Wednesday, December 7, 2011

Meaningful Use Core Measure # 13 - The Patient Generated Clinical Visit Summary

One of the Meaningful Core Measures is to provide a clinical summary of the office visit [PDF] to each patient.  This a well-intended measure as we know that patients will often retain only a part of all the information that they received at the office visit.  The summary needs to contain very important information about the visit and decisions made during the visit including patient instructions.

Patients when they leave the office often go out with a sheaf of papers and find it difficult to know which ones they really need to read.

I have been actually giving the patient the "task" of creating their own summary of the office visit.  Once we have gone through the history and exam and labs, I will engage them in a discussion on next steps.  Then I ask them to summarize the plans and action steps and write them down on a piece of paper.   They write down what they agree to do instead of what I would tell them to do.  They take this paper with them as a summary of the visit in addition to the EHR  generated printed after visit summary.

This activity can take a couple minutes but is incredibly powerful.  There is something about a patient's own handwritten plan that cannot be replicated by a physician generated print out.

This is a summary created by a hypothetical patient who was diagnosed with high blood pressure.
Patient Generated After Visit Summary
How different is it when a patient-physician discussion results in the patient writing down himself that he will cut back on the alcohol vs a physician telling him to cut back and then handing him a printed patient instruction?

This process has another advantage - it gives the physician an idea about the patient's literacy level.  This has to be addressed in a sensitive manner but is incredibly useful information that each physician should know but often does not.  This may also not be appropriate for patients with writing disability (Parkinson's or Rheumatoid).  In these cases you can ask a patient to tell you what to write down.

If you want you can take scan the handrwitten document with an app on your iphone or android and upload into the EHR (make sure your HIPAA police are OK with this.  One option is not to have any patient identifiers on the image like the one above)