Why Generic After Visit Summaries (AVS) Fail

Do patients look at the EMR AVS?

Yes. One study showed that approximately 86% of patients look at their AVS with underserved patients accessing it the most (Nouri, et al., 2020)

The problems with EMR-generated AVS

Default EMR generated AVS lacks relevance to the individual patients, and it can also contain incorrect information (Mir, et al., 2019). Currently, standardized AVS does not deliver information in a retainable and actionable way. AVS that is not personalized can be meaningless to the patient, poor in quality or not meet person-centered standards (Lyles, et al., 2019).

Does customization of AVS matter?

Customization of AVS can address the gap that exists between the potential and actual usefulness of the AVS. Personalized patient information, that involved the clinician, has resulted in meaningful improvement in health outcomes (Simonsmeier, et al., 2022).

What customizations matter?

• Plain language (or 6th grade or below) and language concordant with language spoken/read by patient
• Condition-specific with condition-specific red flags on when to seek care
• Has a clear action plan
• A reason for referral or medication

(Federman, et al., 2017)(Nouri, et al., 2020)

• Periodic revision, treated as an iterative process, by the clinician (Zubkov, et al., 2025)
• Some evidence shows that the amount of information does not matter (Pavlik, et al., 2014) and some evidence suggests limiting information to 3-4 messages (Wittink & Oosterhaven, 2018)
• Visual aids or diagrams (Vamos, et al., 2019)
• What happened in today's visit
• Information available from multidisciplinary resources

References

Federman AD, Sanchez-Munoz A, Jandorf L, Salmon C, Wolf MS, Kannry J. Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design. J Am Med Inform Assoc. 2017 Apr 1;24(e1):e61-e68. doi: 10.1093/jamia/ocw106. PMID: 27497793; PMCID: PMC7651937.

Lyles CR, Gupta R, Tieu L, Fernandez A. After-visit summaries in primary care: mixed methods results from a literature review and stakeholder interviews. Fam Pract. 2019 Mar 20;36(2):206-213. doi: 10.1093/fampra/cmy045. PMID: 29846584.

Mir TH, Osayande A, Kone K, Bridges K, Day P. Assessing the Quality of the After-Visit Summary (AVS) in a Primary-Care Clinic. J Am Board Fam Med. 2019 Jan-Feb;32(1):65-68. doi: 10.3122/jabfm.2019.01.180055. PMID: 30610143.

Nouri SS, Pathak S, Livaudais-Toman J, Gregorich SE, Kaplan CP, Diamond L, Karliner L. Use and Usefulness of After-Visit Summaries by Language and Health Literacy among Latinx and Chinese Primary Care Patients. J Health Commun. 2020 Aug 2;25(8):632-639. doi: 10.1080/10810730.2020.1833385. Epub 2020 Oct 15. PMID: 33059522; PMCID: PMC8362332.

Pavlik V, Brown AE, Nash S, Gossey JT. Association of patient recall, satisfaction, and adherence to content of an electronic health record (EHR)-generated after visit summary: a randomized clinical trial. J Am Board Fam Med. 2014 Mar-Apr;27(2):209-18. doi: 10.3122/jabfm.2014.02.130137. PMID: 24610183.

Simonsmeier BA, Flaig M, Simacek T, Schneider M. What sixty years of research says about the effectiveness of patient education on health: a second order meta-analysis. Health Psychol Rev. 2022 Sep;16(3):450-474. doi: 10.1080/17437199.2021.1967184. Epub 2021 Aug 24. PMID: 34384337.

Vamos CA, Merrell L, Detman L, Louis J, Daley E. Exploring Women's Experiences in Accessing, Understanding, Appraising, and Applying Health Information During Pregnancy. J Midwifery Womens Health. 2019 Jul;64(4):472-480. doi: 10.1111/jmwh.12965. Epub 2019 May 3. PMID: 31050386.

Wittink H, Oosterhaven J. Patient education and health literacy. Musculoskelet Sci Pract. 2018 Dec;38:120-127. doi: 10.1016/j.msksp.2018.06.004. Epub 2018 Jun 27. PMID: 30017902.

Zubkov MR, Lin CT, Yi J. Health Information Systems and Electronic Health Record Optimization: Strategies to Enhance Electronic Health Record Usability and Clinician Workflow. Med Clin North Am. 2026 Mar;110(2):163-176. doi: 10.1016/j.mcna.2025.07.003. Epub 2025 Dec 1. PMID: 41622007.