Introduction
As many patients and clinicians have experienced, patients tend to forget most of what they are told during outpatient visits. In fact, patients forget 40% to 80% of the information from healthcare providers. Of what patients do remember, they remember about half incorrectly1 and the more information they are given, the less they remember2. Moreover, patients desire more information than they typically receive about their illnesses and treatment plan3. Poor retention of the treatment plan leads to non-adherence, medication errors, missed appointments and perceptions of miscommunication with the provider.
Clinical summaries of outpatient visits are a means to provide patients with the information they need after a visit with their healthcare provider4. The federal government recognizes the importance of this form of communication since the clinical summary, known as the After Visit Summary (AVS), is part of the meaningful use criteria that determines reimbursements for electronic health record implementation to physicians and hospitals.5,6 The Veterans Administration (VA) has committed to seeking meaningful use certification of the Veterans Health Information Systems and Technology Architecture (VistA) through its open source software development and an AVS would be needed to meet that certification7. What is currently available as an AVS through VistA and the Computerized Patient Record System (CPRS) is not adequate due terminology and formats that are neither patient-centered or patient-friendly.
In previous studies, a printed AVS has been shown to enhance patient trust and confidence in their physician8 and contribute to patient satisfaction.5 Despite the fact that combining oral and written information is more effective than using either oral or written information alone9, a printed AVS may be be anachronous to the trend towards electronic health records. Personal Health Records (PHR’s) provide patients with electronic access to their health record and may increase patients' engagement in their healthcare10. However, while the use of PHR’s is increasing not all patients have access to them. In fact, most veterans have not registered for the VA’s MyHealtheVet website and of those who have, only about 25% have full access to their records to include progress notes, prescriptions, secure messaging and other personal health information11. Even when patients have access to a PHR, patients access the AVS more frequently that other information available to them.12
The AVS has been selected by the Veterans Health Administration (VHA) Innovations Selection Board and approved by the Veterans Administration (VA) Undersecretary for Health to be funded for national deployment. The VA Loma Linda Healthcare System Informatics Team is working closely with the VA’s Virtual Lifetime Electronic Record (VLER) program on national deployment including uploading the AVS to MyHealtheVet (MHV) and MHV Secure Messaging. This manual provides instructions for the use of the current version of the AVS.
1 Kessels, RPC. Patient’s memory for medical information. Journal of the Royal Society of Medicine, May 2003; 96: 219-223.
2 McGuire, LC. Remembering what the doctor said: organization and adults’ memory for medical information. 1996;22(4): 403-428.
3 Tang PC, Newcomb, C. Informing patients: a guide for providing patient health information. JAMIA 1998;5(6): 563-570.
4 Throop C, The Ix After-Visit Summary (AVS), Center for Information Therapy. October 2009
5 Jha AK, et al A progress report on electronic health records in US hospitals . Health Affairs 2010: 29(10): 1951-1957
6 Centers for Medicare and Medicaid Services, Stage 2, Eligible Professional, Meaningful Use Table of Contents, Core and Menu Set Objectives, https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/downloads/EP-MU-TOC.pdf
7 Conn J. Modern Healthcare. October 25, 2012. http://www.modernhealthcare.com/article/20121025/NEWS/310259956, accessed May 2013
8 Tang PC, Newcomb, C. Informing patients: a guide for providing patient health information. JAMIA 1998;5(6): 563-570.
9 Coulter A. Patient engagement – what works? J Ambulatory Care Manage.2012; 35(2): 80-89.
10 Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records. A scoping review. JAMIA 2011; 18:515-532.
11 VHA Support Service Center (VSSC). https://securereports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fSecureMessaging%2fSM_Penetration&rs:Command=Render , Accessed October 31, 2013
12 Ralston JD, Carrell, D, Reid R, Anderson M, Moran M, Hereford J. Patient web services integrated with a shared medical record: patient use and satisfaction. JAMIA 2007; 14:798-806.