Challenges optimizing the after visit summary

Abstract

Background: The after visit summary (AVS) is a paper or electronic document given to patients after a medical appointment, which is intended to summarize patients' health and guide future care, including self-management tasks. Objective: To describe experiences of health systems implementing a redesigned outpatient AVS in commercially available electronic health record (EHR) systems to inform future optimization. Materials and Methods: We conducted semi-structured interviews with information technology and clinical leaders at 12 hospital and community-based healthcare institutions across the continental United States focusing on the process of AVS redesign and implementation. We also report our experience implementing a redesigned AVS in the Epic EHR at the Mount Sinai Hospital in New York City, NY. Results: Health systems experienced many challenges implementing the redesigned AVS. While many IT leaders noted that the redesigned AVS is easier to understand and the document is better organized, they claim the effort is time-consuming, Epic system upgrades render AVS modifications non-functional, and primary care and specialty practices have different needs in *

Creation of a Patient-Centered Journey Map to Improve the Patient Experience: A Mixed Methods Approach

“…Research has found that patient needs vary based on health contexts of chronic illness vs acute medical situations, and longitudinal primary care vs specialty care. 26,27 Current solutions provided by EHR vendors may not meet the needs of patients, caregivers, or providers. 26 Health care providers have the opportunity to push the development of health care visit summaries tailored to patient learning styles, incorporating technological solutions such as audio and video to supplement printed materials.…”

Writing outpatient letters to patients

“…This was intended to empower patients and encourage self-management by helping them to understand their health, but AVS documents are often long, poorly laid out, and contain a lot of medical jargon. Clinicians and patients have attempted to improve the layout and readability of these documents, and to incorporate the type of plain language that is used in patient addressed letters; however, the inflexible architecture of electronic health records makes it difficult to implement these improvements 12…”

“…Subheadings can help with clinical coding of the information22 but using too many headings in a “pro forma” layout makes the letter impersonal and harder to read 12…”

Exploratory Survey on the Subjective Meaningfulness of Digitization among Nurses at two Hospitals in Japan

“…In addition, young people may have different levels of ICT literacy, which may deteriorate with heavy workloads and tiredness. Managers may also need to keep in mind that digitization has not always been handled in ideal ways [5][6][7][8][9]. We are awaiting a comparison between data from our hospitals and data from Freiburg.…”

“…Although various advantages of digitization have been reported, such as access to information that brings added value in increasing usage and health information exchange, consideration for older professionals was also mentioned in terms of skills needed to use the system [8]. Electronic health records are also reported to have some limitations in optimizing after visit-summaries [9]. However, well-trained nurses showed relatively high rates of ICT manipulation [10].…”