Development of an Electronic Medical Record-Integrated Enhanced After-Visit Summary

Communication between patients and providers is essential to patient-centered care and can lead to improved care quality. Poor communication, however, may impede improvement in patient self-management and outcomes. Electronic health records (EHRs) and patient portals provide outlets for clinician-patient information sharing, but they are less likely to be used by older, low-income, and minority patients. An after-visit summary (AVS) is a paper document given to patients post-appointment and is intended to inform them about their health, services received, and how they can take care of their health. If properly designed, the AVS can be used as an educational tool, facilitate patients’ understanding of their health, and encourage adherence to preventive tasks.

This project researched evidence-based strategies and incorporated them into the development of a patient-centered AVS. Investigators implemented the AVS in an EHR system and pilot-tested the prototype among patients and providers. By communicating printed health information, researchers aimed to increase the comprehension and usability of the document for all populations, including patients with limited health literacy, English proficiency, or cognition.

The specific aims of the project were as follows:

• Identify the content, formatting, and features of the AVS that are most important to patients, caregivers, and healthcare providers. 
• Develop a prototype AVS based on findings. 
• Test the impact of the prototype on patients’ experience with care and understanding of their healthcare self-management tasks. 

Phase I of the project focused on researching preferred AVS context and formatting, identifying barriers and facilitators of AVS optimization and implementation, and creating an optimized AVS prototype in an EHR system. The second phase tested the impact of the AVS on patient outcomes in pre-treatment and treatment periods. Researchers found that the optimized AVS increased patients’ use of the tool as a reminder to take their medications; it also increased their likelihood of receiving an AVS from the clinician. However, the new AVS did not improve patient comprehension of the content, or its value for appointment reminders. While researchers identified several features that could improve patient-centeredness, such as preferences for content and workflow integration recommendations, EHR end users are limited in their ability to make modifications to the AVS. These study findings provide information for improvements in AVS content and formatting for future AVS advancement.