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Relevant and Pertinent Short
Survey Results (receives ToC only)
Final Analysis
February 19, 2016
Robert Dieterle
Holly Miller, MD
Russel Leftwich, MD
Summary of Participation
Organization
American Academy of Family Physicians
American Hospital Association
American Medical Association
Other
Total
Responses
62
27
163
23
275
Practice Location
Practice Location
Urban
Suburban
Rural
Responses
%
% US Pop
87
147
61
32%
46%
22%
26%
53%
21%
Note: % US Population is based on self declaration in US survey
Responses by Specialty
Specialty
Allergy/Immunology
Anesthesiology
Cardiology
Dermatology
Emergency Medicine
Endocrinology
Family/General Practice
Geriatrics
Internal Medicine
Medical Genetics
Count
4
3
5
15
14
7
102
1
41
0
Specialty
Neurological Surgery
Neurology
Obstetrics/Gynecology
Oncology(Cancer)
Ophthalmology
Orthopedics
Otolaryngology
Pathology
Pediatrics
Physical Medicine & Rehab
Count
Specialty
Count
0
2
8
5
10
5
4
0
12
1
Plastic Surgery
Preventative Medicine
Psychiatry
Radiology
Surgery
Urology
Other
Blank
0
0
6
0
6
2
22
1
1
3
Pharmacy
Plastic Surgery
Pulmonary
Radiation Oncology
Rheumatology
1
Other
Clinical Informatics
Family Medicine
Gastroenterology
hospice / palliative
hospitalist
Infectious Diseases
Intensive Care Medicine
1
2
6
2
1
med/peds
Medical Acupuncture
Nephrology
occupational medicine
Otolaryngology
Palliative Medicine
Pediatric Neurology
2
3
2
Responses by Practice Type
Practice Type
Count
Ambulatory Primary Care: Hospital owned or Integrated Delivery Network
179
Ambulatory Specialty Care: Hospital owned or Integrated Delivery Network
25
Hospital based
63
Skilled Nursing Facility
6
Unaffiliated Multi-specialty group
17
Unaffiliated Primary Care Practice
63
Unaffiliated Specialty Care Practice
57
Note: Respondents may indicate more than one practice type
Responses by Size of Practice and
Patient/Payer Mix
Size of Practice
Count
Patient Mix (Payer Type) (>10%) Count
Solo Practice
33
Commercial
249
2 – 5 Providers
87
Medicare
252
6 – 10 Providers
50
Medicaid
175
11 – 20 Providers
35
VA/DoD
18
> 20 Providers
67
Self-Pay
87
Not Applicable
3
Unsure
5
EHR Use by Practice Size
Solo
2-5
6-10
11-20
< 1 year
1
3
1
1
1-3 years
8
11
5
2
3-8 years
14
40
22
> 8 years
6
32
22
> 20
Total
% using
6
2%
2
28
10%
11
18
105
39%
21
47
128
48%
Exchanging ToC Documents
Sending
Receiving
No Plans / None
30
11%
In next 12 months
29
11%
< 12 months
82
30%
127
46%
> 12 months
134
49%
148
54%
Volume of ToC Documents Received
None
1-5
6-10
11-20
 20
Blank
% any
Hospital Discharge
53
67
63
40
41
11
80 %
Referral Request
101
75
23
20
35
21
60 %
Consult
51
61
35
49
60
19
80 %
Home Health
135
45
25
26
17
27
46 %
Long Term Care / SNF
158
50
14
11
12
30
36 %
Behavioral Health
154
63
15
5
7
31
37 %
Notes: 1) volume of ToC documents per month
2) % any excludes blank responses
Incorporation
Count
%
Personally Incorporate some discrete clinical data
91
33 %
Someone in practice is assigned to incorporate
68
25 %
EHR automatically incorporates discrete clinical data
53
19 %
Review ToC as a document only
121
44 %
Notes:
1) respondent may select more than one answer
2) % is of the 275 respondents
General Issues
Count
%
No Issues
16
6%
Too Much Information (I want to receive less)
153
56 %
Information that I need is missing
127
46 %
Organization or structure makes it difficult to use
202
73 %
Needs summary
158
57 %
