeks, with no significant difference among groups at either time. Satisfaction with AVS content was high and did not differ among groups. Recall of specific content categories was low and unrelated to group assignment. Health literacy was unrelated to recall and satisfaction. Supplying patients with printed instructions and information when they leave a medical encounter has become common practice. Before the availability of electronic health records (EHRs), patient educational materials often took the form of handouts and pamphlets and sometimes videos or interactive computer programs. Most EHRs enable clinicians to supply patients with individualized information in the form of an after visit summary (AVS) based on data available in patients' medical records. Recent legislation has all but required this feature to be included in the EHR for eligibility for financial incentives by meeting the Centers for Medicare and Medicaid Services' (CMS) Meaningful Use (MU) guidelines for the AVS.1 Core Measure 13 describes the objective to provide to patients clinical summaries about each office visit. According to §495.6(d)(13)(ii), the expectation is for, "Clinical summaries provided to patients for more than 50% of all office visits within 3 business days." 2The minimum set of elements recommended by CMS to achieve stage 1 of MU includes patient The EHR-generated AVS represents a potentially efficient and effective tool to support a variety of objectives for optimal patient outcomes in primary care. The majority of adult patients are followed for chronic conditions, such as hypertension and type 2 diabetes, which require long-term adherence to self-management behaviors. The concept of patient activation as a central factor in effective chronic disease self-management underlies many current behavioral interventions to improve outcomes. 3,4 In this conceptualization, the activated patient is provided with useful information about his or her condition(s), uses this information to undertake the recommended treatment plan, and engages with the provider in shared decision making to achieve desired health outcomes. The AVS can be viewed as a communication cha...

Opportunities to improve clinical summaries for patients at hospital discharge

“…Notably, literature on clinical summaries exists for the outpatient setting, but not for the equivalent document provided to patients during the hospital discharge process 32–34. Moreover, these studies assess patient and provider perceptions of clinical summaries, with limited data on health outcomes, aside from self-reported medication adherence in one study 32. Regardless, our results are consistent with others in identifying opportunities to improve clinical summaries.…”

Meaningful Use of Pharmacogenetics

“…Specifically, there have been no generalizable RCTs supporting the widespread implementation of the EMR or any of its meaningful‐use criteria (http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf). For example, one such meaningful‐use criterion—an after‐visit summary—was evaluated in an RCT, which did not demonstrate increased patient satisfaction or recall of health‐related visit information 4 . Another meaningful‐use criterion is repeated documentation of smoking status, which is also of unclear medical value 5 .…”

“…For example, one such meaningful-use criterion-an after-visit summary-was evaluated in an RCT, which did not demonstrate increased patient satisfaction or recall of health-related visit information. 4 Another meaningful-use criterion is repeated documentation of smoking status, which is also of unclear medical value. 5 Notably, the meaningful-use criterion to document family health history in at least 20% of patients (http://www.…”

Patients' perceptions of their doctors' notes and after‐visit summaries: A mixed methods study of patients at safety‐net clinics

“…A study of patients' perceptions of After‐Visit Summaries among predominantly White, college‐educated primary care patients identified multiple opportunities to improve the usefulness of the content . Another study among a majority Hispanic population found that patients liked receiving a clinical summary, and that the quantity of content did not affect patient recall or satisfaction . Feedback from safety‐net populations about use of electronic portals, and both doctors' note and After‐Visit Summary content will help optimize opportunities for communication and engagement.…”