Usability of Electronic Health Record–Generated Discharge Summaries: Heuristic Evaluation (Preprint)

Abstract

BACKGROUND Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. OBJECTIVE 1) Identify the information about elderly patients’ recent acute care visits needed to coordinate their care. 2) Use this information to assess discharge summaries. 3) Provide recommendations to help improve the quality of electronic health record (EHR)-generated discharge summaries, thereby increasing patient safety METHODS A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently-discharged elderly patients. Based upon that data, two heuristics for creating useful discharge summaries were created. The new heuristics, along with seventeen previously-developed medical documentation usability heuristics, were applied to assess four simulated elderly-patient discharge summaries. RESULTS The initial research effort yielded lists of 29 items that should always be included in elderly-patient discharge summaries, and 7 “helpful, but not always necessary” items. Evaluation of four elderly-patient discharge summaries revealed that none of the documents contained all 36 items; between 14 and 18 were missing. The documents each had several other issues and they differed significantly in organization, layout, and formatting. CONCLUSIONS Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care-transition-related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization. CLINICALTRIAL not applicable.