I do not receive them in a timely fashion
85
31 %
Notes:
1) respondent may select more than one answer
2) % is of the 275 respondents
Hospital Discharge Preference
Indicate your preference for Hospital Discharge ToC documents:
Prefer
Neutral
Disagree
Limited Information form current hospitalization
68 %
17 %
15 %
Same information as traditional discharge summary
81 %
13 %
6%
All information from the current hospitalization
15 %
18 %
67 %
All information from all hospitalizations
11 %
15 %
75 %
Notes:
1) Prefer includes Strongly Prefer, Prefer
2) Disagree includes Disagree and Strongly Disagree
3) average of 255 respondents
Hospital Discharge Experience
Indicate the percentage of Hospital Discharge ToC documents that have the
following:
None
<50 %
>50 %
Limited Information from current hospitalization
20 %
46 %
34 %
All information from current hospitalization
27 %
42 %
31 %
All information all hospitalizations
59 %
32 %
9%
Missing Important information for patient care
10 %
47 %
43 %
Notes:
1) excludes blank and N/A responses
2) average of 225 respondents
Ambulatory ToC Preference
Indicate your preference for ambulatory (e.g. referral/consult) ToC documents:
Prefer
Disagree
All information from the current ambulatory visit
81 %
19 %
Limited information from all ambulatory visits (e.g. new or
changed information only)
87 %
13 %
All information from all ambulatory visits
38 %
62 %
Notes:
1) Prefer includes Strongly Prefer, Prefer and Neutral
2) Disagree includes Disagree and Strongly Disagree
3) average of 235 respondents
Ambulatory ToC Experience
Indicate the percentage of ambulatory (e.g. referral/consult) ToC documents that
have the following:
None
<50 %
>50 %
All information from the current ambulatory visit
11 %
39 %
49 %
Limited information from all ambulatory visits (e.g. new or
changed information only)
18 %
65 %
17 %
All information from all ambulatory visits
44 %
41 %
15 %
Missing Important information for patient care
16 %
55 %
29 %
Notes:
1) excludes blank and N/A responses
2) average of 216 respondents
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
Valuable
Admission Diagnosis
Advance Directives
Allergies / Intolerances
82 %
60 %
81 %
Section
Family History
Functional Status
History of Past Illness
Valuable
27 %
58 %
49 %
Section
Payer Information
Plan of Treatment
Problems
Valuable
24 %
89 %
83 %
Encounters
42 %
History of Present Illness
84 %
Procedures
89 %
Chief Complaint / RoV
85 %
Hospital Consultation
86 %
Results
90 %
Discharge Diagnoses
92 %
Hospital Course
81 %
Review of Systems
24 %
Discharge Diet
41 %
Immunizations
57 %
Social History
34 %
Discharge Instruction
68 %
Medical Equipment
41 %
Vital Signs
53 %
Discharge Medications
94 %
Mental Status
60 %
Notes: 1) Valuable includes Valuable and Necessary Responses
2) average of 263 respondents
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
Valuable
53 %
Advance Directives
Allergies / Intolerances
78 %
91 %
Assessment
Section
Immunizations
Instructions
Interventions
Valuable
55 %
66 %
79 %
Section
Valuable
Plan of Treatment
Problems
Procedures
91 %
83 %
86 %
Chief Complaint / RoV
88 %
Medical Equipment
44 %
Results
88 %
Diagnosis
96 %
Medications
96 %
Review of Systems
30 %
Encounters
45 %
Mental Status
53 %
Social History
36 %
Family History
31 %
Nutrition/Diet
39 %
Subjective
50 %
Functional Status
51 %
Objective
54 %
Vital Signs
59 %
History of Past Illness
46 %
Payer Information
