Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design.

Abstract

We explored patients' and clinicians' perspectives on electronic health record (EHR)-generated outpatient after-visit summaries (AVSs) to inform efforts to maximize the document's utility. This qualitative study involved focus groups and semistructured interviews with patients ( n = 39) and clinicians ( n = 56) in adult primary care practices serving socioeconomically diverse communities in New York City; Long Island, New York; and Chicago, Illinois. Focus group and interview transcripts were coded and analyzed following standard qualitative methods. Core themes included the use and purpose of the AVS, content modification and prioritization, formatting improvements, customization, privacy and accuracy concerns, and clinician workflow concerns. While most patients valued the document as a visit summary, others considered it a general summary of their health and health care issues, useful for sharing with family or clinicians even if they had access to their health records via web portals. Patients expressed a preference for the order of content items, and many wanted the reasons for medications and referrals stated. Additionally, some patients were confused by multiple medication lists indicating started, stopped, and modified medications, and a single "current" medication list was preferred by both patients and doctors. Concerns were raised about the risk of violating patient privacy and challenges to clinician workflow. The AVS is valued by patients and clinicians. Both groups have identified numerous ways it can be improved, but also several obstacles to improvement and effective use. EHR vendors should work with stakeholder groups to improve the AVS to ensure that this important communication device achieves its patient-centered potential.