Appl Clin Inform 2018; 09(03): 714-724
DOI: 10.1055/s-0038-1668093
Research Article
Georg Thieme Verlag KG Stuttgart · New York

A Heuristic Evaluation to Assess Use of After Visit Summaries for Supporting Continuity of Care

Patrice Tremoulet
1  Health Devices Department, ECRI Institute, Plymouth Meeting, Pennsylvania, United States
2  Department of Psychology, Rowan University, Glassboro, New Jersey, United States
,
Ramya Krishnan
1  Health Devices Department, ECRI Institute, Plymouth Meeting, Pennsylvania, United States
,
Dean Karavite
3  Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Naveen Muthu
3  Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
4  Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Susan Harkness Regli
5  Department of Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
,
Amy Will
6  National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, United States
,
Jeremy Michel
3  Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
4  Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
7  ECRI Institute Technology Assessment, Plymouth Meeting, Pennsylvania, United States
› Author Affiliations
Funding This effort was fully funded by ECRI Institute.
Further Information

Publication History

28 February 2018

27 June 2018

Publication Date:
12 September 2018 (online)

Abstract

Background Outpatient providers often do not receive discharge summaries from acute care providers prior to follow-up visits. These outpatient providers may use the after-visit summaries (AVS) that are given to patients to obtain clinical information. It is unclear how effectively AVS support care coordination between clinicians.

Objectives Goals for this effort include: (1) developing usability heuristics that may be applied both for assessment and to guide generation of medical documents in general, (2) conducting a heuristic evaluation to assess the use of AVS for communication between clinicians, and (3) providing recommendations for generating AVS that effectively support both patient/caregiver use and care coordination.

Methods We created a 17-item heuristic evaluation instrument for assessing usability of medical documents. Eight experts used the instrument to assess each of four simulated AVS. The simulations were created using examples from two hospitals and two pediatric patient cases developed by the National Institute of Standards and Technology.

Results Experts identified 224 unique usability problems ranging in severity from mild to catastrophic. Content issues (e.g., missing medical history, marital status of a 2-year-old) were rated as most severe, but widespread formatting and structural problems (e.g., inconsistent indentation, fonts, and headings; confusing ordering of information) were so distracting that they significantly reduced readers' ability to efficiently use the documents. Overall, issues in the AVS from Hospital 2 were more severe than those in the AVS from Hospital 1.

Conclusion The new instrument allowed for quick, inexpensive evaluations of AVS. Usability issues such as unnecessary information, poor organization, missing information, and inconsistent formatting make it hard for patients, caregivers, and clinicians to use the AVS. The heuristics in the new instrument may be used as guidance to adapt electronic health record systems so that they generate more useful and usable medical documents.

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by ECRI's Institutional Review Board.


Supplementary Material