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 |