Table 5.

Themes and domains of the after-visit summary, physician perspectives

Theme	Domain
AVS use and applications	Physician use
	Review information with patient to reinforce issues addressed during visit
	Clarify health information; generate AVS selectively for patients depending on their need
	Patient use
	Reference tool
	Share information with other clinicians
	Prompt physician to clarify information; correct old or misleading information
Preferred AVS content	Follow-up appointment information, including day of the week
	Specialty referral appointment information and reasons for referrals
	Specific goals of care
	Tasks assigned to patient to complete before next visit
	Reason for visit
	Listing of issues addressed during the visit
	Care plan, including treatments and instructions
	List of members of the care team
	Immunization history
	Pharmacy where patient should obtain medications
	Problem list
	Vital signs
	Exclude certain items, including lab tests that were ordered, race and ethnicity
	Customization of content
	Up-to-date medication list, without separate lists of started or discontinued medications
Preferred AVS formatting	Brief AVS
	Simplified information for improved patient comprehension
	Use of larger font sizes, especially for older adults
	More white space
	More explicit section headings, including use of larger fonts and bold typeface
	Ability to easily highlight key text, using larger font or bold typeface
	First page should include items pertinent to current visit (eg, reason for visit, care plan, goals of care, recent vital signs, provider’s name and contact information, follow-up appointment information, list of current medications, pharmacy to which prescriptions were sent)
Accuracy and other problems of AVS content	Inaccurate medication and problem lists
	Removing noncurrent medications from list results in medications appearing in “stop taking” or “discontinue” lists, causing patient confusion
	Problem lists contain diagnosis names not intended for patients; lay language needed for diagnoses and problems
	Lack of availability of Spanish and other languages
Interface	Need for dropdown menus or other strategies that reduce free-text (eg, self-management tasks, diagnoses, or problems that are the reasons for medications and referrals, goals of care, referrals; easy access to patient education materials associated with diagnoses)
	Preview window to review AVS before it is printed
Workflow concerns	Inadequate time to review AVS with patients (potential solutions discussed, included placing the printer in the exam room or having a nurse review the AVS with the patient)
	Inadequate time to populate AVS with customized information, such as instructions or goals (potential solution discussed was engaging other team members, such as nurses or medical assistants, in the process along with the patient; eg, pre-review AVS to ensure accuracy of information about medications and diagnoses)
	Privacy concerns in practices that employ centralized printers (potential HIPAA violation if AVS content discussed in common areas)
	Some physicians unaware of AVS content because it is printed at the registration desk and given to patients by a clerk at check-out