Relevant and Pertinent Short Survey Results Summary May 5, 2016 Robert Dieterle Holly Miller, MD Russel Leftwich, MD

Summary of Participation Organization Total ToC1 American Academy of Family Physicians 103 62 American Hospital Association 34 28 American Medical Association 433 163 Other 43 23 613 275 Note 1: ToC – declared they have received ToC Documents Note: there are no significant differences in in answers between the full set of respondents and the 275 that have experience receiving ToC documents

Demographics Practice location distribution matches US population distribution General Practice and all relevant specialties represented All practice types (IDN/Hospital/Unaffiliated) represented Response by practice size represents solo to >20 provider practices All payer types well represented

EHR and ToC Experience 84% have used EHRs for more than 3 years 64% have or plan to send ToC documents 47% have received ToC documents hospital discharge and consults are the most common documents (80% receive at least one of each per month) 44% review the ToC as a document 33% incorporate discrete clinical data personally C i

General ToC Issues 56% declare too much information 46% declare needed information is missing 73% declare ToC organization and 57% declare lack of a clear summary are a problem >31% did not receive ToC in a timely fashion

Hospital Discharge 81% want same information as traditional discharge summary 68% want limited information rather than all hospitalization data 43% declare that important information is missing over 50% of the time

Ambulatory >81% want all information from the current ambulatory visit >87% want new or changed information from all ambulatory visits 49% declare they receive all information from the current ambulatory visit in the ToC at least 50% of the time 29% declare that important information is missing over 50% of the time

Value of Specific Information Hospital Discharge and CCD 18 of the 26 sections (includes optional sections) are considered valuable or necessary by over 50 % of those receiving ToCs Of the 26 sections listed only 4 are consider valuable or necessary by less than 30% of the respondents Ambulatory (consult/progress note/CCD) 20 of the 28 sections (includes optional sections) are considered valuable or necessary by over 50 % of those receiving ToCs Of the 28 sections listed only 1 is consider valuable or necessary by less than 30% of the respondents

Scope Preferred for Specific Information Hospital Discharge and CCD 65% want all procedures (from all hospitalizations) Roughly 50% want last available functional status (51%), plan of treatment (51%), review of systems (66%) and vital signs (48%) Hospital studies and results are equally distributed between last, first and last and all Ambulatory (consult/progress note/CCD) Majority want functional status (77%), plan of treatment (74%), problems (64%), procedures (52%) , results (65%) review of systems (87%) and vital signs (79%) from the current visit only (not from prior or all visits)

Medications Hospitalization Ambulatory Visit 89% declare active and prescribed meds at discharge necessary (60% declare they are always received) admission (88%) and administered (82%) medications necessary or useful (<25% declare they are always received) Ambulatory Visit new (89%) and discontinued (83%) medications are necessary (52% declare they always receive new meds and only 31% declare they receive discontinued meds) 68%% declare current meds at time of visit are necessary (43% declare they are always received)

Alternative Approaches 39% want to receive less information 61% want to receive more information if they have better display and incorporation capability A significant number of respondents want (4 or 5 out of 5) User defined summaries (48%) Table of contents with links (44%) Drag and drop for incorporation of discrete data (47%) Automated incorporation (44%) Detection of duplicate data (53%)

Comments and Follow-up Count Percentage Contact information 142 23 % Willing to participate 278 46 % Providing contact information 129 Provided exit comments 86 14 % Note: this from all respondents

Summary 47% of responding providers currently receive ToC documents Hospital visit – want same information as paper discharge document Ambulatory – want all information from current visit Ambulatory – want changed information from prior visits Over 50% want 18 of 26 and 20 of 28 sections Only 4 sections of discharge summary / CCD and 1 section of consult/progress note/CCD are wanted by <30% 56% want less information -- appears to be related to repeated sections (e.g. results / vitals from hospitalizations) and prior visits 61% want better tools to review and incorporate 46% declare important information is missing in ToCs