Patient Digital Engagement With After Visit Summary in Ambulatory Care.

Importance: The after visit summary (AVS) is believed to be a critical mechanism for postvisit communication, and health systems are widely adopting digital AVS systems to comply with federal regulations. However, little is known regarding the physician time cost of writing the AVS and whether patients routinely engage with the digital AVS. Objective: To assess patterns of patient digital AVS engagement following ambulatory care visits and the associated physician time cost. Design, Setting, and Participants: This cross-sectional study analyzed ambulatory care visits that occurred between June 1, 2018, and May 31, 2023, at a large, urban, academic health care system with multiple hospitals and outpatient clinics. All ambulatory visits by adults between the study period that were captured in the institutional electronic health record system were included. Data were analyzed in May 2025. Main Outcomes and Measures: The primary outcome was engagement with the digital AVS through the patient portal following an ambulatory visit. Secondary measures included patient demographic factors, visit variables (including clinic specialty [primary care, urgent care, medical specialties, surgical specialties] and visit type [video, nonvideo]), and physician-specific behaviors (including time spent writing patient instructions, using composition tools, and physically printing the AVS). Results: A total of 6 262 623 ambulatory care visits were analyzed. Most visits were made by female patients (3 890 100 [62.1%]), and 51.0% of all patients were aged 55 years or older. Digital AVS engagement increased from 20.8% in 2018 to 37.6% in 2023. Physicians spent a median (IQR) duration of 1.38 (0.52-3.28) minutes per visit writing patient instructions, despite the AVS not being viewed in 62.4% of encounters. AVS composition varied by physician specialty, with surgeons using a greater percentage of templated text (63.6% of AVS text) and medical specialists entering more text manually (50.7% of AVS text). Patient engagement varied by demographic factors, with higher engagement among married vs single patients (AME, 6.6 [95% CI, 6.1-7.1] percentage points) and retired vs employed patients (AME, 5.1 [95% CI, 4.5-5.6] percentage points). Lower engagement with the digital AVS was found among males vs females (AME, -3.1 [95% CI, -3.7 to -2.5] percentage points), non-English speakers vs English speakers (AME, -15.0 [95% CI, -15.9 to -14.2] percentage points), and those with Medicare (AME, -3.3 [95% CI, -4.2 to -2.5] percentage points) or public insurance (AME, -3.6 [95% CI, -4.4 to -2.9] percentage points) compared with private insurance. Physician behavior was also associated with digital AVS engagement, with presence vs nonpresence of physician-written patient instructions associated with higher engagement (40.5% vs 34.3%) and printed vs nonprinted AVS associated with lower engagement (31.6% vs 38.8%). Compared with primary care, medical and surgical specialties were associated with lower digital AVS engagement (medical: AME, -4.3 [95% CI, -5.3 to -3.2] percentage points; surgical: AME, -2.9 [95% CI, -4.1 to -1.7] percentage points), while urgent care showed no significant difference (AME, -0.6 [95% CI, -2.2 to +1.0] percentage points). Conclusions and Relevance: In this cross-sectional study of ambulatory visits, digital AVS engagement increased but remained low and was associated with a high time investment for physicians. This inefficiency in postvisit communication emphasizes the need to reconsider such communication, particularly with unmarried males, non-English-speaking populations, and publicly insured populations, and in specialty care settings.