Metrics Definition - Patient Communication and Education

Patient Communication Meaningful Use Norm

Connect Care communication norms relate to meaningful use expectations respecting the provision of information, education and communication supports to patients. Key clinical information system workflows include timely and effective use of: 

Further details of the relevant meaningful use norms are summarized in the Connect Care Clinician Manual:

Patient Communication and Education Metrics

Evaluation the quantity (consistency) of use of patient education and communication supports at the end of visits or hospitalizations is difficult because AVS printing is built-in (and automated) as part of discharge workflows and is a required operating procedure. Whether printed materials are actually received by patients and families is better assessed through in-person quality assurance spot-checks. Rates of patient invitation, successful sign-up, and active use of the MyAHS Connect patient portal are readily available.

Evaluating the quality of content of patient encounter communication is currently limited to detecting the presence of structured data elements within an AVS that reflect provider interaction with sections focused on education and post-encounter care coordination. 

Whether inpatient providers succeed in promoting MyAHS Connect uptake is reflected in the proportion of patients at discharge whose patient portal status (including in standardized discharge summaries) is "Active" or "Pending" or "Declined".

After Visit Summary Quantitative Metric

Proportion of discharged patients where nursing discharge checklist records indicate that instructional materials (AVS) are provided to the patient or designated decision-maker.

After Visit Summary Qualitative Metric

Proportion of discharged patients where the patient's AVS contains evidence of use of patient education, transition plan or follow-up instructions.

AHS Connect Status

Proportion of discharged patients where the patient's MyAHS Connect status is "Active", "Pending" or "Declined".

Workflow

Encounter Documentation Norms and related Workflows are  described in the Connect Care Clinician Manual.

After Visit Summary Quantitative

AVS documents are automatically generated and printed at completion of emergency, outpatient or inpatient encounters. The summary is also automatically exposed in MyAHS Connect. Accordingly, measuring whether the AVS is generated or printed does not reflect whether the information is provided to patients or families.

Nursing discharge checklists include an entry for whether instructional information (AVS), together with patient belongings, are explicitly provided to patients at discharge from inpatient encounters. This flowsheet information can be used as a proxy for whether patients actually receive their AVS.

After Visit Summary Qualitative

Minimum use activities, like medication and problem reconciliation, determine the content of parts of the AVS. 

In addition, completing all steps of the Discharge Navigator will ensure prescriber awareness of tools for adding to, or revising, AVS content.

MyAHS Connect Status

Hospitalization provides an important opportunity to promote patient sign-up for MyAHS Connect patient portal services, particularly since the portal provides a "Day at a Glance" feature that helps patients and families anticipate important inpatient events.

Posters and flashcards are prominent in most inpatient units. In addition, inpatient charts provide visual indicators of patient portal activity at the top of the (left column) Storyboard. Clicking on the MyAHS Connect icon opens a tool for inviting or re-inviting sign-up with email or printed prompts.

Data

After Visit Summary Quantitative

Nursing safe discharge checklists include an entry for whether instructional information (AVS), together with patient belongings, are explicitly provided to patients at discharge from inpatient encounters. This flowsheet information can be used as a proxy for whether patients actually receive their AVS.

After Visit Summary Qualitative

These AVS sections are associated with specific note type identifiers, which can be assessed for presence or absence in encounter-linked notes (EPT 20330):

Note types used by AHS are documented in the Builder Handbook:

MyAHS Connect Status

MyAHS activation status is displayed in most provincially standardized summative document templates, including discharge summaries. This reflects values in a single data element, which should be the basis for metrics.

Of the above, values [1] OR [3] OR [5] would constituted compliance with the Norm.

Many other data elements are available, giving additional information about how a patient was invited, when they signed up, whether there is proxy access, etc.

Metrics

After Visit Summary Quantitative Metric

Description

Denominator

Numerator

Calculation

Filters

Analytics Definition

After Visit Summary Qualitative Metric

Description

Denominator

Numerator

Calculation

Filters

MyAHS Connect Status Metric

Description

Denominator

Numerator

Calculation

Filters


Limitations

After Visit Summary Quantitative Metric

The current proxy for provision of an AVS to a patient at discharge is a discharge checklist flowsheet row that should be completed as a standard operating procedure. However, the data entry is not associated with a Hard Stop and so this metric depends upon data entry behaviors and compliance with procedural norms. Moreover, the flowsheet row does not explicitly call out the AVS as the patient instruction material that should be provided. 

After Visit Summary Quality Metric

There is more than one way to enter follow-up provider information in Connect Care. Some discharge order sets have provisions for entering follow-up referral requests or triggering requests for other types of post-op encounters. Occasionally, information may not make it into the AVS.

If providers do not follow sequential steps in discharge management, then it may be possible for an AVS to be generated before all follow-up and patient education information is entered; and the AVS content provided to the patient may not reflect the AVS content recorded in the system (MyAHS Connect AVS will still be complete).

MyAHS Connect Status Metric

Barriers to access to MyAHS Connect include complex Alberta Health sign-up constraints that force patients to apply for, and maintain in active state, a MyAlberta Digital Identity. Obtaining this incurs delays. More importantly, the MyAlberta identity is only available to Albertans who can produce a (physical) Alberta Identity Card or Alberta Driver's License. Marginalized groups (lacking these documents or easy access to processes for getting them) will not be able to maintain patient portal access. Newcomers to Alberta and all patients from other provinces or countries will not be able to complete the sign-up process and will remain in a "Pending" status until their activation code expires, at which point they disappear from the numerator.

Reports

Radar Dashboards

Reporting Workbench

Slicer-Dicer

Components

Summative documentation content is supported in Connect Care (Epic) with standardized templates that make use of AHS-validated standardized components, many further described in the Builder Handbook.