A content analysis of the Meaningful Use clinical summary: do clinical summaries promote patient engagement?

Abstract

This study analyzed Meaningful Use (MU) clinical summaries (CS) given to 100 older adults (⩾ 65) from 10 family physicians in an urban primary care practice. In the United States, MU was designed to promote and enhance patient engagement in hospitals and clinics across the country, providing financial incentives to physicians attesting to the Meaningful Use of a certified Electronic Health Record by meeting a series of measures and objectives. The CS is intended to support patient and family engagement by communicating elements discussed during the clinical encounter including an updated medication list, problem list, and plan of care (POC). Despite the $27.7 billion spent distributing MU payments to more than 418,000 Eligible Professionals in ambulatory care to date, there is little discussion in the scholarly literature supporting the use of the CS to facilitate patient engagement. Ten CS were accessed from each of 10 family physicians during a regular practice week. Directed content analysis and descriptive statistics were used to evaluate the summaries. Key variables of analysis included diagnoses, medications, plan of care content, availability, completeness, health literacy, format, and readability. CS contained an average of 5.2 diagnoses and 10 medications. Summaries contained vital signs (98%), lab results (9%), smoking status (88%), professional care team members (4%), follow-up appointments (46%), and POC (67%); 37% of CS were judged to be incomplete. Readability scores indicated that a university education was required to understand the CS. CS support patient engagement by supplying information that supports behavior change and self-management, however barriers to patient engagement exist, including (a) access, (b) poor document readability, and