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Are patient portals a substitute for discharge summaries?

- With all the EHR Incentive Program’s focus on patient engagement, personal health records (PHR) and accountable care, centered around the use of patient portals, one might assume that the paper-based discharge summary is a thing of the past.  But one physician argues that the discharge summery isn’t obsolete: in fact, it’s an incredibly valuable tool for patients and for clinicians.  In an article for The Hospitalist, John Nelson, MD, MHM says that printed discharge summaries can provide information that isn’t accessible through portals, give physicians a chance to review last-minute details of patients preparing to go home, and help hospitals reduce preventable readmissions and extend the continuum of care.

Patient portals do provide benefits, Nelson says, especially when connected to a patient’s EHR.  But most portals don’t let patients access a physician’s notes, and multiple physicians working with the same patient typically don’t get an email or text notification that changes have been made.  “Things like the need to recheck a lab test to ensure normalization prior to discharge, or make arrangements for outpatient colonoscopy to pursue the heme-positive stool found on admission, have sometimes slipped off the radar during the hospital stay and can be caught when preparing discharge summary,” Nelson explains.

In order to be a useful tool, the discharge summary should contain, at minimum, the following information: the reason for hospitalization, significant findings, procedures and treatments provided, the patient’s discharge condition, post-release instructions for patients and caregivers, and the attending physician’s signature.  Keeping this information all in one place may help patients make better sense of their conditions and be clearer about the next steps in their recovery.  It also provides a simple and standardized way for the patient to transfer the information to their primary care physician (PCP) for follow-up.

“Creation of the discharge summary isn’t the only relevant step. It should be transcribed on a stat basis (e.g. within two to four hours) and pushed to the PCP and other treating physicians,” Nelson suggests.  “It isn’t enough that the document is available to the PCP via an EHR; these doctors need some sort of notice, such as an email.”  This will also help PCPs take advantage of the new “transitional care management codes”, which require a telephone follow-up and subsequent face-to-face visit with moderate and high-risk patients after discharge.  With the same, comprehensive information available to both the patient and the PCP, these consults can become more meaningful to all parties concerned.

“I bet this simple act would have all kinds of benefits, including at least modest reductions in overall health-care expenditures and readmissions,” Nelson predicts, but he worries that patient portals are being seen as a substitute for discharge summaries instead of a complimentary tool.  As accountable care initiatives become more popular and hospitals look for new ways to avoid Medicare readmissions penalties, the discharge summary can be an important part of the quest to simplify patient hand-offs, help patients understand their responsibilities, and keep preventable readmissions to a minimum.

 

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