Clinical Summaries: A Valuable Part of Meaningful Use Requirements

I am a unicorn. I am one of the few physicians to qualify for the year one payment detailed in the HITECH act for achieving "meaningful use." I attested, waited (and waited), and was actually paid the mythical money for qualification. 

My experience in doing so was mixed. The majority of the criteria are actually fairly easy to meet if you have implemented a qualifying EHR product. One of these criteria, however, made life difficult even for me, a 15-year veteran of EHR use: the clinical summary. The criterion is as follows: Clinical summaries provided to patients for over 50 percent of all office visits within three business days. These summaries can be given to the patient at the time of the encounter or sent via e-mail.

There are several reasons this is difficult to accomplish. First, it requires a summary that includes all pertinent information regarding each office visit. This means that all this information needs to be gathered, put into a reasonable format, and then printed out (or e-mailed) for the patient at each visit. Some EHR vendors are making "canned" summary reports that gather the data needed, but the one from my vendor was not formatted in such a way to give "meaningful" information to the patient. I chose to make my own summary.

The second reason it is difficult is that generating the clinical summary requires a change in behavior on the part of the doctor. Like anyone else, doctors don't like change, especially if that change creates more work. If the summary is confusing to the patient, it will not only take extra time to give to the patient, it may generate more questions than it answers.

To fix this problem, I set out to make a handout that was truly "meaningful." What does the patient want or need to know at the end of each visit? It ends up that the requirements for the handout actually do match what patients need to know:

• What was the diagnosis?
• What is the plan?
• Were any medications started or stopped?
• Were any tests, labs, or consults ordered?
• What were the results of the tests done in the office?
• When is the follow-up visit?

My handout put all of this in a patient-friendly format with very little extra physician work during the visit. Now I am focusing more on maximizing this communication, because my patients are delighted with the handout. The clinical summary has become the culmination of the visit - something tangible that patients get for their time and money. I communicate better, the patients are happier, and I qualify for the bonus!

My experience, however, is not normal. Since I am a "power user" of our EHR (read: geek) and regularly modify our EHR, I could do this in a way that most offices cannot. But my experience in creating a "meaningfully useful" clinical summary reveals the following:

• The clinical summary must be worth the effort to print.
• A good clinical summary is definitely worth the effort.

Make sure your EHR vendor's clinical summary is something you would want when leaving your own doctor's office. If it is not, then get them to change it. It's definitely worth it.

* Another core requirement of meaningful use stipulates that a provider must have the capability to exchange key clinical information with other providers. To find out more read "Meaningful Use: The Electronic Communication Requirement" online at: http://bit.ly/electronic-comm.

Robert Lamberts, MD, who is board-certified in internal medicine and pediatrics, practices in Augusta, Ga. His practice won the 2003 Davies Award for outstanding application of IT in a primary-care setting. He authors the popular medical blog “More Musings (of a Distractible Kind)” http://more-distractible.org. Dr. Lamberts can be reached atrob.lamberts@gmail.com.