The Quality of Electronic Discharge Summaries for Post-Discharge Care: Hospital Panel Assessment and IT to Support Improve...
Overview<br />Objectives<br />Discharge summaries<br />Methods<br />Findings<br />Information Technology based remediation...
Objectives<br />Panel assessment of quality of Electronic Discharge Summaries(EDS) information for supporting post-dischar...
Discharge Summary<br />Synopsis of patient condition<br />Communicates post-discharge framework of care<br />In Auckland:<...
Methods<br /><ul><li>Collaborated with WDHB
Collected 200 de-identified hard copies of Electronic Discharge Summaries (EDS)
This study includes 40 randomly identified EDSs</li></li></ul><li>Methods<br /><ul><li>Panel
Two senior hospital specialists
One experienced specialist clinical coder
Questionnaire
Assessment of quality
Assessment of relevancy</li></li></ul><li>EDS Sections<br />
EDS Analyses Questionnaire - Information Quality<br />Information optimal to support ongoing management of the<br />patien...
Findings: Assessment of Quality by EDS Sections<br />20%<br />30%<br />45%<br />42%<br />
Quality Issues in EDS<br /><ul><li>Irrelevant information
Missing results/ interpretation
Information hard to access
Information written in other  section
Poor formatting
Incomplete follow up advice
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The Quality of Electronic Discharge Summaries for Post-Discharge Care: Hospital Panel Assessment and IT to Support Improvement

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Mehnaz Adnan
National Institute for Health Innovation, University of Auckland
(3/11/10, Civic 2, 1.30)

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  • Questionnaire goal is to measure the quality and relevancy of written information in the items identified by previous studies to be important for continual management of the patient [1, 2, 21] .
  • All summaries were evaluated for the quality of information using yes/no options in the questions for the following key items in EDS with a comment.
  • indicate how important you think each entry is with respect to the needs of a GP viewing the summary for purposes of ongoing management of the patient. ORANGE for “most important” items which must be available directly in the top-level summaryGREEN for “important” items which should be accessible with one mouse click from the top-level summary.BLUE for “least important” items which would be better excluded from the discharge summary report.
  • panel members were asked to code the reports using orange, blue and green highlighters.orange -&gt; ‘most important’ green -&gt; ‘important’blue -&gt; ‘least important’
  • We have improved our hyperlinking capability to providing linking to one topically relevant page instead of a list of pages returned by MedlinePlus. Currently we are exploring the provision of semantic descriptions for the abbreviations in Discharge Summaries text. Planning on conducting a user feed back to determine the efficacy of such a system is currently under way.
  • The Quality of Electronic Discharge Summaries for Post-Discharge Care: Hospital Panel Assessment and IT to Support Improvement

    1. 1. The Quality of Electronic Discharge Summaries for Post-Discharge Care: Hospital Panel Assessment and IT to Support Improvement<br />MehnazAdnan<br />With: Jim Warren, Martin Orr<br />
    2. 2. Overview<br />Objectives<br />Discharge summaries<br />Methods<br />Findings<br />Information Technology based remediation plan<br />
    3. 3. Objectives<br />Panel assessment of quality of Electronic Discharge Summaries(EDS) information for supporting post-discharge care <br />Improvement of the EDS information quality using Information Technology <br />
    4. 4. Discharge Summary<br />Synopsis of patient condition<br />Communicates post-discharge framework of care<br />In Auckland:<br />Transmitted via HL7 messages<br />Hard copy to patient on discharge<br />
    5. 5. Methods<br /><ul><li>Collaborated with WDHB
    6. 6. Collected 200 de-identified hard copies of Electronic Discharge Summaries (EDS)
    7. 7. This study includes 40 randomly identified EDSs</li></li></ul><li>Methods<br /><ul><li>Panel
    8. 8. Two senior hospital specialists
    9. 9. One experienced specialist clinical coder
    10. 10. Questionnaire
    11. 11. Assessment of quality
    12. 12. Assessment of relevancy</li></li></ul><li>EDS Sections<br />
    13. 13. EDS Analyses Questionnaire - Information Quality<br />Information optimal to support ongoing management of the<br />patient in <br />General Practice?<br />Provides adequate information to the patient about his/her ongoing care?<br />
    14. 14. Findings: Assessment of Quality by EDS Sections<br />20%<br />30%<br />45%<br />42%<br />
    15. 15. Quality Issues in EDS<br /><ul><li>Irrelevant information
    16. 16. Missing results/ interpretation
    17. 17. Information hard to access
    18. 18. Information written in other section
    19. 19. Poor formatting
    20. 20. Incomplete follow up advice
    21. 21. No useful information
    22. 22. Missing important information
    23. 23. Information is written in other section
    24. 24. Insufficient information
    25. 25. Unclear goals
    26. 26. Incorrect, incomplete and missing advice
    27. 27. Information written in other section
    28. 28. No useful synopsis
    29. 29. Brief or incomplete advice
    30. 30. Missing information
    31. 31. Use of abbreviation and medical jargon</li></li></ul><li>EDS Analyses Questionnaire - Information Relevancy<br />How important each entry is for a GP <br />ORANGE  “most important”<br />GREEN  “important” <br />BLUE  “least important” <br />
    32. 32. Assessment of Relevancy- Proportion of Importance per EDS Section<br />
    33. 33. EDS Quality Issues - Summary<br /><ul><li>Irrelevant data in laboratory results
    34. 34. Insufficient follow up information for GP
    35. 35. Insufficient self-management information for patients </li></li></ul><li>IT-based Remediation Plan<br />Interactive Decision Support<br />Recommend Advice to Patient<br />Writing Support<br />Critique Advice to Patient<br />Patient Support<br />Semantic Annotation<br />Synonym Provision<br />Reading Support<br />Hyperlink to Explanatory Material<br />
    36. 36. Writing Support in EDS<br />High Risk Medications<br />Recommended Auto Text<br />Critique<br />
    37. 37. Readability Support in EDS<br />
    38. 38. Key Messages<br /><ul><li>Discharge Summaries have deficiencies in information quality
    39. 39. Information technology can assist in improving quality of information in EDSs
    40. 40. We provide</li></ul>Writing Support in free text ofEDS<br />Reading Support in the form of synonyms and dynamic hyperlinks<br /><ul><li>Supports goal of empowering patients in their care process</li></li></ul><li>Ongoing Work<br />Expert panel feedback for readability support for the hyperlinked pages<br />Topic-specific<br />Explains concept<br />Likely to help patient with his/her post-discharge care<br />
    41. 41. Further Reading<br />Assessment of Text Characteristics of Electronic Discharge Summaries:<br />M. Adnan, J. Warren, and M. Orr, "Assessing Text Characteristics of Electronic Discharge Summaries and their Implications for Patient Readability," in Second Australasian Workshop on Health Data and Knowledge Management 2010.<br /><ul><li>Methods/Results of Recent Studies:</li></ul>M. Adnan, J. Warren, and M. Orr, "Enhancing Patient Readability of Discharge Summaries with Automatically Generated Hyperlinks," Health Care and Informatics Review Online, December 2009.<br />M. Adnan, J. Warren, and M. Orr, “Ontology Based Semantic Recommendations for Discharge Summary Medication Information for Patients" 23rd IEEE Symposium on Computer-Based Medical Systems (CBMS 2010); Perth, Australia; 2010.<br />
    42. 42. Contact<br />Mehnaz Adnanmadn002@aucklanduni.ac.nz<br />For this presentation and others from HINZ please go to the hive<br />

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