After Visit Summary. Engaging clinical stakeholders and patients

Transcription

1 After Visit Summary Engaging clinical stakeholders and patients

2 Overview Importance of engaging patients and families Building a patient-centered After Visit Summary How we did our work Lessons learned

3 Engage patients and families in their healthcare Improves health outcomes Supports decision-making about healthcare options Builds self-confidence and self-care skills Improves patient/family coping Increases participation and adherence in continuing care Improves the quality of patient-physician interaction

4 Health Literacy and the Electronic Health Record Health literacy is the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions.* IOM Report: "Health Literacy: A Prescription to End Confusion.

5 Building a patient-centered After Visit Summary Establish governance Involve key clinician stakeholders Involve patients

6 Establish governance AVS workgroup goals Define clear roles and responsibilities for the development and maintenance of patient education content generated from EPIC Work with the EPIC team, service lines and departments to coordinate resources and clarify mechanisms for the development and maintenance of patient education content Provide visible leadership to support the AVS implementation and delivery of patient education content Define what constitutes patient education content related to EPIC smart text, patient letters, consents, patient education resources Develop guiding principles for writing smart text and smart phrases using health literacy principles Develop a plan for effectively communicating the work of this group Identify and recommend metrics to measure success of this group

7 Involve key clinical stakeholders Clinicians Surgery Subspecialties Primary care Epic clinician champions Nursing Pharmacy Laboratory Patient Education

8 Involve patients Core principles of patientand familycentered care Dignity and respect Participation Collaboration Information sharing

9 How we did our work

10 Convened workgroups Inpatient Ambulatory

11 Conducted an environmental scan Fairview Allina Health Partners Essentia

12 Developed a framework Informed Patient Patient Ed materials AVS EPIC Capabilities Operations Content

13 Establish guiding principles The AVS is a tool for the patient. The AVS should be given to the patient after the visit. Use the AVS to provide concise patient instructions. The AVS is not meant to replace existing patient education handouts and decision support tools. Use patient-friendly language in the AVS. Reconcile all patient information on the AVS with other information the patient may have received.

14 Criteria used to build Meaningful Use requirements RARE Campaign Comprehensive Discharge Planning

15 Requirements for Ambulatory AVS Element Meets AVS section Epic Data Source Meaningful Use Patient Name Yes Header Print Group MODEL AMB AVS: HEADER (STYLED) Providers office contact information Yes Header Print Group Park Nicollet SmartText Header Date and Location of visit Yes Header Print Group MODEL AMB AVS: HEADER (STYLED) Updated medication list Yes Your Current Medications Are Print Group AVS: Amb current meds Updated vitals Yes Vital signs from your visit Print Group AVS: VITALS (RICH TEXT)

16 RARE Campaign Comprehensive Discharge Planning PN Gap Analysis Topic/Element Plan for meeting/fulfilling Written discharge plan includes the following: Reason for hospitalization Recommend removing priority and class from printed AVS Medications to be taken post discharge, including, as appropriate, resumption of pre-admission medications. Addressed in Epic enhancement o Purpose of medication o Dosage of medication o When to take medication o How to take medication o How to obtain medication Self-care activities such as diet, activity level or limitations, weight monitoring DME/supplies that patient will need for care o Purpose of DME/supplies o Where to obtain DME/supplies Symptom recognition and management what to do if patient has a question, a problem arises or condition changes, including of symptoms of which to notify health care provider o Who to contact o How to contact o Emergency contact Addressed in Epic enhancement Status Enhancement Enhancement

17 Trained clinicians Developed work flows Wrote best practices

18 Best practices for instruction section of the AVS Provide concise instructions Signs and symptoms to watch for* When to call the doctor* Medication management* (additional instructions not listed in medication section) F/u appt information* (if not listed in appointment section) Diet and activity recommendations* Reference to supplemental handouts

19 Best practices for instruction section of the AVS Reconcile patient instructions with other information the patient may have received. Use supplemental handouts instead of duplicating information in the AVS. Use patient-friendly language, avoid medical jargon and terminology. Keep patient instructions short and simple - no longer than 1-3 short paragraphs.

20 Best practices for instruction section of the AVS Review and update SmartPhrases and Dot Phrases regularly. Do not copy and past copyrighted information form non-park Nicollet sources (i.e., web sites, text books, journals, vendors). Reinforce the information verbally.

21 Talked to patients Move instructions so they can be read first. Medication list could be improved by clarifying medications that are discontinued and newly started. List brand name first, then generic name of medication. Lots of information on this form, could it be shorter, no specific ideas on how to shorten. Ok to get separate handouts with AVS. Instruction section needs to be concise and specific and actionable. Immunization information valuable. Print in color. Keep belongings section. Add information on code status or health care directive information.

22 Lessons Learned Establishing workgroups created sense of shared ownership. One AVS does not fit all. Clinicians care about the AVS and want to make it better. Patients value the AVS. Process is as important as the content. There will always be glitches and opportunity for improvement.

23 Next Steps 2012 Enhancement Optimize the instruction section Patient education vendor solution Epic deputies