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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Value – Hospitalizations (Discharge Summary/Continuity of Care) ToC
Please indicate for each category of information the value to your practice from Hospital Discharge ToC documentation
Section
All
Exp
Discharge Medications
92%
94%
Allergies / Intolerances
80%
81%
Immunizations
48%
57%
Discharge Diagnoses
90%
Hospital Course
79%
Encounters
47%
42%
Results
89%
Problems
83%
Discharge Diet
37%
41%
Procedures
86%
Discharge Instruction
64%
68%
Medical Equipment
36%
Chief Complaint / RoV
85%
Functional Status
59%
58%
Social History
34%
Plan of Treatment
Mental Status
60%
Family History
29%
27%
Hospital Consultation
84%
Advance Directives
56%
Payer Information
24%
History of Present Illness
82%
Vital Signs
52%
53%
Review of Systems
28%
Admission Diagnosis
History of Past Illness
49%
Notes: 1) Percentage include responses of Necessary and Valuable
2) All is an average of 583 respondents, Exp is based on the 263 with ToC experience
3) Stop light coding is based on responses – green: highly relevant,
yellow: relevant,
red: less relevant

10. Value – Hospitalizations (Discharge Summary/Continuity of Care) ToC
Please indicate for each category of information the value to your practice from Hospital Discharge ToC documentation

11. Value – Ambulatory Encounters (Consult/Progress Note/Continuity of Care) ToC
Please indicate for each category of information the value to your practice from ambulatory visit ToC documentation
Section
All
Exp
Diagnosis
94%
96%
Interventions
74%
79%
History of Past Illness
47%
46%
Medications
93%
Physical Exam
64%
66%
Immunizations
55%
Plan of Treatment
88%
91%
Instructions
60%
Medical Equipment
38%
44%
Chief Complaint / RoV
86%
Vital Signs
56%
59%
Nutrition/Diet
36%
39%
Results
Mental Status
52%
53%
Social History
Assessment
85%
Objective
54%
Family History
33%
31%
Procedures
83%
Encounters
50%
45%
Payer Information
28%
History of Present Illness
81%
82%
Functional Status
51%
Review of Systems
30%
Problems
Subjective
Allergies / Intolerances
78%
Advance Directives
Notes: 1) Percentage include responses of Necessary and Valuable
2) All is an average of 583 respondents, Exp is based on the 255 with ToC experience
3) Stop light coding is based on responses – green: highly relevant,
yellow: relevant,
red: less relevant

12. Value – Ambulatory Encounters (Consult/Progress Note/Continuity of Care) ToC
Please indicate for each category of information the value to your practice from ambulatory visit ToC documentation

13. Value – Hospitalization and Ambulatory Experience with ToC Only
Section
Hosp
Amb
Medications
94%
96%
Problems
83%
History of Past Illness
49%
46%
Diagnosis
92%
Allergies / Intolerances
81%
78%
Encounters
42%
45%
Results
90%
88%
Instructions
68%
66%
Medical Equipment
41%
44%
Plan of Treatment
89%
91%
Mental Status
60%
53%
Nutrition/Diet
39%
Procedures
86%
Advance Directives
Social History
34%
36%
Interventions
79%
Functional Status
58%
51%
Family History
27%
31%
Chief Complaint / RoV
85%
Immunizations
57%
55%
Review of Systems
24%
30%
History of Present Illness
84%
82%
Vital Signs
59%
Payer Information
28%
Notes: 1) Percentage include responses of Necessary and Valuable
2) Hospital is average of 263 respondents and Ambulatory is aver of 255 respondents
3) Excludes for Hospitalization: Admission Diagnosis, Hospital Course
4) Excludes for Ambulatory: Assessment, Physical Exam, Objective Subjective
5) Stop light coding is based on responses – green: highly relevant,
yellow: relevant,
red: less relevant

14. Value – Hospitalization and Ambulatory Experience with ToC Only

15. 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)

16. 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)

17. 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%)

18. 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

19. 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