1. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Long Survey Results Summary 5/27/2015 1 Relevant and Pertinent

2. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Respondent Demographics Hospital:3 Health System:4 Professional Society:4 Self:2 09/25/2013 2

3. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Question 1 & 2 09/25/2013 3 "Insuffient detail about specific problems, diagnoses, past history, medication trials in past. Key info is often inaccurate (e.g., meds). Minimal highlighting of key findings (labs, etc) vs laundry list of normal info interspersed with occ abnormal finding. Formatting is hard to read and find what's needed. " N/A Formatting and content. Generally lacks clarity on what the patient was seen for, the patient's story (HPI), relevant exam findings, a clear diagnosis, assessment and plan. At the same time, there is too often too much "metadata" about the visit and literally too much "completeness" with regard to all problems and meds rather than any focus on what was assessed or changed, too many labs (especially hospital discharges after prolonged hospitalization) rather than selected labs the sender wanted to share, too much canned patient education material with the provider entered highlights buried. "We receive many types of clinical documents, both electronic and paper. Visiting nurses send a massive quantity of data, without any clinical summary without any relevance to the practicing provider. We receive information from skilled nursing facilities that also have no clinical summary and are not well organized. This can compromise care as some of these patients have acute conditions. Information coming into consultants from primary care often does not clearly state the reason for referral. We have found CDAs to be of no value to date. We do not currently import these documents into our EMR." Undigested data dumps Primarily the forwarded information represents noise which obscures efficient access to the desired information. No easy way to rapidly search for the desired data points They are often out of date. For example, a patient may be discharged from the hospital and then we get the discharge CCD 1-2 months later. Procedure notes (i.e. colonoscopy) - the information brought over is not relevant as it includes one time meds given for the procedure that we are then asked to accept/reject. The final path reports aren't ready - which make the clinical content incomplete. I would like to note that ANY information on patients is helpful. What is NOT helpful is the inabillity to parse and easily locate specific pieces of the patients record. Specialty physicians may only want one small piece of information while a primary doctor may want to review several pieces in a single visit. The existing formats do not alow for this. Therefore, in busy practices like ours, the usefulness of the exchanged documents deteriorates. Add to this if there were more than one document from multiple sources which also occurs frequently, the compounds the issues. "Helpfulness of documents strongly depends on clinical case (case by case basis). the most needed information can be difficult or time consuming to identify. Summaries and Transitions of Care historically have a dreadful track record. We think often “everything” is sent “just to be sure”, as this is new ground for the majority of those implementing the standard. Our concern is that we move carefully in making recommendations so that we focus on the patient and what data is necessary for improved quality care. Helpfulness of documents strongly depends on clinical case (case by case basis). " The helpfulness of the documents depends on clinical use case and the data needed to make an informed decision. CCD and discharge summaries are more helpful for new patient admissions due to comprehensiveness of data. Also, helpfulness of documents depends on EHRs ability to parse the data from CCD and to present that data to the clinician through a user-friendly graphical interface. Important aspect of data presentation is the ability to filter and sort through data, and ability to visualize data using graphics. Documents which do not address the patients present diet, enteral feeding, parenteral nutrition, recommended restrictions and/or food allergies are not helpful. In particular, patients transitioning from one area of care to another (long-term, post-acute care from/to acute care) often have incomplete or missing nutrition content in SOCR documents. In the case of missing food allergy data and/or significant condition-specific restrictions, failure to include this data is a patient safety risk. (E.g. patients with severe criticality food allergy, renal patients with potassium restrictions, stroke patients with dysphagia requirements, medically fragile patients who are malnourished due to condition specific and/or limited p.o. intake; and/or patients on enteral/parenteral feedings whose fluid/nutrition needs are solely dependent upon administration rather than consumption of fluids/nutrients.) In some states, a nutritionist can write an nutrition order to continue continuity of nutrition care; in others, the physician must be contacted to place the nutrition/diet order before the patient can eat. Nutrition/diet order and/or patient preference (if no condition specific diet modifications are indicated) and food allergies (or No known allergies documentation) should be included in a SOCR. "1. too large - too long - too many pages2. hard to find the info our providers need3. incomplete info - what is provided may not be all that our providers need.4. assessment info is subjective and may be subject to different interpretation5. format - most of our providers' systems use structured data displayed on a careen but not as a document" Insufficient detail Minimal highlighting of key findings Laundry list Formatting: Hard to read Too much completeness, no clinical summary Undigested data dumps Noise Lack of data related to specialty

4. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Question 3 09/25/2013 4 Presentation, organization, and structure more the issue, rather than any specific section. Labs are repetitive, unorganized, not useful. Redundant and repeated data Incomplete/Erroneous

5. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Question 4: Document Size 09/25/2013 5

6. © 2015 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Data Element Relevance 09/25/2013 6