28 %
History of Present Illness
82 %
Physical Exam
66 %
Notes: 1) Valuable includes Valuable and Necessary Responses
2) average of 255 respondents
Preference – current Hospitalization ToC
Please indicate for of information you wish to receive for each category
Section
Last Only
First/Last
All for x days
All
Functional Status
51 %
30 %
11 %
8%
Hospital Studies/Results
22 %
31 %
11 %
37 %
Plan of Treatment
51 %
13 %
12 %
23 %
Procedures
17 %
7%
12 %
65 %
Results
25 %
29 %
11 %
34 %
Review of Systems
66 %
20 %
7%
7%
Vital Signs
48 %
35 %
10 %
9%
Notes: 1) average of 253 respondents
Preference – prior Hospitalization stays
included in the ToC
Please indicate for of information you wish to receive for each category for each prior
hospital stay
Section
Last Only
First/Last
All for x
days
All
None
Functional Status
38 %
13 %
7%
2%
40 %
Hospital Studies/Results
31 %
11 %
8%
17 %
34 %
Plan of Treatment
43 %
9%
8%
8%
32 %
Procedures
28 %
5%
7%
29 %
31 %
Results
37 %
11 %
7%
14 %
31 %
Review of Systems
36 %
11 %
4%
2%
47 %
Vital Signs
38 %
14 %
5%
4%
39 %
Notes: 1) average of 249 respondents
Preference – Ambulatory Visits
Please indicate for of information you wish to receive for each category
Section
Current visit
only
Current and x
prior visits
All visits
Functional Status
77 %
18 %
5%
Plan of Treatment
74 %
16 %
9%
Problems
64 %
19 %
17 %
Procedures
52 %
22 %
27 %
Results
65 %
20 %
14 %
Review of Systems
87 %
8%
5%
Vital Signs
79 %
15 %
6%
Notes: 1) average of 248 respondents
Hospital Toc Medication Information
Preference
Necessary
Useful
Never Use
Ambulatory medications a time of admission
50 %
38 %
12 %
Medications administered during hospital stay
22 %
60 %
17 %
Medications active or prescribed at discharge
89 %
9%
2%
Experience
Always
Receive
Occasionally
Receive
Never
Receive
Ambulatory medications a time of admission
24 %
56 %
20 %
Medications administered during hospital stay
22 %
52 %
26 %
Medications active or prescribed at discharge
60 %
31 %
9%
Notes: 1) average of 256 respondents
Ambulatory Toc Medication
Information
Preference
Necessary
Useful
Never Use
Active medications at time of visit
68 %
26 %
6%
New medications prescribed during visit
89 %
9%
2%
Medications discontinued during visit
83 %
15 %
2%
Medications discontinued during last year
15 %
58 %
27 %
All previously discontinued medications
10 %
44 %
46 %
Always
Receive
Occasionally
Receive
Never
Receive
Active medications at time of visit
43 %
49 %
8%
New medications prescribed during visit
52 %
40 %
8%
Medications discontinued during visit
31 %
55 %
14 %
Medications discontinued during last year
5%
38 %
57 %
All previously discontinued medications
4%
31 %
65 %
Experience
Notes: 1) average of 251 respondents
Alternative Approach
All
Currently
receiving ToC
Prefer sender to limit information
107
39 %
106
39 %
Prefer more information and better
display/incorporation capability
168
61 %
168
61 %
1
2
3
4
5
No Resp
User defined summary
3%
1%
8%
19 %
29 %
40 %
Table of contents with
links
1%
3%
10 %
18 %
26 %
41 %
Drag and Drop
3%
3%
6%
18 %
29 %
41 %
Automatic incorporation
3%
3%
8%
17 %
27 %
42 %
Duplication detection
1%
3%
3%
16 %
37 %
40 %
Notes: 1) totals may not equal 100% due to rounding
2) 53 respondents provided suggestions
Comments and Follow-up
Count
Percentage
Contact information
52
19%
Willing to participate
137
50%
14
10%
21
8%
Providing contact information
Provided exit comments