After-visit summaries take 90 seconds; most go unopened

Clinical takeaway: Personalized instructions offer higher engagement, but a portal alone may not reach most patients. AI scribes may cut documentation time without improving uptake, so consider alternate communication approaches.

The after-visit summary (AVS) became standard in US care after Medicare incentive programs, and most health systems have since shifted from print to digital delivery through patient portals. Whether patients actually use the digital version, and what it costs physicians to produce it, has not been well documented.

A cross-sectional analysis of 6.26 million adult ambulatory visits at the University of California San Francisco between 2018 and 2023 found digital AVS engagement rose from 20.8% to 37.6% over the study period. Yet 62.4% of summaries went unviewed. Printed AVS distribution fell over the same window, from 53.6% to 16.7%.

Physicians spent a median of 1.38 minutes per visit writing instructions in the 40.6% of visits where instructions were authored. The authors estimated this could translate to roughly 70 hours per year for a physician running two 32-patient clinics weekly. Engagement was higher when instructions were personalized (40.5% vs 34.3% without).

Composition strategy varied by specialty. Surgical specialists relied most on templates (63.6% of instruction text) and spent the least time per visit (median 0.90 minutes). Medical specialists wrote the highest share of text manually (50.7%) and produced the shortest instructions overall. Urgent care physicians spent the most time per visit (median 1.93 minutes).

Engagement gaps were largest among non-English speakers (15 percentage points lower than English speakers), patients aged 85 or older (12 points lower than those under 35), and Black patients (11 points lower than White patients). Publicly insured and Medicare patients were each roughly 3 points less likely to engage than privately insured patients. Compared with primary care and urgent care, medical and surgical specialty visits showed lower engagement.

The setting is a single academic system, so practice patterns and demographics may not generalize. The analysis cannot confirm whether patients who opened the AVS read or understood it, and portal access may have been shared with family or caregivers in some cases.

AI scribes that auto-generate the AVS were adopted at the study's end and may reshape both physician time and content quality. The wider issue: digital postvisit communication is not reaching the patients most likely to need clear follow-up. Phone outreach, language-concordant materials, and targeted portal onboarding may be needed alongside the AVS itself.

"Given the association of these documentation tasks with physician burnout, identifying strategies to reduce time cost while maintaining quality of care and information transfer is critical," the authors wrote.

Source: Halvorson RT. JAMA Netw Open. 2026 May 28. Patient digital engagement with after visit summary in ambulatory care