To help alleviate some of the unknown surrounding this requirement, here are some tips on developing an office workflow for providing clinical summaries:
1. Keep in mind, paper clinical summaries will not have to be provided forever. Eventually, patients will be able to view their clinical summaries from a patient portal (in which they are provided log-in information and can have access to much of their healthcare record).
2. Until the patient portal is ready, paper summaries are the only option. Although clinics have three business days to provide the summary, to curb postage costs, we recommend offering the clinical summary when a patient checks out. The check-out staff can ask the patient if he/she would like a summary of the day's visit, and if he/she indicates 'yes', then the summary can be printed from the Daily Schedule. If the patient does not want the summary, then the staff member can record in the electronic chart that the summary was declined by the patient (for Allscripts Enterprise users, click on the blue "i" icon in the patient banner).
3. Providers are often discouraged by the requirement, not because they are opposed to the patient receiving the summary, but they want to finish documenting the visit before the patient receives the summary. If the patient is offered the summary at check out, the provider feels rushed. Here's what we suggest: document the essentials, namely the Plan and Active Problems (diagnoses), and finish the details when time allows. Much of the Clinical Summary is populated by information that the staff and nurses input (Vitals; Medical, Family, Social Histories; Demographics), so if the provider can get the Plan completed (Orders for Meds, Labs, Imaging, Referrals, Follow Ups, etc.), then the patient will receive the required documentation. Typically, the Plan is necessary for completing despite the clinical summary requirement, so this workflow shouldn't be much of a stretch for most providers.
4. Some providers have asked about how the clinical summary is populated (what sections are pulled in from the note versus the chart). For Allscripts Enterprise 11.2 users, the following sections of the note populate the summary: Chief Complaint, Reason for Visit, and HPI. From the chart, Active Problems, Medical Histories, Vitals, Immunizations, Allergies, and Orders populate the summary.
5. Keep in mind that for Stage One Meaningful Use reporting, the requirement for providing the clinical summary is only 50% of patient visits. This lenient percentage gives clinics a little wiggle room - time to adjust to the workflow, budget in the costs, and practice documenting differently, if needed. We recommend that clinic managers and administrators look over the Daily Schedule regularly, and if clinical summaries are not being produced (or documented as "denied"), the providers and staff are made aware of the issue.
Remember, change can be tough, but often, change can improve patient care. The ultimate goal of providing the clinical summary is to improve communication between provider and patient, which is good for everyone.