Impact of Meaningful Use Patient Engagement Objectives in a Multicultural Practice-Based Research Network

Stage 3 Meaningful Use (MU) criteria have a number of objectives for patient engagement, including providing patients with after-visit summaries (AVS), patient-specific education resources, and secure messaging for provider-patient communication. While the use of an AVS is increasing, research to inform their design is limited. This project built on a prior project of AVSs, Evaluation of Computer Generated After-Visit Summaries to Support Patient-Centered Care, to evaluate the current utilization of patient engagement features of a widely implemented electronic health record (EHR) in primary care settings.

The specific aims of the project were as follows:

• Describe (1) the content of AVS Patient Instructions Sections generated during the previously AHRQ-funded project and (2) the relationship between AVS Patient Instruction Section content, including diagnosis-specific instructions, patient education materials, non-English language materials, and patient-reported outcomes.
• Survey primary care providers about their knowledge, attitudes, and practices related to using the AVS Patient Instructions Section, including use of (1) “smart phrases” designed by the system, (2) “smart phrases” produced by the individual provider or practice, and (3) non-English language materials and patient characteristics that determine decisions about the content of patient instructions.
• Compare patients’ utilization of a secure Web portal to view their medical records and communicate with providers in a private practice versus a public health care setting that serves uninsured, under-insured, and predominantly minority patients.

The project was carried out in three health care systems participating in a practice-based research network called SPUR-Net, a member of the Primary Care MultiEthnic Network (PRIME-Net) Center of Research Excellence and Learning. Two of the clinic systems served a privately insured population, and the third served a low-income, underinsured, and predominantly minority population. The study had three major components: (1) secondary qualitative data analyses with existing data collected on AVS; (2) a survey of physicians in three clinic systems to understand their current practices and beliefs regarding AVS use to provide individualized, visit-specific information; and (3) an abstraction of medical records to determine patient use of web portals.

The investigators found that AVSs without an instruction section were viewed as less useful than those with instructions. More than 80 percent of physicians reported using the instructions section and reported favorable attitudes toward AVS as a tool to promote patient engagement. The study also found that fewer than 10 percent of patients in the safety net clinics logged into the EHR web portal to access their records or communicate with providers. Outcomes indicated that Stage 3 MU criteria related to clinical summaries were realistic and already used in the studied clinics; however, criteria related to messaging through web portals may present future challenges in safety net systems.